Post-acute And Long-term Care Research Articles

Clinical Practice Guideline for Diabetes Management in the Post-Acute and Long-Term Care Setting

The newly revised Clinical Practice Guideline (CPG) for Diabetes Management in the Post-Acute and Long-Term Care (PALTC) Setting is an extremely useful resource that incorporates new evidence and perspectives related to overall goals in diabetes care. The CPG provides detailed information in usable Tables for how to use and manage the increasing number of medication alternatives for PALTC patients with diabetes. In addition, the CPG addresses the critical roles of all members of the interprofessional team for the optimal management of older adults living with diabetes.The primary goal of care as described in the CPG is to make diabetes management individualized and consistent with the patient's/resident's goals of care, and to optimize quality of life and the ability to live in the least restrictive setting possible. To achieve this, the CPG emphasizes the importance of understanding the patients’ overall health status, what their preferences and values are, their life expectancy, the clinical benefit of tight versus more liberal control of glucose, risk of hypoglycemia, and impact of treatment on quality of life and ability to live in a certain setting of care (e.g., if injectable therapy is possible). As with other PALTmed CPGs, this new CPG takes the team through the process of recognition, assessment, treatment and monitoring. Implementation of the Diabetes Management in PALTC Settings CPG can help those working in these settings ensure that their patients and residents are getting the most appropriate and current evidence-based treatment for this challenging clinical problem.

Antimicrobial Use in Veterans Affairs Community Living Centers, 2015 - 2019

Background: Optimizing antimicrobial use (AU) among post-acute and long-term care (PALTC) residents is fundamental to reducing the morbidity and mortality associated with multidrug-resistant organism (MDROs), as well as unintended social consequences related to infection prevention. Data on AU in PALTC settings remains limited. The U.S. Department of Veteran Affairs (VA) provides PALTC to over 23,000 residents at 134 community living centers (CLCs) across the United States annually. Here, we describe AU in VA CLCs, assessing both class and length of therapy. Methods: Monthly AU between January 1, 2015 and December 31, 2019 was extracted from the VA Corporate Data Warehouse across 134 VA CLCs. Antimicrobials and administration routes were based on the National Healthcare Safety Network AU Option protocol for hospitals. Rates of AU were measured as the days of therapy (DOT) per 1,000 resident-days. An antimicrobial course was defined as the same drug and route administered to the same resident with a gap of ≤ three days between administrations. Course duration was measured in days. AU Rates were measured as the days of therapy (DOT) per 1,000 resident-days. Results: The most common class of antimicrobial course administered during the study period was beta-lactam/beta-lactamase inhibitor combinations (15%) followed by fluroquinolones (14%), extended-spectrum cephalosporins (12%) and glycopeptides (11%; Figure 1). Neuraminidase inhibitors had the longest median (IQR) course duration (10 (IQR 8) days), followed by tetracyclines (8 (IQR 8) days), and then folate pathway inhibitors, nitrofurans and 1st/2nd generation cephalosporins (7 (IQR 7) days). Overall, 60% of antimicrobial courses were administered orally, with fluroquinolones the most frequently administered orally (20%). From 2015 – 2019, the annual rate of total antimicrobial use across VA CLCs decreased slightly from 213.6 to 202.5 DOT/1,000 resident-days. During the 5-year study period, fluroquinolone use decreased from 27.47 to 13.36 DOTs/1,000 resident-days. First and 2nd generation cephalosporin use remained relatively stable, but 3rd or greater generation cephalosporin use increased from 14.70 to 19.21 DOTs/1,000 resident-days (Figure 2). Conclusion: The marked decrease in the use of fluoroquinolones at VA CLCs from 2015-2019 is similar to patterns observed for VA hospitals and for non-VA PALTC facilities. The overall use of antibacterial agents at VA CLCs decreased slightly during the study period, but other broad-spectrum agents such as 3rd or greater generation cephalosporins increased over the same period. The strategies used to decrease fluroquinolone use may have application for other antibiotic classes, both in VA and non-VA PALTC settings.Disclosure: Robin Jump: Research support to my institution from Merck and Pfizer; Advisory boards for Pfizer

Two Novel Antibiotic Use Metrics for Facilities and Individual Prescribers in Post-Acute and Long-Term Care Settings

