CALTCM, to use a boxing term, has “punched above its weight” throughout the COVID-19 pandemic. So many of our members have put in countless hours, all in service to our mission and vision, which is always worth noting:

  • Promote quality patient care across the long-term care continuum through medical leadership and education.
  • Provide quality education for long term care professionals;
  • Promote effective medical leadership;
  • Promote ethical delivery of care; and
  • Promote the rights of patients. 

One of the most remarkable facts that must be mentioned is that we are a small non-profit association with few resources and only one staff person, the indefatigable Barbara Hulz.  Barbara did everything that was asked of her, and then some, allowing our organization to accomplish a tremendous amount on behalf of our members and the vulnerable older adults who reside in the long-term care continuum.  As President of CALTCM on February 29, 2020 I became aware of the outbreak of COVID-19 in a Kirkland, Washington nursing home. After discussions with our CEO, Dr. Dan Osterweil, our President-elect Dr. Albert Lam and other Board members, our efforts began in earnest.  

On March 5th, we sent an email to the California Department of Public Health (CDPH) with an offer to provide leadership and management training focused on infection prevention.  On March 6th, we received a reply stating that CDPH would “keep in mind” our offer.  They suggested that we put together a webinar.  We didn’t hesitate.  Dolly Greene and Dr. Jay Luxenberg stepped up and on March 9th CALTCM had the first of many webinars, “COVID-19: What Nursing Homes Need to Know.”  One of our recommendations was the need for full-time infection preventionists in nursing homes.  Keep in mind, the WHO officially declared COVID-19 a pandemic two days later!

On March 10th, as President of CALTCM, I was quoted saying that COVID-19 was “the greatest threat to nursing home residents that we have seen in many years, if not forever.”  I truly wish that I had  been wrong, but I was already communicating with other CALTCM members and colleagues around the country.  Those of us in the field of long-term care medicine knew what was coming.  As New York sent COVID-19 patients into nursing homes, the Governor of California was about to propose doing the same.  The CALTCM Board of Directors took immediate actions passing three separate resolutions on March 19th and 20th with clear recommendations to not transfer COVID+ patients into COVID-naive facilities, to minimize unnecessary transfers and to mandate full-time infection preventionists.  This was only March, when others say that they “didn’t know what was coming,” and it felt like “there was nothing that could have been done.” The members of CALTCM never felt this way as we continued to make recommendations and provide guidance to the state health department, the federal government and the nursing home industry.

By the end of March, Dr. Lam came up with the concept and catchphrase for the “CALTCM Quadruple Aim for COVID-19 Response,” the four elements of which were:

  • Sufficient and properly used PPE
  • Readily available testing of staff and residents
  • Stellar Infection Prevention
  • Emergency Preparedness/Incident Command Mode 

I was able to share our Quadruple aim with both Anderson Cooper and Rachel Maddow in April, as CALTCM’s efforts were being heard on the national stage.

Many of our colleagues understood the value of testing, which was part of our Quadruple Aim, but we also recognized that testing was not happening to the extent necessary.  This led to the formation of our first Delphi Panel, which published our testing recommendations on May 31st.  Prior to publication, we shared an embargoed version with State and Federal officials, which may very likely have influenced testing policy.  A second Delphi project was handed off to the Coalition for Compassionate Care of California, which led to AFL 20-73 focused on advance care planning in the wake of COVID-19. A third Delphi project led to yet another publication related to visitation.  In October, CALTCM’s Delphi Steering Committee combined with our Vaccine Delphi group and began having weekly meetings to discuss how to approach the upcoming vaccination effort in nursing homes.  This led to various additional recommendations. Recently this group sent a letter that resulted in a meeting with officials at CMS.  Based on a White Paper that we published in April, we also published a paper describing an aspirational approach to COVID-19 in nursing homes in July. 

In addition to all of these efforts, CALTCM made significant inroads in regard to our interactions with CDPH and the California Department of Social Services (CDSS).  We now meet every two weeks with CDPH and monthly with CDSS to discuss a variety of issues identified by our public policy committee.  We are regularly given the opportunity to weigh in on All-Facilities Letters (AFLs) and Provider Information Notifications (PINs) with edits and comments.  Our members are participating in a variety of state advisory committees.

In April of 2020, in collaboration with Health Services Advisory Group (HSAG), California’s Quality Improvement Organization, we initiated weekly phone calls with infection preventionists from nursing homes across the state.  These calls were so successful that a weekly webinar was added in relatively short order.  Both of these continue to this day with CALTCM actively involved.  

In September, Governor Newsom signed AB 2644, which requires every nursing home in California to have a full-time infection preventionist.  We are the only state in the country with this requirement.  It comes on the heels of CALTCM’s efforts and advocacy for such a requirement.

CALTCM is also the proud sponsor of AB 749, which will require all nursing home medical directors in California to become certified by the American Board of Post Acute and Long Term Care Medicine (ABPLM) within five years.  This bill builds on decades of AMDA efforts to promote and support the important role of the medical director.  AB 749 has thus far passed out of the State Assembly with no opposition, and will soon be heard by the State Senate.  We encourage you to add your voice to the advocacy for this bill.  CALTCM represents our members and your voice matters.

CALTCM was also actively involved in SB 650, which addresses related party transparency, a topic that we addressed in a February Health Affairs article.   We are part of a coalition that includes AARP and the SEIU in support of the PROTECT ACT, which is a suite of bills that includes AB 749 and SB 650 that endeavors to focus on improving the quality of care in California nursing homes.

COVID-19 will impact long term care for years to come.  We hope that this is only the beginning of CALTCMs efforts to make a difference in working towards improving the quality of care for vulnerable older adults in California.

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