Post-acute And Long-term Care Research Articles

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.

Improving Care for Patients with Dementia: What to Do Before, During, and After a Transition

Improving Care for Patients with Dementia: What to Do Before, During, and After a Transition

PALTC Steps Up Strategies to Attract Nurses

PALTC Steps Up Strategies to Attract Nurses

Development of a Gerontology Graduate Certificate in Post-Acute and Long-Term Care.

Nurse practitioners (NPs) can provide safe, effective, quality care to older adults in post-acute and long-term care (PALTC) settings. However, there is a paucity of exposure to PALTC settings in most NP educational programs. Therefore, the current authors developed an elective graduate certificate in gerontology with an emphasis in PALTC for NP students. The graduate certificate curriculum was developed by faculty with expertise in nursing and gerontology education. The PALTC certificate comprises 15 credit hours of online didactic courses, 80 leadership hours, 200 clinical hours, and a scholarly project dedicated to PALTC. Completion of a graduate certificate in PALTC is a novel model for preparing NP students for practice in PALTC settings. The current article serves as a framework for other programs to reference as they develop individualized graduate certificate PALTC programs in their academic institutions. [Journal of Gerontological Nursing, 45(10), 47-52.].

Shared Learning for Better Outcomes

Shared Learning for Better Outcomes