Stewardship in the Modern World

Abstract

In last month’s column I addressed the concept of stewardship. I applied this concept to the emotions of my father and his fellow pilot cadets in World War II, which I found in dad’s letters home during the war. The word “stewardship” is defined in the Oxford dictionary as “the job of supervising or taking care of something.” For my father and his fellow pilots in training that “something” was their country and a way of life that they felt would be destroyed if they did not personally intervene. Nearly 80 years ago my father, his friends, and some 10 million other American men and women of the Greatest Generation made a commitment. They were not going to allow their world to be controlled by outside forces — it would be shaped only from within, and only by them. I would not for a moment suggest that the challenges we face today in our post-acute and long-term care world compare to the magnitude of the events in World War II. However, well-meaning (and some not-so-well-meaning) entities are pushing for ill-advised, profit-minded changes based on a lack of understanding as to how care functions best for our patients. Changes in PALTC, when done correctly, should originate internally and reflect those who best understand the environment and have the best interests of patients in the forefront. That is to say, by us. We can drive this positive change only by generating an ample supply of committed, well-trained practitioners and caregivers, and by demonstrating the value such a workforce brings to the table. We have the knowledge and experience to construct the best environment in which to provide care and effectively, safely transition the increasingly complex and often vulnerable patients within PALTC. These two goals are exactly those of the Foundation for PALTC Medicine. The pathway to these goals is through stewardship, focusing on “taking care of something.” Stewardship can take two potential forms. The first is through contributing financially to the Foundation. The second is by performing exemplary actions that aid our patients and inspire others to be the best, most compassionate clinicians they can be. Unsurprisingly, AMDA – The Society for Post-Acute and Long-Term Care Medicine is the home of both avenues of stewardship. The 2020 winners of the Medical Director of the Year Award, the William Dodd Founder’s Award, and the James Pattee Award for Excellence in Education all have the attributes I have noted. For example, one of these PALTC stewards has sponsored young clinicians to the Futures Program for several years, has incentivized young clinicians to become Certified Medical Directors (CMDs), and makes regular donations at the Wall of Caring during the Annual Conference. Another of our award winners exhibits commitment to PALTC every day, often driving four to six hours one way to the facility then working all day, holding evening meetings or presentations, and finally staying in a hotel in order to work again the next day. Without this doctor’s dedication, some of these facilities would likely close. In the award winner’s nomination letter, one administrator wrote, “Residents are never a disease or a number … [this individual] takes time with each and every resident to ensure that they know they are heard. It is a talent and a gift … a gift that is even rarer in doctors who have so much responsibility and so much territory to cover, with so little time to accomplish this. Yet [this individual] handles all situations with grace, patience, and the utmost dignity and respect … it is never about going through the motions.” I ask that each of you follow the stewardship examples of our award winners — who will be celebrated in an upcoming issue of this publication — in 2020 and beyond. Doing so will create a stronger Foundation and consequently a Society better able to shape a PALTC world that is best prepared for patients, clinicians, and caregivers. Dr. Lett has practiced in the PALTC continuum for more than three decades as a hands-on clinician and medical director. He has served AMDA in multiple capacities including as president, on multiple committees, and is the current chair of the Foundation for PALTC Medicine.