Caring for Patients in Long-Term Care Facilities

NPs Bring Peace of Mind and Better Outcomes:


83-year-old Shirley Ward takes a deep breath as nurse practitioner (NP) Elaine Makarowski listens to her lungs. But the checkup didn't happen in a clinic. It happened in assisted-living facility Waunakee Manor, where Ward lives.


Makarowski, RN, MSN, APNP, is one of 10 UW Health nurse practitioners who provide care for patients at 19 long-term care and rehabilitation facilities throughout Dane County. The goal of the program is to take primary care services to skilled nursing facility (SNF) residents so they don't have to leave for care.


Laura Makarowski, RN, MSN, APNP, works with a patient in an assisted living facility, in a program that prevents residents from having to leave the facility to get primary care servicesThat's important to Ward.


"It means a lot because otherwise I'd have to go across town (to a clinic)," said Ward.


Makarowski said Ward is one of 550 assisted living, long-term care facilities and rehabilitation facilities residents who benefit from the service.


"It provides a picture into her life and the lives of other patients. This is their home. So I get acclimated and get to know them," explained Makarowski. "My days are flexible. So if a patient needs care, I can find time to see them almost immediately."


The nurse practitioners say the program reduces stress, improves resident and family satisfaction, increases safety and provides continuity with nursing facility staff.


"Nurse practitioners stay connected and in contact with residents' UW Health primary care physicians and specialists to deliver care that utilizes both physicians' and nurse practitioners' skills and expertise," said Rhonda Hoyer, RN, MS, ANP-BC, UW Health's director of advanced practice providers.


Primary care physicians see their patients once a month.


Makarowski, who provides care at two of the 19 facilities, said care for both short-term and long-term residents runs the gamut.


Laura Makarowski (left) is one of 10 UW Health nurse practitioners who provide care for patients at 19 long-term care and rehabilitation facilities throughout Dane County"We deal with everything from acute issues and end-of-life discussions to managing prescriptions and hospital orders to make sure they're correct and clarified," said Makarowski. "We also ensure safe discharges from SNFs to either home or assisted living, advocate for patients by attending care conferences and many other things."


The care is identical to the care provided in clinic and that improves patient outcomes, said Makarowski. The NPs have full access to x-rays, ultrasounds and laboratory services.


"Since we get to know our patients very well, we can identify even subtle changes that may indicate a change in condition," said Makarowski.


Hoyer said the program is a money saver since it has reduced emergency department visits and hospital readmissions.


"We studied hospital readmissions and found that the nurse practitioner program has saved at least $2 million in readmissions," said Hoyer.


The program started 20 years ago with one nurse practitioner and has now grown to 10 NPs. And assisted-living residents like Shirley Ward continue to count the program as a blessing.


"It makes me feel great," said Ward. "I can't even explain it."


Tell Us What You Think - And Win This "Heart Art"


Share your feedback for a chance to win this heart art

We value your insight and would love to hear from you.


Please submit your feedback on any or all stories from Remarkable Healthcare Through the Art and Science of Nursing.


When you submit your comments, your name will be entered in a drawing for the recycled vial cap "heart art" pictured here.


The art was created by staff from the UW Health art and sustainability programs, and is featured in the banner of and


Tell us what you think for a chance to win