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. I have represented the Society at the American Medical Association (AMA) and National Quality Forum, and I’ve played an active role in the Society’s publications, including serving as editor in chief of Caring for 10 years and now as an associate editor of JAMDA. When I attended my first Society meeting, probably in 1996, I felt like I had found my tribe. But I never dreamed then that one day I would be elected to lead our Society.
Stepping into the Society’s presidency in March 2021 is undoubtedly among the proudest and most humbling experiences of my professional life. I’ve been honored to serve on other organizations’ boards and committees, but the Society has always felt like my professional home, our members like family, and our meetings like joyful and relatively nondysfunctional family reunions. I have very much appreciated the guidance and mentoring from many of our past presidents and other leaders over the years, and am especially thankful for the great stewardship from David Nace, MD, MPH, our outgoing president, for the remarkable leadership he has shown over the last year. Dave’s will be very big shoes to fill, and I promise to give this position my diligent attention and passion. Our Society’s executive director, Christopher Laxton, CAE, has been a diligent, methodical, and evenhanded guiding presence over his years since taking the helm, and his presence too has been invaluable.
This last year has been among the most challenging, heart-wrenching, devastating, and eye-opening experiences many of us have ever endured — with respect to our professional lives, and far beyond. And as I write this column, it is nowhere near over as we continue to experience record-high COVID-19 death rates daily in the United States. But I will concentrate this column on our Society and its mission.
The people we take care of (and work with) in PALTC have been disproportionately harmed by the coronavirus pandemic, with over 100,000 deaths among residents of U.S. long-term care facilities so far. The lack of a coordinated, science-based, and unfettered federal response to the pandemic amplified the devastation, and the notable absence of geriatricians and PALTC specialists at the highest level of planning set back federal efforts further. In fact, it is disappointing that the new administration’s coronavirus task force lacks any geriatricians (although there are pediatricians and Ezekiel J. Emanuel, MD, PhD, who is known for saying he doesn’t want to live past age 75). COVID-19 has shed a bright light on some of the shortcomings of our facilities and their industry, and we can only hope that when all is said and done, there will be some valuable and enduring improvements to be achieved.
One positive aspect of the pandemic has been that our Society’s visibility and credibility have increased, with our members and leaders appearing in national media and invited to serve on important panels and workgroups. For example, Dr. Nace served on the federal Coronavirus Commission for Safety and Quality in Nursing Homes, and my California homie, Mike Wasserman, MD, has been featured on national news segments with the likes of Anderson Cooper and Rachel Maddow. I’d like to see this trend continue, as national attention focuses on the vulnerable population we care for and on practical strategies to improve our care processes.
Another bonus has been that our Society really stepped up to the forefront in addressing COVID-19 in all of its clinical, regulatory, and psychosocial mayhem promptly and comprehensively. Our COVID-19 website (https://paltc.org/COVID-19) and our online forum addressed issues in real time, providing invaluable assistance to members and non-members across the country and undoubtedly saving lives in the process. We have shared our concerns with the Centers for Medicare & Medicaid Services as they arise, and sometimes CMS has even listened to us.
The Society has also, under the leadership of Christian Bergman, MD, CMD, convened a group of members who are participating in state public health, regulatory, and legislative initiatives throughout the pandemic to share strategies, successes, and concerns. This group will be recognized as a formal subcommittee to our Public Policy Committee, called the State-Based Policy and Advocacy Subcommittee, and will continue its work beyond the pandemic. I am hoping this work keeps our members actively engaged in state-level policy pertaining to PALTC settings, clinicians, and patients.
We learned this past year that virtual visits via telemedicine, while not a substitute for in-person visits, can be very successful. Similarly, our pivot to a virtual Annual Conference, while not as personally satisfying as an in-person event, was a great achievement, thanks in large part to the Society’s Professional Development and Meetings staff member, David Gabel, and his team. Even the House of Delegates was able to complete its business virtually under the expert gavel of Chair Suzanne Gillespie, MD, RD, CMD, and we passed several important resolutions.
This year, a bylaws change that has been several years in its evolution is expected to expand full Society membership to all PALTC professionals with doctoral-level training, in addition to our previous expansion welcoming advanced practice nurses and physician assistants some years ago. Inclusivity and diversity have been long-standing goals of our Society; shortly after the murder of George Floyd last summer, our Board of Directors drafted and adopted the “Statement on Racial Inequities” (https://bit.ly/AMDAequity). We convened another successful virtual conference in November with a focus on leadership, ethics, health care disparities, and racial inequality.
What can we expect in the year to come? I suspect much of it will be consumed in trying to recuperate from the ravages of COVID-19. The new federal administration seems to be focused on reinstating a respect for science, which should be a welcome change. I hope the Defense Production Act can be invoked — a year late but still in time to save lives — with a focus on vaccination and testing. Equity issues will continue to take center stage as well, and the far worse outcomes of COVID-19 outbreaks for nursing facilities in underresourced zip codes will be studied.
The clamor of consumer advocates for increased staffing (and minimum nurse staffing requirements) and transparency in facility ownership and related party transactions will undoubtedly intensify, and not without justification. We have learned much about infection prevention and control, including the appropriate use of personal protective equipment, and this should help us if another serious infectious disease emerges in the future. We will see more of a push to provide home- and community-based services to keep older and functionally impaired or chronically ill people out of institutional, congregate-care settings until it’s absolutely necessary — and that is a good thing. We will see more private and two-bed rooms in nursing homes, and fewer three- and four-bed rooms with shared bathrooms — also a good thing.
Various efforts to completely revamp the long-term care industry will be studied in the aftermath of the pandemic’s devastation. The areas to be examined include staffing concerns, for-profit versus nonprofit issues, the ability of real estate owners to funnel funds away from direct resident care to related parties with minimal scrutiny, workforce shortage issues including decent working wages for direct-care staff, and the apparently failed current federal survey process. We pledge to be part of those discussions
As goals for my year as the Society’s president, I would like to continue to improve our Society’s reach and reputation in health care policy and in the media. Our members know firsthand how important it is to have engaged, knowledgeable, caring medical directors and other direct-care clinicians in nursing homes, and competent, geriatrics-oriented medical care available in residential elder care (assisted living, group homes). Yet we have had limited success in getting CMS to even compile and maintain a listing of nursing home medical directors. This is one area we’ll continue to work on this year, in conjunction with legislators, CMS, the AMA, and other stakeholders.
Moving forward in 2021, I hope that all of us can start to heal together from the wounds we’ve sustained. As PALTC professionals, we choose to devote our careers to providing care to the frail, ill, vulnerable, functionally and cognitively impaired populations because we care deeply and passionately for them. We must keep our patients and their families, along with the front-line heroes we work arm-in-arm with, the devoted nursing home staff, as our main priority. And we need to make sure that our work does not go unnoticed. Members and readers, if you have suggestions on what we should be doing, please feel free to contact me anytime. As our Society’s president, I will work to ensure that our voices are heard and our mission is advanced in the year to come and beyond.
Dr. Steinberg is president for 2021-2022 of AMDA – The Society for Post-Acute and Long-Term Care Medicine.
The pivot to a virtual format for the 2020 Annual Conference allowed Society members to stay connected during the uncertain early days of the pandemic.