The charts are always voluminous, filled with checklists designed to satisfy accreditation or reimbursement criteria, and rarely have any information about what is actually happening. Social workers, who apparently escaped most of the check-list computerized-medical-record format mentality, often actually tell stories and speak of the all-important dynamics among family, patient, and caregivers. Nursing note are generally formulaic and repetitive. My favorite nursing note is "skin is warm and dry", which tends to be repeated by every shift once one of the nurses uses it. I am not sure what that means, but they must. I think it means that the patient is alive (not cold) and not diaphoretic (broken out in a cold sweat from pain) -- I guess. Physician notes are highly variable -- sometimes amazingly detailed and comprehensive, but usually cryptic. Like nursing care, physician care often falls to the lowest common denominator in nursing homes -- but there are always angels among caregivers who choose to work in nursing homes and do good things.
Complaining about quality of medical documentation in nursing homes, however, is a bit like complaining about the wine list at McDonald's -- in theory they are "homes". But as our patients get older and medically complicated -- more so than in the history of mankind -- the process of taking care of them gets more "hospital-ish" and less like "home". And nursing homes are not really equipped to handle these patients; they are, moreover, highly (say that again, highly) variable in the quality of care. Unless there are informed staff who pay attention (the latest buzz-word is "mindful", which means attending to what you are doing rather than thinking about your Google stocks) patients without concerned family are are pretty much at the mercy of a system that is not designed to provide complex medical care.