Physicians who provide care for nursing home residents are regularly challenged by ethical and legal issues. Because nursing home care is complicated by numerous regulations and because nursing home residents have complex medical and social problems, some issues are unique to the long-term care setting and others present in unfamiliar ways. Some issues frequently encountered in this context are discussed: advance directives, competence and decision-making capacity, decisions about life-sustaining treatment, resident abuse, restraints, psychotropic medications, risk management, participation in research, and ethics committees. With knowledge of the legal and ethical framework and understanding of some of the common, complicated issues that arise, physicians should be better equipped to provide optimal care for nursing home residents.
(Arch Intern Med. 1996;156:249-256)