Caring for Patients in Long-Term Care Facilities

NPs Bring Peace of Mind and Better Outcomes

83-year-old Shirley Ward takes a deep breath as nurse practitioner Elaine Makarowski listens to her lungs. But the checkup didn’t happen in a clinic. It happened in assisted-living facility Waunakee Manor, where Ward lives.

Makarowski, NP, is one of 10 UW Health nurse practitioners who provide care for patients at 19 long-term care and rehabilitation facilities throughout Dane County. The goal of the program is to take primary care services to skilled nursing facility (SNF) residents so they don’t have to leave for care.

That’s important to Ward.

“It means a lot because otherwise I’d have to go across town (to a clinic),” said Ward.

Makarowski said Ward is one of 550 assisted living, long-term care facilities and rehabilitation facilities residents who benefit from the service.

“It provides a picture into her life and the lives of other patients. This is their home. So I get acclimated and get to know them,” explained Makarowski. “My days are flexible. So if a patient needs care, I can find time to see them almost immediately.”

The nurse practitioners say the program reduces stress, improves resident and family satisfaction, increases safety and provides continuity with nursing facility staff.

NPs stay connected and in contact with residents’ UW Health primary care physicians and specialists to deliver care that utilizes both physicians’ and nurse practitioners’ skills and expertise.

Makarowski, who provides care at two of the 19 facilities, said care for both short-term and long-term residents runs the gamut.

“We deal with everything from acute issues and end-of-life discussions to managing prescriptions and hospital orders to make sure they’re correct and clarified,” said Makarowski. “We also ensure safe discharges from SNFs to either home or assisted living, advocate for patients by attending care conferences and many other things.”

The care is identical to the care provided in clinic and that improves patient outcomes, said Makarowski. The NPs have full access to x-rays, ultrasounds and laboratory services.

“Since we get to know our patients very well, we can identify even subtle changes that may indicate a change in condition,” said Makarowski.

UW Health has found that bringing these primary case services to SNF residents has not only reduced emergency department visits and hospital readmissions, it has saved at least $2 million in readmissions.

The program started 20 years ago with one nurse practitioner and has now grown to 10 NPs. And assisted-living residents like Shirley Ward continue to count the program as a blessing.

“It makes me feel great,” said Ward. “I can’t even explain it.”