Background: Measuring and reporting antibiotic use are essential to antimicrobial stewardship activities. The most common metric to assess facility-level use is days of antibiotic therapy per 1000 days of care (DOT/1000 DOC). This metric may be difficult to calculate, not be readily comparable, or not provide actionable data to individual prescribers, particularly those that work in post-acute and long-term care (PALTC) settings. Here we use data from a centralized dispensing pharmacy to develop antibiotic use metrics suitable for offering individualized feedback to prescribers working in PALTC settings. Methods: We obtained medication dispensing data and resident census data for 13 PALTC settings within the same network. After omitting non-pharmacologic items and limiting the data to medications dispensed from 1/2020 – 12/2022, we determined the following metrics by month: days of antibiotic therapy (DOT), number of medications prescribed, number of antibiotic courses prescribed (antibiotic starts), and the number of individual residents issued a prescription for any medication (unique residents). These metrics were assessed for each facility (2020 – 2022) and for prescribers responsible for > 1% of prescriptions within that facility (2022 only). Prescriber-level unique residents was the number of residents issued a prescription by the given provider. We obtained facility-level census data to calculate antibiotic DOT/1000 resident days of care (DOC) as a standard to which we compared novel metrics. Results: During the 3-year study period, 1718 prescribers at 13 PALTC settings wrote for 672256 medications, including 31087 antibiotic courses. At the facility level, the correlation between monthly antibiotic starts (courses)/unique residents and antibiotic DOT/1000 DOC was 0.83 (p < 0 .0001). The correlation between monthly antibiotic DOT/unique residents and antibiotic DOT/1000 DOC was 0.98 (p < 0 .0001). Trends in monthly values of both novel metrics and DOT/1000 DOC were consistent across the examined period (Figure 1). For individual prescribers, both novel metrics permit assessment and comparison of antibiotic prescription rates over time (Figure 2). Conclusions: Pharmacy dispensing data can be used to determine antibiotic DOT/unique residents and antibiotic starts/unique residents at the facility level and for individual providers. The novel metric antibiotic DOT/unique residents demonstrated strong correlation with antibiotic DOT/1000 DOC at the facility level. In addition to supporting tracking and reporting of antibiotic use among PALTC settings, these new metrics permit visualization of the antibiotic prescribing rates of individuals prescribers, as well as peer comparison, which in turn can lead to actionable feedback that helps improve antibiotic use in the care of PALTC.

Legal and Ethical Considerations of Artificial Intelligence for Residents in Post-Acute and Long-Term Care

This article proposes a framework for examining the ethical and legal concerns for using artificial intelligence (AI) in post-acute and long-term care (PA-LTC). It argues that established frameworks on health, AI, and the law should be adapted to specific care contexts. For residents in PA-LTC, their social, psychological, and mobility needs should act as a gauge for examining the benefits and risks of integrating AI into their care. Using those needs as a gauge, 4 areas of particular concern are identified. First, the threat that AI poses to the autonomy of residents can undermine their core needs. Second, how discrimination and bias in algorithmic decision-making can undermine Medicare coverage for PA-LTC, causing doctors' recommendations to be ignored and denying residents the care they are entitled to. Third, privacy rules concerning data use may undermine developers’ ability to train accurate AI systems, limiting their usefulness in PA-LTC contexts. Fourth, the importance of obtaining consent before AI is used and discussions about how that care should continue if there are concerns about an ongoing decline in cognition. Together, these considerations elevate existing frameworks and adapt them to the context-specific case of PA-LTC. It is hoped that future research will examine the legal implications of these matters in each of these specific cases.

SHEA position statement on pandemic preparedness for policymakers: building a strong and resilient healthcare workforce.

Throughout the COVID-19 pandemic, many areas in the United States experienced healthcare personnel (HCP) shortages tied to a variety of factors. Infection prevention programs, in particular, faced increasing workload demands with little opportunity to delegate tasks to others without specific infectious diseases or infection control expertise. Shortages of clinicians providing inpatient care to critically ill patients during the early phase of the pandemic were multifactorial, largely attributed to increasing demands on hospitals to provide care to patients hospitalized with COVID-19 and furloughs.1 HCP shortages and challenges during later surges, including the Omicron variant-associated surges, were largely attributed to HCP infections and associated work restrictions during isolation periods and the need to care for family members, particularly children, with COVID-19. Additionally, the detrimental physical and mental health impact of COVID-19 on HCP has led to attrition, which further exacerbates shortages.2 Demands increased in post-acute and long-term care (PALTC) settings, which already faced critical staffing challenges difficulty with recruitment, and high rates of turnover. Although individual healthcare organizations and state and federal governments have taken actions to mitigate recurring shortages, additional work and innovation are needed to develop longer-term solutions to improve healthcare workforce resiliency. The critical role of those with specialized training in infection prevention, including healthcare epidemiologists, was well-demonstrated in pandemic preparedness and response. The COVID-19 pandemic underscored the need to support growth in these fields.3 This commentary outlines the need to develop the US healthcare workforce in preparation for future pandemics.

