I recently sent holiday cards to family and friends. The card, adorned with pictures that highlighted the memorable moments of 2022, was emblazoned with the message “What a year!” As I reflect on the recent activities of AMDA – The Society for Post-Acute and Long-Term Care Medicine, it strikes me that the same message applies. Since we last gathered a year ago for our 2022 Annual Conference in Baltimore, our professional society has been tireless in its mission to develop and support the workforce and to improve quality in PALTC settings. As the COVID-19 pandemic continues to disproportionately burden the workforce and residents of our care settings, there is unprecedented interest in improving long-term care, and the work of our Society is more important than ever.
Current Relationships
In order to accomplish our work, the Society has advanced several collaborative relationships that target support and improvement in PALTC. These relationships are critically important to our field because they strengthen everyone’s understanding of the complex issues in PALTC and amplify evidence-based messages to broad, diverse audiences.
In October, I was proud to represent the Society in a roundtable discussion between the White House COVID-19 Response Team, federal public health officials, and other presidents of leading organizations that represent America’s physicians, nurse practitioners, and physician associates to discuss efforts to protect people against and treat COVID-19 this winter. Health care professionals play a critical role in ensuring older adults receive the best care to prevent and treat COVID.
Inspired by the roundtable, the Society collaborated with the American Society of Consultant Pharmacists, American Association of Nurse Practitioners, American Academy of Physician Associates, and Gerontological Advanced Practice Nurses Association to release “COVID-19 Vaccination and Therapeutics in PALTC Toolkit: Resources for Clinicians” (Nov. 14, 2022; https://bit.ly/3QzwBM0). This open-access toolkit, which includes concise, ready-to-use resources to promote the benefits of the COVID-19 bivalent booster and oral antiviral therapeutics, has been widely disseminated and used.
The Society also serves an important role in collaborative PALTC advocacy efforts. We are working with Consumer Voice, the Green House Project, and others to produce several policy podcasts focused on how to achieve the goals of President Biden’s 2022 White House plan to improve nursing home care (“Fact Sheet: Biden-Harris Administration Announces New Steps to Improve Quality of Nursing Homes, Oct. 21, 2022,” http://bit.ly/3QOkNpn). We’ve joined Leading Age, the Institute for Healthcare Improvement, the Hartford Foundation, and others in the Moving Forward Coalition (https://movingforwardcoalition.org/), an effort to operationalize the recommendations of the recent National Academies of Sciences, Engineering, and Medicine (NASEM) report (The National Imperative to Improve Nursing Home Quality, National Academies Press, 2022, https://doi.org/10.17226/26526).
We are partnering with the American College of Emergency Physicians to establish workgroups with the primary goal of developing guidance (best practices, definitions, toolkits) on senior-friendly emergency medicine and improved transitions of care. These projects include formulation of best practices in the form of guidelines and/or protocols on the management of asymptomatic hypertension, asymptomatic bacteriuria/urinary tract infections, and agitation. Our hope is to help nursing homes, emergency departments, and hospitals understand their joint capabilities and, through these best practices, ensure optimal care for older adults.
The Society has been an active partner of the West Health Institute in its “Collaborative for Telehealth and Aging.” The collaborative completed a survey of U.S. clinicians to describe the uses as well as the perceived advantages and challenges of telehealth and age-friendly telehealth practices. Ongoing work will build on this research to develop guidance and resources for optimizing telehealth with older adults. The need for resources like these is readily appreciated by PALTC clinicians like me, who have struggled to navigate the intricacies of deploying telehealth modalities in nursing homes and assisted living facilities during the pandemic.
The Moving Needles Project (https://movingneedles.org/), now in year two of a five-year cooperative agreement between the Society and the Centers for Disease Control and Prevention, continues our efforts to make routine adult immunization a standard of care for PALTC residents and an expectation for staff. Working with pilot sites from nursing homes, assisted living, and home- and community-based services, the team is using quality improvement interventions to test strategies to improve immunization rates. Again, we see the Society leading timely, high-quality collaborative work that is sure to impact thousands of lives.
