Table 4 How Being in a Nursing Home Influences Diabetes care

 Diabetes care easier

“Well [the diet is] easy because I’m here; if I wasn’t here no, it would be hard.” (#4, Male, 68)

“Just having somebody take care of your medications for you makes a hell of a difference because you would skip if you took as much medication as I did.” (#4, Male, 68)

 Peer Influence: Negative

“I know there are a lot of different foods that other people get that I don’t get.” (#8, Male, 86)

 Peer Influence: Positive

“You really want a lot of people there so you can get a good feedback; what are they eating and why are they eating this and can I get any other ideas from them and why are they not eating this…if it is helping them.” (#12, Female, 78)

 Factor

Representative Physician Quotes

 More information and more control

“The residents are a captive audience so to speak. We don’t have to worry about them not showing up to an appointment or having to remember, the system really takes over that role.” (#6, Male, 47)

“I have a lot of collateral information and so just using that to help make decisions and kind of have an honest conversation with him not in a confrontational manner but just saying, ‘I know sometimes you might order food in; just take this into consideration.’” (#4, Female, 32)

 Over treatment

“Versus outpatient, [nursing home residents] are going to get more fingersticks.” (#4, Female, 32)

“The tough thing in a nursing home setting is that oftentimes it’s a structured environment so medications are given at a particular time and it’s hard when the patient can’t deliver their own insulin because if they’re not feeling hungry for breakfast they may still have been given an insulin shot before breakfast.” (#3, Male, 37)