Post-Acute and Long-Term Care Leaders' Perspectives on Leading During COVID-19.

Post-acute and long-term care (PALTC) delivery is complex, and the COVID-19 pandemic created additional complexities. This qualitative study investigates how PALTC administrators responded to the pandemic, factors that impacted their leadership role and decision-making. Participants from North Carolina (N = 15) and Pennsylvania (N = 6) were interviewed using an interview guide containing open-ended questions. The results revealed three themes: (1) critical knowledge and competencies; (2) resources, supports and essential actions taken; and (3) psychosocial impact. The findings suggest communication and relationship building were the most useful competencies. Lack of staff was a primary stress point during and after the pandemic.

More of a Good Thing: A Framework to Grow and Strengthen the PALTC Careforce

The current staffing shortage across all disciplines of post-acute and long-term care (PALTC) settings is affecting the health and safety of residents, as well as the well-being of the current staff. The need to retain and recruit new talent to this challenging but fulfilling setting demands that we look to existing evidence-based strategies and identify ways to implement them quickly, effectively, and in a sustainable way. Using the 4 Ms Framework of the Age-Friendly Health System developed by the Institute for Healthcare Improvement and the John A. Hartford Foundation (What Matters, Medication, Mentation, and Mobility), we can build on successful strategies to address what matters to staff, mental health, career mobility, and the overall safety and wellness of our nation's careforce. This paper summarizes “More of a Good Thing: A Framework to Grow and Strengthen the PALTC Careforce,” a series of 6 roundtable discussions held in 2022 that brought together clinicians, industry leaders, and change-makers to share strategies that have been researched and successfully implemented and discuss ways to scale and disseminate them to a broader audience. The role of PALTC leadership is highlighted, with key points from the final roundtable discussion outlined, and challenging leadership to think about what they can begin doing immediately to build trust with existing staff and lay the foundation for a stronger nursing home careforce. Next steps for “More of a Good Thing” include a survey of participants about what they have tried, what has been successful, and what barriers they face; a series of focused interviews with leaders; and potential collaboration with quality improvement organizations to help facilities build on and implement the strategies presented.

WHAT DO LONG-TERM CARE LEADERS SAY ABOUT THEIR PREPAREDNESS FOR COVID-19? A QUALITATIVE STUDY

Abstract The post-acute and long-term care (PALTC) sector has, in some respects, served as the epicenter in the U.S. during the COVID-19 pandemic. Many decisions were carried out by administrative and/or clinical leaders during this pandemic. The decisions were made based on their professional experiences, and recommendations by the Centers for Medicare & Medicaid Services (CMS). However, little research has reported on the perspective of those administrators who took the lead during this most difficult time. This study aims to understand how responses and decisions were formed during COVID-19 to ensure resources were available protect staff and residents. Accordingly, this study tried to answer two key questions: 1) What did the PALTC administrative and clinical leaderships learn? 2) What can we do better not if, but when COVID ever “…hits again?” We interviewed nursing home and/or assisted living administrators in two conveniently selected states: Pennsylvania and North Carolina. These interviews (each of which took about 30 minutes) were conducted over Zoom using structured and open-ended questions. The transcripts were entered and analyzed using NVivo – a qualitative data analysis software. The results revealed several themes including communications, relationship building, experience as an administrator, fears and resilience, as well as successful activities to support their staffs such as recognition, bonuses, and food bags prepared for their family. The findings highlight some important administrators’ thoughts which recommend key future strategies. These include whether preparedness assets, knowledge, resources, and policies were adequate and where the future efforts should focus.

