This year another member of the podcast family of AMDA – The Society for Post-Acute and Long-Term Care Medicine saw the light of day. Caring On-The-Go’s first episode premiered on January 27, 2021, featuring three stories selected by Caring for the Ages’ Editor in Chief Elizabeth Galik, PhD, CRNP.

When I started my career as an intensive care unit nurse, I thought I had a pretty good idea of what it takes to be a nurse practitioner (NP). But my experience in post-acute and long-term care over the past five years has certainly changed that. It has been a privilege to be a part of older adults’ care teams. The relationships I have developed over the last five years as an adult geriatric NP have afforded me a lifetime of smiles, tears, laughter, and personal growth in addition to my professional experience, and this is just the beginning of my journey in PALTC.

The year 2013 was chronicled in a diary kept by Hendrik Groen (the author’s pseudonym), the self-proclaimed “inmate” of an assisted living senior community in the Netherlands. In the resulting book, The Secret Diary of Hendrik Groen, 83¼ Years Old (Grand Central/Hachette, 2017), each day has some description of the prior day’s goings-on. “If I sound like an old grump, isn’t that what this diary is for?” he wrote. “It lets me gripe and moan from time to time, and it doesn’t bother anyone.” He came to rely on these daily reflections at first because they helped to keep his mind sharp.

As a newly hired nursing home medical director in the 1990s, I felt unprepared for the challenges of the position. I looked for education and training specific to this care setting and was delighted to find, and join, the American Medical Directors Association, which subsequently became AMDA – The Society for Post-Acute and Long-Term Care Medicine. Over the ensuing 25 years, I have had the privilege of being an active member of our Society. Like many of our leaders, I’ve spent countless hours serving on the Board of Directors, working on multiple committees and workgroups, helping draft clinical practice guidelines, making Capitol Hill visits, and attending almost every Annual Conference since the mid-1990s.

During 2020, members of AMDA – The Society for Post-Acute and Long-Term Care Medicine and other practitioners counted on virtual programming for education and information, and one popular source was the Society’s webinars. That will continue this year with a lineup of 30-minute and 60-minute webinars featuring leading experts on a wide range of practical and cutting-edge topics. Among the programs scheduled to date:

At the very end of 2020, the Consolidated Appropriations Act of 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS). Here are some of the highlights:

The newest addition to the Society’s podcast family, Caring On-The-Go brings readers issue highlights and exclusive commentary in a new format. 2

Website: https://paltc.org/annual-conference

Mrs. S is an 89-year-old white woman who has been living in a long-term care facility for two years; she transitioned from an independent living setting (an apartment) after she began to have difficulty managing her personal care and medications safely. She has a past medical history of dementia, believed to be a multi-infarct dementia (current Montreal Cognitive Assessment score is 14/30), a history of hypertension, type 2 diabetes, depression, and degenerative joint disease.

The family of AMDA – The Society for Post-Acute and Long-Term Care Medicine has lost a dear friend and esteemed colleague, Dr. William “Bill” Smucker, who passed away on January 11 with his family at his side. Dr. Smucker was a long-time friend and supporter of the Society who served on many committees and was frequently a guest lecturer at our Society’s Annual Conference. Dr. Smucker also served as president of OMDA – The Ohio Medical Directors Association and was very influential and an educational leader for the Ohio Chapter.

Dear Dr. Jeff: The nursing home where I work has given excellent, person-centered care to a large and diverse group of residents for many years. Our CMS ratings are always four or five stars. During the pandemic, our staff has literally risked their lives and endangered their families to care for frail residents, including many whose COVID status was unknown because we could not get access to tests or were forced to accept them before test results were known. Yet our reputation in the community remains poor.

Twenty-Two Things I Wish I Had Known When I First Started Doing Nursing Home Work

It is well-known that many residents in the post-acute and long-term care setting have contracted, suffered from, and succumbed to COVID-19. Lesser known is that many PALTC wound experts expect the rates of pressure injuries to increase due to the virus’s impact on oxygen perfusion and the vascular system. These experts are encouraging PALTC clinicians to have candid conversations with patients and their responsible parties about the concept of maintenance and/or palliative wound care (Wound Manag Prev 2020;66:5–7).

For the past three years, I have been the chair of the Advancing Excellence in Long-Term Care Collaborative (AELTCC). It is a membership-based, not-for-profit, national coalition that provides a forum for government, professional, consumer, trade, clinical, and other stakeholders to discuss diverse perspectives, policies, regulations, and environmental trends that affect post-acute and long-term services and supports.

The light at the end of the tunnel is in view. In recent weeks, many post-acute and long-term care residents and others have begun receiving COVID-19 vaccines. One key challenge that remains is getting staff to agree to be vaccinated. “There is so much medical misinformation on social media, where many people get their information,” said Leslie Eber, MD, CMD, president of the Colorado Society for Post-Acute and Long-Term Care Medicine. “We have to overcome this with facts, but we have to do this carefully.”

The role of the post-acute and long-term care medical director has evolved over the years. However, talk to any members of AMDA – The Society for Post-Acute and Long-Term Care Medicine who fill this role, and you will hear the passion in their voices as well as their love for their residents and respect for their teams. During the pandemic, these practitioners not only have had to be great leaders and communicators, they also needed to quickly become COVID-19 experts — or close to it.

Caring’s Editor in Chief Elizabeth Galik, PhD, CRNP, helps family members navigate tough decisions about a loved one’s need for nursing home care.

A few months ago, I received a call from a retired post-acute and long-term care practitioner who was trying to help a friend locate and schedule an appointment with a geriatric mental health specialist for his mother. The resident was 85 and lived in a small assisted living community about 90 minutes from a major metropolitan area. She had a long history of depression, anxiety, and what sounded like an undiagnosed dependent personality disorder. She had been admitted to the assisted living community one year earlier, and there was no evidence of a neurocognitive disorder.