You are a guest in someone else’s building

The first thing to learn about how to work with nursing homes as a practice is whose building it is. The facility holds the license, answers to state surveyors and is responsible for each resident’s daily care. Every resident already has an attending physician. A visiting practice, whether it provides wound care, podiatry or primary care, adds to that structure and does not replace it.

Practices that are invited back are easy to host. They arrive when they said they would, leave orders the floor can carry out and never make the nursing staff look bad in front of a family.

Learn who does what before the first visit

Titles vary, but the roles do not:

  • Administrator. Runs the facility and signs any agreement with your practice.
  • Director of nursing. Responsible for nursing care, and usually the judge of whether your visits help.
  • Medical director and attending physicians. The attending keeps overall responsibility for the resident. Be clear whether your clinician is consulting or taking over as attending.
  • Unit managers and the wound or treatment nurse. Your partners on rounding day and the people who carry out your orders.
  • MDS coordinator. Completes the resident assessments the facility submits, and draws on your documentation to do it.

Keep one contact sheet per building, with a name and a direct line for each.

Settle the paperwork early

Most facilities want documents on file before a clinician sees a resident: license, liability coverage, health screening and background records, and a request for access to the record system. For facilities in the Metro East, the clinician also needs an Illinois license.

Then confirm three things for each resident:

  1. The order. Most buildings require a consult order through the attending or a standing facility process.
  2. Consent. Residents choose their clinicians. Ask how the facility records consent from the resident or representative.
  3. Coverage and stay type. During a Medicare-covered skilled stay, many services and supplies are bundled into the facility’s payment, while a practitioner’s professional services are generally billed separately. Place of service and supply responsibility can differ for long-term residents.

Confirm the third point with your billing team and the facility’s business office before the first visit, not after the first denial.

Make rounds predictable

Pick a day and a time window for each building and keep them. Staff plan showers, therapy and dressing changes around you, and a clinician who appears at random finds nobody free.

Send your visit list to your contact ahead of time and ask for additions: new admissions, residents back from the hospital and anyone staff are worried about. Round with the wound nurse or unit manager when you can. Share the wound rounds preparation checklist with the facility’s nurses.

Leave nothing hanging when you walk out

Before leaving the building:

  • Tell the nurse, in person, what changed for each resident seen
  • Put orders into the facility’s process. An order written only in your own record does not exist for the floor
  • Write orders the staff can carry out with products the facility stocks, or arrange the supply first
  • Flag anything the attending should know that day
  • Say when notes will arrive, and meet that time

Notes belong in the facility’s chart, where the next nurse and the next surveyor will look.

Agree on communication between visits

Residents change between rounding days. Decide in advance how the facility reaches your practice, what kind of change warrants a call and how quickly you can commit to answering.

The facility follows its own change-of-condition process, including notifying the attending, and calls 911 for an emergency. A visiting practice is not an emergency service. A shared format helps: our guide to communicating wound changes with SBAR gives nurses a structure for those calls.

Meet with the director of nursing a few times a year to review how it is going.

Set expectations you can keep

A facility should be able to expect the same clinician on a steady schedule, notes and orders on time, documentation that holds up during a survey, and respect for staff and for the attending’s role. In return, ask for a current list, a nurse available during rounds and prompt notice of transfers and declines.

Keep the relationship clean. Federal and state laws restrict giving anything of value in return for referrals, so have counsel review any paid arrangement with a facility.

Gateway helps practices across Greater St. Louis and the Metro East with facility visit coordination, wider mobile wound care operations and facility outreach. Clinical decisions stay with the treating practice. Use the practice support inquiry form or call 314-325-0126.

Common questions

Do we need a contract with a nursing home to see residents there?

It depends on the building and the service. Many facilities let a consulting clinician see residents on an attending’s order once required documents are on file. Others want a written agreement. Ask the administrator, and have your attorney review any arrangement that involves payment in either direction.

How often should a visiting practice round in a facility?

The clinician sets visit frequency for each resident by clinical need, and payers expect the record to support it. For the building, a fixed recurring day works better than irregular visits. Choose a schedule you can sustain through vacations and staff changes.

Who writes the orders, the visiting clinician or the attending?

Facility policy decides. In some buildings the visiting clinician writes orders directly. In others the clinician recommends and the attending approves. Either way, the attending stays informed and the order goes into the facility’s system. Ask the director of nursing before the first visit.

What should we do when orders are not being carried out?

Ask what is in the way. The usual causes are a missing supply, an order written in terms the floor does not use, or short staffing. Fix what is yours to fix. If it continues, take specifics to the unit manager or director of nursing.

Related pages

Updated October 2026