The Role of Clinical Leaders in Workforce Development and Retention in Post-Acute and Long-Term Care

The Role of Clinical Leaders in Workforce Development and Retention in Post-Acute and Long-Term Care

A Season for PALTC: Improving Quality, Increasing Transparency, and Strengthening Our Workforce

A Season for PALTC: Improving Quality, Increasing Transparency, and Strengthening Our Workforce

Donor Recognizes the Unique Benefits of Giving to the Foundation for PALTC

Donor Recognizes the Unique Benefits of Giving to the Foundation for PALTC

The Non- Universal Understanding of the New Jersey Universal Transfer Form: Evaluating Resident Physicians’ Knowledge Gaps

Miscommunications and handoff errors are 2 leading causes of preventable medical errors in the US. In an effort to decrease these types of errors when transferring patients from one facility to another, the New Jersey (NJ) Universal Transfer Form (UTF) was jointly developed by providers, hospital administrators, and the New Jersey Department of Health in 2011 to standardize the communication of pertinent clinical information during care transitions. The UTF serves as an important tool for relaying information especially in the Post-Acute and Long-Term Care (PALTC) Arena when PALTC residents are transitioned to and from hospitals.

Health System Success in Delivering Bamlanivimab Within Post-acute and Long-Term Care Facilities

ObjectivesPost-acute and long-term care (PALTC) residents are disproportionately affected by coronavirus 2019 (COVID-19). We describe a health system approach that incorporated PALTC stakeholders to treat residents effectively and efficiently with monoclonal antibodies during the pandemic.DesignRetrospective observational.Setting and ParticipantsIntegrated health system headquartered in Sioux Falls, South Dakota, with urban hub and surrounding rural communities. Patients of the health system include PALTC and assisted living (AL) residents of facilities.MethodsMonoclonal Data Registry captured time to infusion after a positive COVID-19 test, residency (independent or PALTC), and site of infusion (PALTC, hospital outpatient, infusion center). AL residents are included in PALTC data. Registry limited to patients living in SD. Communication and operational resources were tailored to support PALTC infusions. The monoclonal antibody therapy administered to PALTC residents during the first 6 weeks after emergency use authorization (EUA) of monoclonal antibodies was bamlanivimab. The EUA for bamlanivimab was revoked due to lack of effectiveness against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants on April 16, 2021.ResultsThe results are analyzed for the 6 weeks after bamlanivimab EUA. In PALTC, there was a median of 3 days between positive test and infusion. The total number of monoclonal antibody infusions captured in the registry during this time was 87 PALTC on-site infusions.Conclusion and ImplicationsA collaborative approach between health system executives and PALTC experts quickly enabled access to potentially life-saving therapy to a vulnerable population. PALTC settings should be routinely included in health system investment and planning to improve the capacity of the system to achieve optimal outcomes, prevent unnecessary mortality, and preserve health care resources.

A Robotic Device to Enhance Nursing Home Provider Telepresence During and After the COVID-19 Pandemic.

The COVID-19 pandemic presented significant challenges to face-to-face communication with people residing in post-acute and long-term care (PALTC) settings. Telemedicine is an alternative, but facility staff may be overburdened with the management of the equipment. Here we introduce the use of a mobile HIPPA-compliant telepresence robot (MTR) to bridge this barrier, which may be beneficial to reimagine options for PALTC in the future.

Rapid Telehealth-Centered Response to COVID-19 Outbreaks in Postacute and Long-Term Care Facilities.

Purpose: The vulnerability of postacute and long-term care (PA/LTC) facility residents to COVID-19 has manifested across the world with increasing facility outbreaks associated with high hospitalization and mortality rates. Systematic protocols to guide telehealth-centered interventions in response to COVID-19 outbreaks have yet to be delineated. This article is intended to inform PA/LTC facilities and neighboring health care partners how to collaboratively utilize telehealth-centered strategies to improve outcomes in facility outbreaks. Methods: The University of Virginia rapidly developed a multidisciplinary telehealth-centered COVID-19 facility outbreak strategy in response to a LTC facility outbreak in which 41 (out of 48) facility residents and 7 staff members tested positive. This strategy focused on supporting the facility team remotely using rapidly deployed technologic solutions. Goals included (1) early identification of patients who need their care escalated, (2) monitoring and treating patients deemed safe to remain in the facility, (3) care coordination to facilitate bidirectional transfers between the skilled nursing facility (SNF) and hospital, and (4) daily facility needs assessment related to technology, infection control, and staff well-being. To achieve these goals, a standardized approach centered on daily multidisciplinary virtual rounds and telemedicine consultation was provided. Results: Over a month since the outbreak began, 18 out of 48 (38%) facility residents required hospitalization and 6 (12.5%) died. Eleven facility residents have since returned back to the SNF after recovering from their hospitalization. No staff required hospitalization. Conclusions: Interventions that reduce hospitalizations and mortality are a critical need during the COVID-19 pandemic. The mortality and hospitalization rates seen in this PA/LTC facility outbreak are significantly lower than has been documented in other facility outbreaks. Our multidisciplinary approach centered on telemedicine should be considered as other PA/LTC facilities partner with neighboring health care systems in responding to COVID-19 outbreaks. We have begun replicating these services to additional PA/LTC facilities facing COVID-19 outbreaks.

