Abstract
In Reply. —Dr Manning makes two assertions, one correct and one incorrect. He correctly calls for a more active role for nurses in caring for nursing home patients, but he bases this suggestion on the assumption that nursing home patients are not sick and therefore that physicians have no legitimate role in their care. Nothing would be farther from the truth. Patients do not end up in nursing homes as part of their retirement plan. Although the precipitating reason for their admission may be more functional, most have several serious illnesses. Indeed, the actuarial calculations for acute health care costs under Medicare estimate that nursing home patients will have more than twice the average costs of typical Medicare patients. More important, good primary care can make a big difference. For example, many nursing home patients are overmedicated and suffer iatrogenic complications as a result. 1,2 Manning's call for a more
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