Abstract
EVERY day more than 1.5 million Americans awaken in 1 of close to 20 000 nursing homes.1Some of these facilities provide excellent care, but the poor quality of care provided by many nursing homes has been repeatedly documented in the lay press, medical literature, and congressional testimony (Los Angeles Times. February 17, 1989; pt 1:3).2-4While the problems of many nursing home residents are more functional and psychosocial than medical,1,5the increasing acuity of medical conditions in this population since the implementation of the prospective payment system6,7demands that physicians be intimately involved in care provided in nursing homes. Yet, the majority of primary care physicians do not participate in the care of nursing home residents,8and very few of those who do provide care for substantial numbers of nursing home residents have received formal training in geriatric medicine or long-term care. Physician visits
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