Policy Efforts
The Society’s efforts to advocate for policy updates to improve PALTC have also been needed more than ever before. Highlights of these efforts in 2022 include remarkable milestones toward increased recognition of the importance of engaged medical directors. California’s milestone legislation AB 749, requiring certification for medical directors, is anticipated to increase the number of those enrolling in our medical direction trainings. Other states are working on similar legislation.
Our team is working to ensure access to high-quality educational experiences. This policy change also affords an important opportunity to understand the impact of certified medical directors. We are working with leading health service researchers to design and deploy research to better understand the medical director workforce and their efforts and impact.
Following years of advocacy from our members, the Nursing Home Disclosure Act, new legislation requiring public reporting of a facility’s medical director, was introduced in the 117th Congress in September 2022 and has recently been reintroduced to the 118th Congress. In national and local venues, the Society has engaged in countless discussions with legislators, governmental agency leaders, and other stakeholders about the importance of identifying and engaging medical directors during the survey process. In so many ways, it feels as though medical directors are on the cusp of the recognition they have long and richly deserved.
Educational Tools
The Society continues its tradition of developing evidence-based educational materials and clinical tools. Highlights from 2022 include the 3Ds (delirium, depression, and dementia) clinical practice guideline update, which is available online (http://bit.ly/3DCPG) and includes relevant guidance for clinicians evaluating and treating dementia, delirium, and depression in PALTC.
Webinars, such as the recent two-part “Medicare Billing and Coding Update,” have offered timely answers for new regulations (https://apex.paltc.org/). We have now produced more than 230 podcasts (and counting), effectively making conversations about hot topics in PALTC readily accessible to learners everywhere.
The People Behind the Society
Critical to the Society’s work are the outstanding contributions of our superlative staff. Over and over, we call on them, and they consistently respond with unwavering commitment to our mission, vision, and values. As president and member, I could not be more grateful for their support.
I am also grateful for the strong leadership that Phil Sloan, MD, MPH, and Sheryl Zimmerman, PhD, provided during their tenure as editors-in-chief of JAMDA. I have no doubt that our new editors-in-chief, Barbara Resnick, PhD, CRNP, and Paul Katz, MD, CMD, will carry on this tradition.
In response to the planned retirement of our executive director, Chris Laxton, CAE, we convened an executive director search committee and have retained the firm Vetted Solutions. The search process is on schedule to identify a new executive director before Chris’s planned retirement in spring 2023. Chris’s contributions to the Society are beyond measure. We gratefully celebrate his leadership and wish him the best in his retirement.
There have been many changes in our lives in the past few years, both in and outside of health care. In PALTC, it has been a time of significant loss and stress. Society members need each other now more than ever before. In our online forums, at our in-person meetings, and in the shared experience of our work, the Society’s culture of caring and support has been a compassionate antidote to burnout.
My sincere gratitude goes to the committee and board members who lead this family. By contributing your time, energy, and intellect to our mission, you have changed countless lives, including my own. I invite members to become a part of this special group of people. If you are interested in serving on a society workgroup or committee, please reach out via our website. Our next president, Milta Little, DO, CMD, will be appointing new committee members soon. She is sure to lead us to new heights in the year ahead, and your help will be invaluable.
As I conclude my presidency, I am honored and humbled to have of served in this role. My journey with the Society began in 2005 when I attended our Annual Conference as a Foundation Futures participant. As a geriatric medicine fellow, my participation came when I needed to determine the direction of my fledgling medical career. The Society offered me the inspiration, knowledge, and community that I needed. The rest, as they say, is history.
At our 2023 Annual Conference in Tampa, I am elated to be ushering in the largest number of Foundation Futures participants ever: about 90 including 12 advanced practice clinicians! Please join me in welcoming these new members of our Society. In number, diversity, and commitment, they embody the evolution and impact of PALTC. They are the future leaders of our field, and they are needed now more than ever.
Dr. Gillespie is president of AMDA – The Society for Post-Acute and Long-Term Care. She lives in Rochester, New York, where she is associate professor of medicine at the University of Rochester School of Medicine and Dentistry.
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