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A Vision for Post-Acute and Long-Term Care From AMDA Leaders

      I don’t think that there will be very many of us working in post-acute and long-term care settings who will be sorry to see 2020 come to a close. The COVID-19 pandemic, natural disasters, economic instability, and racial injustice have challenged us in our professional and personal lives. A little over a year ago, the editorial team of Caring for the Ages was excited as we planned for a themed issue to focus on PALTC of the future. Most of us didn’t anticipate a deadly global pandemic that would infiltrate PALTC, wreak havoc on the lives of so many, and change our professional priorities for the foreseeable future.
      With the New Year upon us, we are hopeful for evidence-based treatments and a safe, effective, and available COVID-19 vaccine. Our wish list for 2021 also includes personal protective equipment; access to adequate testing for patients, staff, and visitors; policies to address racial and economic disparities; and practitioners, staff, families, patients, and those who provide oversight all working together to solve the challenges that we face. We asked experts in AMDA – The Society for Post-Acute and Long-Term Care Medicine to weigh in on their vision for the future of PALTC by answering the following questions:
      • What will PALTC look like in the future?
      • Where do you see yourself living when you are 85 years old?
      • Has COVID-19 impacted your opinion in any way?
      We were fortunate to receive an overwhelming response. Rebecca Elon, MD, MPH; Richard Stefanacci, DO, MGH, MBA, AGSF, CMD; and Karl Steinberg, MD, CMD, HMDC, each share their insights in individual articles that are featured in this special issue. Steven Levenson, MD, CMD, provides guidance into how regulatory requirements have shaped future challenges and opportunities for PALTC. I encourage you to read all their thoughtful contributions. In this Caring Collaborative, I have the pleasure of summarizing the common themes about the future of PALTC shared by the Society’s leaders, which include (1) changes to the physical environment, (2) meaningful, person-centered engagement with patients, (3) increased use of innovative technology, and (4) increased commitment to the PALTC workforce.

      Physical Environments

      The physical environment of PALTC of the future will likely include buildings with smaller occupancy, private rooms, and more homelike environments with open areas and increased access to the outdoors. David Smith, MD, CMD, envisioned “a central services building with surrounding small group homes of smaller occupancy. This will have the additional advantage of cohorting residents to better match cognitive and behavioral characteristics, improve the ‘math’ regarding infection control, and make things much more homelike.” There would be even greater physical separation between patients who are admitted for post-acute convalescence, and long-term care facilities would decrease in number and size due to the provision of more home care options.

      Person-Centered Engagement

      All our experts emphasized the importance of person-centered care. According to Barbara Resnick, PhD, CRNP, her “hope and dream is that there will be an increased opportunity for all older adults to engage in meaningful activities. That means that the focus on regulations needs to be about what residents want versus what regulators think is important.” At age 85, Dr. Resnick hopes to live “in a lovely assisted living setting that is a nice community, smaller, but still a community. Something like a small kibbutz in which we all have jobs and engage in meaningful activities.” Paige Hector, LMSW, the associate editor of Caring for the Ages, envisions a future in which “nursing homes will be reimagined as homes that provide purpose as well as care and comfort for the people that live and work there.”

      Innovative Technology

      The use of innovative technology will abound in PALTC settings of the future. From surfaces that will repel infectious organisms, to floors that will decrease the risk of falls and injuries, PALTC settings will increasingly rely on technological advances to minimize risk and improve care quality. Susan Levy, MD, CMD, projects that telehealth — coupled with on-site visitation — is here to stay. Rajeev Kumar, MD, CMD, describes the expansion of “artificial intelligence and robotics that will enable us to provide care at a reasonable cost. Voice-activated technology to harness on-demand caregiving and Remote Patient Monitoring to prevent adverse events, such as falls and sepsis, will become common practices.”

      A Good Place to Work

      In addition to providing high-quality, person-centered care to our patients, the PALTC settings of the future will also be ideal places to work. Dallas Nelson, MD, CMD, envisions a future when PALTC is better financially resourced. “The pay for work in the nursing home needs to be made equitable with the rest of health care.” Ms. Hector also points to the need for livable wages for direct care workers “so they can work comfortably in one facility and not have to balance multiple jobs. Retention will be so high that we will have waiting lists for people who want to work in the nursing home and be part of something special.”
      Although we have several challenges ahead of us, I am hopeful about the future of PALTC. The resilience of residents and staff and the sense of a caring community that I have experienced in many PALTC settings is something to admire. As for me, COVID-19 hasn’t changed my mind about finding the continuing care retirement community or assisted living community that meets my needs in the future. My daughter, an only child, already has my person-centered care plan committed to heart and is prepared to share it with my care team: a cup of strong coffee in the morning to enjoy at the nurses’ station, walks outside, good dental care, pet visits, music from the 1970s, family visits, and pizza on Friday with friends to share it.
      Dr. Galik is the editor in chief of Caring for the Ages. She is a nurse practitioner in LTC- and community-based settings and a professor at the University of Maryland School of Nursing. She may be reached at [email protected] .