What Is a Stewardship Program — And Why Nursing Homes Need One

In post-acute and long-term care, the difference between good care and great care is often not more intervention, but more precise intervention. That is where stewardship programs come in.

A stewardship program is a structured clinical framework designed to ensure patients receive exactly what they need — no more, no less. It is not about withholding care. It is about replacing “just in case” medicine with evidence-based intent. In nursing homes, where residents are medically complex and margins are tight, stewardship is one of the most effective ways to improve outcomes, reduce risk, and operate more efficiently at the same time.

At The Moxie Health Group, stewardship is not a one-off initiative. It is a core part of how interdisciplinary care is delivered inside skilled nursing facilities.

Why Stewardship Matters in Nursing Homes

Medications, oxygen, inhalers, and antibiotics are often introduced during hospital stays and then continued indefinitely once a patient enters a facility. Over time, this can lead to polypharmacy, unnecessary oxygen dependence, avoidable side effects, and increased survey risk.

Reducing unnecessary medications and oxygen use improves care and fixes financial leakage simultaneously. Every unnecessary drug adds pharmacy costs, monitoring, and downstream complications. Oxygen use carries its own costs — equipment, maintenance, staff time, and regulatory oversight. When waste is reduced, margins improve immediately.

More importantly, fewer unnecessary interventions mean fewer adverse events. Sedation, falls, delirium, hypotension, and respiratory suppression are not just clinical issues — they are expensive ones. Each complication increases emergency calls, hospital transfers, and family dissatisfaction, all of which disrupt census and strain staff.

As Chief Clinical Integration Officer Viviane Manara explains, “stewardship creates value rather than simply cutting costs.” Patients are safer and more stable. Staff workflows improve. Survey outcomes strengthen. Facilities gain the capacity to care for higher-acuity residents with confidence.

🫁 Oxygen Stewardship: Precision Over Default

Oxygen is frequently ordered as a precaution and then never reassessed. Over time, this can mask clinical decline rather than treat it.

An oxygen stewardship approach systematically evaluates whether a patient truly qualifies for oxygen using pulse oximetry, symptom assessment, and exertional testing. Patients who were placed on oxygen “by default” are identified and reassessed. When oxygen is no longer indicated, it is safely discontinued.

Appropriate oxygen use keeps residents more mobile, reduces false acuity signals, and prevents unnecessary long-term dependence that can accelerate deconditioning and trigger emergency responses.

💨 Inhaler Stewardship: Matching Therapy to Disease

Many residents are prescribed multiple inhalers without a clear or current indication. Inhaler stewardship focuses on confirming diagnosis, eliminating duplicate or outdated therapies, and matching medication type and dose to disease severity — not habit.

This approach reduces side effects such as tremors, tachycardia, oral thrush, and confusion, while improving adherence and clinical clarity for both staff and providers.

🧬 Antibiotic Stewardship: Treating Infection, Not Assumptions

Antibiotics are critical when truly needed and harmful when overused. Stewardship ensures antibiotics are prescribed only when there is evidence of infection, not colonization or viral illness. It emphasizes the right drug, the right dose, and the right duration.

This reduces the risk of C. difficile infections, antibiotic resistance, adverse drug reactions, and avoidable hospital transfers — all of which carry significant clinical and regulatory consequences.

Reducing Polypharmacy and Survey Risk

Polypharmacy quietly increases fall risk, cognitive impairment, and hospitalization. A disciplined stewardship model reduces unnecessary medications, simplifies regimens, and strengthens accountability around prescribing decisions.

Surveyors closely scrutinize psychotropics, antibiotics, and oxygen use. Facilities with structured stewardship practices experience fewer citations, fewer plans of correction, and less administrative drain.

Education as the Engine Behind Stewardship

Stewardship works only when providers and facility staff are aligned. Ongoing education is a central pillar of The Moxie Health Group’s model.

As Vice President of Clinical Operations Jessica Orona notes, The Moxie Health Group invests heavily in provider education from onboarding forward through continuous lectures, case studies, and advanced clinical training. That knowledge is then extended directly to facility staff through in-services for CNAs, LVNs, and RNs.

By educating teams at every level, facilities are able to safely accept higher-acuity patients, reduce uncertainty at the bedside, and build confidence as care complexity increases.

The Bottom Line

A stewardship program replaces reflexive medicine with intentional care. By testing who truly needs oxygen, inhalers, antibiotics, and medications—and stopping what is no longer helping—nursing homes improve safety, reduce harm, and operate more efficiently.

It is smarter care, not less care.

Learn More

To learn more about The Moxie Health Group’s interdisciplinary care model and stewardship-driven approach to post-acute care, visit our website.

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