title: Cooperation in the care of the institutionalized elderly in a rural community.
abstract: OBJECTIVE
  To develop a method of addressing and minimizing the institutional, cultural, and regulatory barriers to the care of nursing facility residents in our community.
  
  
  METHODS
  Nurses, administrators, and medical directors from all the nursing facilities in our community plus representatives from the community hospital participated in a monthly meeting where difficult issues in the care of nursing facility residents were discussed. The committee developed responses to these issues that were implemented throughout the community.
  
  
  RESULTS
  This committee has provided an opportunity for the whole community to address problems in the care of the institutionalized elderly. Systems have been developed which have improved communication between nurses and physicians and between nursing facilities and the hospital. Community standards for the care of common problems in nursing facility residents have also been developed. Other unexpected benefits have included community discussion of regulatory concerns, nurse assistant education, and care at the end of life, as well as coordination of laboratory services in the nursing facilities. Other rural communities may find a similar approach useful.
authors.affiliation: Iowa Health Physicians, Ottumwa, Iowa, USA. tep@u.washington.edu
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Phillips
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Blommer