COVID-19 Collaborative Model for an Academic Hospital and Long-Term Care Facilities

The COVID-19 pandemic is devastating post-acute and long-term care (PA/LTC). As geriatricians practicing in PA/LTC and a regional academic medical center, we created this program for collaboration between academic medical centers and regional PA/LTC facilities. The mission of the Geriatric Engagement and Resource Integration in Post-Acute and Long-Term Care Facilities (GERI-PaL) program is to support optimal care of residents in PA/LTC facilities during the COVID-19 pandemic. There are 5 main components of our program: (1) Project ECHO; (2) nursing liaisons; (3) infection advisory consultation; (4) telemedicine consultation; and (5) resident social contact remote connections. Implementation of this program has had positive response from our local PA/LTC facilities. A key component of our program is our interprofessional team, which includes physicians and nursing, emergency response, and public health experts. With diverse professional backgrounds, our team members have created a new model for academic medical centers to collaborate with local PA/LTC facilities.

Identifying and Bridging the Gaps in Antimicrobial Stewardship in Post-Acute and Long-Term Care.

National organizations have developed guidelines and tools for antimicrobial stewardship (AMS) in post-acute and long-term care (PALTC), but there is a need to effectively translate these into actionable, measurable, and impactful programs. An electronic needs assessment survey was developed and distributed to health care providers and administrators involved with AMS activities in PALTC facilities in Maryland. The results of this survey were used to develop a statewide initiative to improve AMS in nursing facilities. The survey revealed that barriers to implementing AMS include limited access or poor utilization of experts in AMS and infectious disease, adverse event data collection tools, and locally developed protocols and guidelines. Strategies to improve AMS included the provision of free continuing education to a multidisciplinary audience and improved access to individuals with expertise in infectious disease and the development of an adverse drug event tool. Continuing to provide meaningful tools and resources that address the specific needs of nursing facilities should lead to improved compliance with regulations and ultimately improved resident outcomes. [Journal of Gerontological Nursing, 46(1), 8-13.].

Diagnosis, Treatment, and Prevention of Urinary Tract Infections in Post-Acute and Long-Term Care Settings: A Consensus Statement From AMDA's Infection Advisory Subcommittee

The diagnosis and management of urinary tract infections (UTIs) among residents of post-acute and long-term care (PALTC) settings remains challenging. Nonspecific symptoms, complex medical conditions, insufficient awareness of diagnostic criteria, and unnecessary urine studies all contribute to the inappropriate diagnosis and treatment of UTIs in PALTC residents. In 2017, the Infection Advisory Subcommittee at AMDA—The Society for Post-Acute and Long-Term Care Medicine convened a workgroup comprised of experts in geriatrics and infectious diseases to review recent literature regarding UTIs in the PALTC population. The workgroup used evidence as well as their collective clinical expertise to develop this consensus statement with the goal of providing comprehensive guidance on the diagnosis, treatment, and prevention of UTIs in PALTC residents. The recommendations acknowledge limitations inherent to providing medical care for frail older adults, practicing within a resource limited setting, and prevention strategies tailored to PALTC populations. In addition, the consensus statement encourages integrating antibiotic stewardship principles into the policies and procedures used by PALTC nursing staff and by prescribing clinicians as they care for residents with a suspected UTI.

Recommendations for Mandatory Influenza Vaccinations for Health Care Personnel From AMDA's Infection Advisory Subcommittee

Preventing influenza infections is a national health priority, particularly among geriatric and adults with frailty who reside in post-acute and long-term care (PALTC) settings. Older adults account for more than 70% of deaths from influenza, a reflection of decreased vaccine effectiveness in that age group. Annually vaccinating health care personnel (HCP) working with these patients against influenza is critical to reducing influenza morbidity and mortality among patients. PALTC HCP have the lowest influenza vaccination rate when compared to HCP in other settings. The Advisory Committee on Immunization Practices recommends that all HCP receive an annual influenza vaccination, including those who do not have direct patient care responsibilities. Here, we discuss the importance of influenza vaccination for HCP, detail recommendations for influenza vaccination practice and procedures for PALTC settings, and offer support to PALTC settings and their staff on influenza vaccinations.

