Those of us who care for vulnerable older adults who live in congregate settings are all 

Once it dawned on us that a pandemic was underway, those of us involved in geriatric care knew that long-term care facilities were going to be in trouble.  And yes, we knew that the usual racial and socioeconomic disparities in outcomes would appear.  But we didn’t know exactly how much trouble, nor did we know exactly how the disparities would play out.  At least for my county of Alameda, for the pre-vaccination phase of the pandemic, we now have answers.

Empathy, like dignity, can be difficult to define but its absence is felt profoundly. Residents, families and co-workers can feel when they are not being treated with empathy. Tapping into the feelings and needs of others is certainly what called many of us to the helping professions.

During the current Omicron surge, COVID-19 vaccines (primary series and boosters) are an essential way for our communities to stay healthy. We would like to share COVID-19 vaccine resources for long-term care facilities (LTCFs) and your members. 

We are in our fifth COVID surge, and my head is spinning with the rapidly evolving federal, state, and local guidance.  Wouldn’t it be nice to visit a platform that tracks all the guidance in a convenient location?  

Two years ago, I retired from an internal medicine practice in the SNF setting with emphasis on Medical Direction, Geriatrics, and Palliative Care.  Last month, I worked 3 weeks providing vacation relief and noticed how “depersonalized” the medical records have become at the acute hospital and SNF levels.  I suspect this is a reflection of our adaptation to EHRs and the perceived need for providers to become more time-efficient.  One of the things I reintroduced into these facilities was the value of the patient’s story.  This is fundamental to establishing working relationships with our patients and their families.  The story is also fundamental to the diagnostic process and leads us away from prescribing more drugs for new symptoms to a more-cost effective and better understanding of the potential causes of the patient’s symptoms.  

Assisting others who are less fortunate, emotionally, socioeconomically, or in poor health, can help change own our perspective to feel more positive.¹ There is literature that suggests, helping others can change brain chemicals leading to more happiness.^1,2 Furthermore, face-to-face volunteering, for example, lending a helping hand at a food bank or church can help reduce loneliness, isolation and can improve social and support networks.^1,3

In my community, our traditional source of providers for caring for our SNF patients has been dwindling for the past several decades as private physicians and new graduates moved into outpatient practices through hospital medical foundations.  Occasionally, older physicians have left their office practice or their foundation employer for the lower cost and flexibility of a dedicated PA/LTC practice.  However, that requires good business skills to navigate the various insurance contracts, on-call support, billing service, EHR platforms, MIPS reporting options, and triage of calls/faxes/texts from various facilities.  As I look at my community, I foresee this workforce of providers continuing to dwindle.  

Life purpose not only means different things to different people, but it also means different things to each person as we progress through the stages and events of our lives. On the formal side, Hill et al., (2010) identified four main types of life purpose as follows:

In 2018, AB 2789, the mandatory provider e-prescribing law for California, was designed to coincide with the new Medicare EPCS (Electronic Prescribing of Controlled Substances) requirement that was to go live nationally at the start of 2022.  AB 2789 goes live January 1, 2022 and extends the EPCS expectations from controlled substance to all prescriber and dispenser prescriptions with very few exemptions possible.  The CMA posted a helpful article on this subject on October 5 (link provided below).

At this year’s annual Summit in October, Dr. Steven Poser presented important information on the distinction between Neurologic and Psychiatric causes of dementia, which I highlighted in the November 1 edition of the WAVE.  

“Now is not the time for additional ‘studies’ to assess the importance of appropriate staffing levels. The combination of inadequate staffing and disparities can only lead to more tragic situations and outcomes, such as those recently seen during the latest hurricane in Louisiana.”  Thus begins CALTCM’s “White Paper on Nursing Home Staffing.”  CALTCM is the medical voice for long term care in California.  Our public policy committee developed this White Paper with the intention of making recommendations based on evidence-based literature.  It was not our intention to debate the financial impact of our recommendations or where nursing staff will come from, given the current huge workforce shortage issues.  We stand for quality care in nursing homes. We absolutely understand many of the issues that have put nursing home care in the precarious state that the COVID-19 pandemic has tragically highlighted. Those issues need to be debated and those problems addressed, but that does not change the existing evidence.  Our White Paper presents the evidence. We’re ready and willing to have a debate over the evidence, though we think it’s more important to have a vigorous discussion on how to finance these recommendations and find the nurses and nursing assistants needed to fulfill these requirements. 

As per the definition in the dictionary, gratitude is “the quality of being thankful, readiness to show appreciation and to return kindness”. Is gratitude an emotion, an attitude, a trait, a habit? It is all that, and more, depends on who you ask.

The pandemic has made us realize two main challenges: the first is how important it is to stay in touch with each other, and the second is how important it is to organize our clinical information and networks so that we can access what we need when we need it.  For the first time in the history of our organization, CALTCM has created a free application for your mobile phone to help you meet these needs. 

At this year’s annual Summit, Dr. Steven Posar, a clinical professor of Geriatric Neuropsychiatry at St. Mary’s College in Notre Dame, Indiana, updated us on this important area of medicine.  

Dr. Dan Osterweil recently received a Lifetime Achievement Award from CALTCM.  During the same week, Governor Newsom signed AB 749, which was authored by Assembly member Adrin Nazarian (D-Van Nuys), Chair of the California State Assembly Aging and Long-Term Care Committee. That these two events occurred together was a poetic coincidence.  For many years Dr. Osterweil has championed the concept of a “medical director utility.” He regularly encouraged many of us to advocate more vociferously for medical directors.  This became the inspiration behind CALTCM’s effort to enhance the role of the nursing home medical director.

Our lives are overwhelmingly busy and it's difficult to stop to realize when and if we are experiencing a happy moment. But what is true happiness and how can you obtain it?

I admitted an older woman to a facility last summer on hospice for terminal cancer, who at that time had minimal pain, controlled with Tylenol.  I was surprised when she said she would like medical aid in dying using the End of Life Option Act.  I alerted the facility and reviewed their policy and procedure from 2017, which permitted this option but certainly didn’t facilitate it.  Since my role was vacation coverage, I subsequently asked her attending physician about his impression of what it was like to die in this facility.  He affirmed my impression of other facilities which rely on hospice to provide care that focuses on medication management of pain and suffering, rather than a comprehensive person-centered approach before and after death.  

New to CALTCM or the annual meeting?  Nursing home and PALTC medicine can be lonely. We don't always have a chance to meet others to share our problems and best practices while getting interesting continuing education credits - especially during the last 18 months. This meeting was created for a virtual setting and is set up for busy professionals. We ask our speakers to distill two hours of content to 15 minutes, and this process assures you get the most critical information.