The 2020 to 2030 decade will have several notable firsts for the United States. For the first time in US history, individuals age 65 and older will represent 20% of the population^[1]. It is anticipated that this surge in the older adult population will see approximately a million more residents in senior living communities such as nursing homes and assisted living. As the healthcare landscape evolves and the senior population grows, post-acute and long-term care (PALTC) organizations have emerged as a lower cost site for complex care. Alternative care delivery models such as telehealth provide a value-based care option to address resident needs by virtually evaluating and treating patients at a distance.

Changes to healthcare will demand more from PALTC organizations today and in the future. By 2030, the projected physician shortage will be somewhere between 40,800 and 104,900^[2]; including both primary and specialty care, with specialty shortages projected to be particularly high. The lack of primary care providers will have an impact on preventive healthcare services which will become more crucial as the risk for health problems increases with an aging population. Additionally, several states in the south and west regions of the United States are expected to have Registered Nurse (RN) shortages between 2,200 and 44,500^[3]. Complicating matters, the shortage of specialists and nursing staff will leave patients with heart failure, Alzheimer’s, strokes, cancer, arthritis, and other ailments with less access to timely care. The decreasing number of unpaid caregivers will further complicate the situation. In 2010, for every person that needed a caregiver, there was an estimated seven caregivers; that number has dramatically decreased to four caregivers for every one person^[4],[5],[6]. Meeting the clinical needs of the 65 and older segment of the population is already a challenge without considering the reduction in medical providers and caregivers.

by Arutyun “Harry” Sarkissian, PharmD. and Janice Hoffman, PharmD., EdD, APh, BCGP, FASCP

Introduction by Flora Y. Bessey, Pharm.D., BCGP

Dr. Harry Sarkissian brings us an enlightening summary of AB 1753, which addresses controlled substances and the efforts of the California legislature to increase security and decrease fraud and theft of controlled substances. This bill is very specific about PAPER prescriptions, and applies some very strict guidelines about how these scripts need to be written.

As we all know, much of the correspondence between our facilities and our pharmacies is via FAX, or scan and FAX/email. The paper that must be used now will show a large “VOID” across the prescription when the FAX/scan is received by the pharmacy. This is an effort to prevent copies of prescriptions being used to generate fraudulent paper prescriptions that could then be filled at any pharmacy. However, there is well-founded concern that some pharmacists would be reluctant to fill a prescription that is marked “VOID!” We may be able to mitigate this with appropriate training of our bench pharmacists, but it is certainly a consideration.

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.

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.