Promising Practices in Long-Term Residential Care: Where Do Physicians Fit In (or Don’t They)?

Abstract

Compared to a decade ago, long-term care residents are likely to be older, frailer, more functionally impaired, more medically complex, and closer to the end of life. Because of this, residents are also less likely to benefit from and more likely to be harmed by the same drugs and routine medical interventions that may have worked well for them earlier in life. Family physicians are well positioned to play a key role in navigating the tensions between life extension, rehabilitation, symptom management, and palliation. Unfortunately, in many jurisdictions, despite more than a decade of primary care reform, family physicians are not attracted to working in long-term residential care (LTRC). The proportion of those working in LTRC has been declining over time, and there is no mandatory training of family physicians in LTRC work. This article reviews the influence of Canadian primary care policy related to the physician role in LTRC facilities and describes a number of promising practices across Canadian provinces to engage them in LTRC teamwork.