The Year in Review: And What a Year it Was

As the year draws to a close, it is a good time to reflect on the accomplishments of your Foundation in 2019. Our mission remains two-fold: Firstly, to address the geriatric workforce deficiency this country faces; and, secondly, to demonstrate the value of those of us who practice in the post-acute and long-term care (PALTC) continuum. So, how did we do in pursuit of these goals? Our work cannot be accomplished without putting our own house in order. We ensured this in several ways:•Updated Foundation strategic plan to better align with the mission and goals of both AMDA – The Society for Post-Acute and Long-Term Care Medicine and the American Board of PALTC Medicine (ABPLM)•Revised Foundation bylaws to create the flexibility necessary to respond to the needs of the AMDA membership•Elected Susan Levy, MD, CMD, as chair-elect and Ken Brubaker, MD, CMD, as secretary /treasurer•Revised the mission and vision statements of the Foundation In addition, the Institutional Advisory Board (IAB) was organized under David Smith, MD, CMD, to provide a forum where Society members and industry leaders such as Acadia Pharmaceuticals, Avanir Pharmaceuticals Inc, Sanofi, Sanofi Pasteur, and Sunovion can come together to discuss issues of mutual interest. We’re even exploring the possibility for IAB members to post non-CME content (all unbranded) about various diseases on the Foundation website in early 2020. As mentioned previously, our prime mission remains expanding the PALTC workforce, which brings me to the Futures Program. This year your Foundation funded the participation of 70 Futures participants in the Society’s annual conference in Atlanta, including three advanced nurse practitioners. The Society state chapters generously funded nearly $40,000, and $11,000 was raised at the Wall of Caring during the conference to support the Class of 2019. Your Foundation will continue to raise funds and awareness of this popular program, while asking for your continued support to sustain and expand it. To further underline the importance of our commitment, your Foundation added a board position to liaise with the Society’s Education Committee to develop the educational content for the program. No better person could be found then Heidi White, MD, MEd, CMD. This year, a new campaign called Futures 2 Futures (F2F) was created to provide a vehicle for Futures alumni to fund a full scholarship for a qualified practitioner for the Class of 2020. This speaks to the impact the Futures program has had on its participants and allows them to “pay it forward” to upcoming practitioners. Our second major Foundation initiative involves recognizing the value of the PALTC practitioner. Exemplary facilities and practitioners serve as the essential role models for our next generation of excellence in PALTC care and deserve being honored. Recognitions of the “best and brightest” in Atlanta included:•Medical Director of the Year: Charles Crecelius, MD, PhD, CMD•William Dodd Founder’s Award: David Smith, MD, CMD•James Pattee Award for Excellence in Education: Naushira Pandya, MD, FACP, CMD•Recognition for the work going on in facilities with the Quality Improvement & Health Outcome Award given to two facilities:oThe Residence at Timber Pines in Spring Hill, FLoHillside Health & Rehabilitation in Missoula, MT•Marissa Galicia-Castillo, MD, a researcher at EVMS, was awarded $5,000 to begin her project “Collaboration Between a Skilled Nursing Facility and a Heart Hospital: Preventing Heart Failure Readmissions to the Acute Care Hospital” I do not want to ignore the fact that your Foundation still supports PALTC research:•We participated in a QI study with Insight Therapeutics and researchers at Brown School of Public Health to evaluate the impact of the annual flu vaccine choice on nursing home residents’ hospitalization risk. Through our recruitment efforts 189 skilled nursing facilities participated in the study, including 110 Signature HealthCARE facilities which the Society President Arif Nazir, MD, FACP, AGSF, CMD, initiated. (Thank you, Arif!) The Foundation received nearly $19,000 for its help with recruitment efforts. The study will continue in 2020.•We helped fund the development of quality measures appropriate for the PALTC population.•We assisted in facilitating a grant from the Retirement Research Fund to update two of the Society’s Clinical Practice Guidelines. While your Foundation is driven by mission, it is powered by all of you! Please go to the Foundation website (https://paltcfoundation.org) to learn more and see how you can help keep all of this great work going. I look forward to an even longer report next year. 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.