Leadership and Management in Geriatrics (LMG) is Expanding

by CALTCM LMG Faculty

Dan Osterweil, MD, FACP, CMD, Ethan Cumbler, MD, FACP, FHM, and Michael Wasserman, MD, CMD

The original course entitled Leadership & Management in Geriatrics (LMG) was established at UCLA over 15 years ago, and has hundreds of proud alumni.  That course, which continues annually under the sponsorship of CALTCM, is focused on individual leaders serving in diverse organizations with many different roles and responsibilities.

In 2018, LMG faculty went beyond training individuals, by creating a new focus on nursing facility teams. Recognizing that a key factor in successful long term care facilities is the leadership team, we developed “LMG for Nursing Homes” (LMG-NH).  Bringing Administrators, Directors of Nursing, Directors of Staff Development, and Medical Directors together to introduce key leadership and management constructs for the “free flowing” NH environment, participants dove into implementation strategies and tactics. The major themes included practice improvement, goal setting and management of human talents, provided under a QAPI (Quality Assurance and Performance Improvement) umbrella. In addition, participants are able to obtain additional support through post-course faculty mentorship.

CALTCM conducted four LMG-NH sessions in 2018, geared toward training leadership teams drawn from the largest consortium of facilities in California. The revised curriculum was designed to meet the needs of the multi-disciplinary management team. This was, to our knowledge, the first state-wide professional workshop bringing physicians, administrators, and nurses together under one roof.  Click here to view short photo slide show of 2018's LMG events.

CALTCM Prepares for the Challenges Ahead in Post-Acute and Long-Term Care

by Timothy Gieseke, MD, CMD

Last July, your Board of Directors (BOD) met in Monterey to review what we have accomplished over the last few years, and plan for our future so that we are able to help our members adjust to a our very dynamic and changing health care environment.  Key trends include: aging population and workforce, new CMS regulations and payment models, more ancillary providers, higher care expectations (dementia care, behavioral health, reducing 30 day readmissions), and more residents with morbid obesity and or serious mental health problems. Technologic factors have been challenging such as: adoption of EHRs by facilities and providers, secure information sharing, and telemedicine.

At CALTCM, we have addressed some of the above issues through our CME meetings, the WAVE newsletters, Collaborations with other organizations (CCCC, CAHF, HSAG, etc.), broadening of our membership (NP as past president of our organization), Leadership and Management in Geriatrics (LMG) courses, and grant developed projects like CALTCM SNF 2.0® (INTERACT implementation & leadership training) and Music and Memory.

An Innovative Collaboration at CALTCM’s 2018 Fall Meeting

by Deborah Wolff-Baker MSN, ACHPN, FNP-BC, GS-C

The November 3rd CALTCM Fall Meeting, Reducing Readmissions Through Better Transitions,  was held at the Betty Irene Moore School of Nursing at UC Davis. This was a unique day in CALTCM history, highlighting not only ways to reduce readmissions through better transitions, but a blooming partnership between CALTCM and the Northern California Chapter of the Gerontological Advanced Practice Nurses Association (NCCGAPNA).

The day began with a keynote talk by Dr. Terry Hill on the hidden burdens of community long-term care provided by family caregivers.  The rest of the morning was packed full of information to educate and inform attendees about issues associated with community discharges and transitions of care with an emphasis on upstream thinking to prevent avoidable hospital readmissions. This information was presented in symposium style with 5 expert Nurse Practitioner members of NCCGAPNA speaking from the perspective of home-based palliative and primary care providers who provide medical care to patients discharged from Skilled Facilities into the community.

Appeals Court Affirms EOLOA Remains in Effect

by Karl Steinberg, MD, CMD, HMDC

On November 27, a California Court of Appeals basically upheld the End of Life Option Act, which had been ruled invalid by a Riverside trial court judge.  The original lawsuit, Ahn v. Hestrin, alleged that the law was not passed through proper channels, and the judge agreed. The law, which allows medical aid in dying for terminally ill patients, was briefly invalidated in May 2018 before this Appeals Court stayed the ruling.  Now, after deliberation, the Court has determined that the original lawsuit was invalid because the plaintiffs lacked standing to bring a lawsuit, since they did not actually have a stake in whether the law existed or not. Since participation is completely voluntary for both patients and physicians, it was felt that they simply did not have any basis to oppose the law.  The dissenting judge went even farther, opining that the original law was passed by appropriate means and there was no basis for the original lawsuit at all.

A Review: Unhealthy Alcohol Use in Primary Care - The Elephant in the Examination Room

by Dan Osterweil, MD, FACP, CMD

Unhealthy Alcohol Use in Primary Care—The Elephant in the Examination Room, by Jennifer Edelman, MD, MHS; Jeanette M. Tetrault, MD, raises the important distinction between alcohol use disorder and unhealthy drinking associated with health status. CALTCM has been on the vanguard of this notion, collaborating with researchers from UCLA and Harvard, offering a CME program aimed at educating primary care physicians in identifying elders at risk for alcohol-related/associated health problems. The program is interactive and a fun way to learn about the subject. It focuses on knowledge and skills required in the primary care office to identify individuals who should be screened and counseled versus those who should be referred to addiction specialists or  psychiatrists.

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