As a general internist with many years of experience across care settings, I occasionally asked a specialist colleague in the acute hospital for input on a puzzling patient-care issue. These curbside consultations sometimes led to formal consultations, but more often they confirmed my thinking or suggested alternative explanations and diagnostic paths to pursue. These consultations have been rare since I gave up acute hospital medicine at the end of 2011.
The January 1, 2027 deadline for California nursing home medical directors to become Certified Medical Directors (CMDs) is quickly approaching. Now is the time for medical directors and facility administrators to review certification requirements and ensure they are on track for compliance.
As I start my journey in the shadows of our prior CALTCM presidents (giants in our field), l will be grounded in what they established, and get strength from their words of wisdom.
Timely documentation is an expectation across healthcare. Many medical groups hold physicians and advanced practice providers to 24–48 hour documentation windows, often tied to billing timeliness and compliance requirements. In a traditional clinic, that’s achievable — labs, imaging, medications, and prior notes usually live in one EHR.
As my presidency of CALTCM comes to an end in just a few weeks, I look back on the past two years with tremendous gratitude. It has been an honor and a privilege to serve as President of an organization and a community that means so much to me.
In my long career as an internist, I was fortunate to work in all settings of care for the first 26 years of my career and then focused on post-acute and long-term care (PALTC) practice the last 21 years. Though much of the latter time was focused on care in the skilled nursing facility (SNF) and continuing care retirement community (CCRC) settings, my personal experiences in small board-and-care homes (like assisted living communities [ALCs], also licensed as RCFEs = Residential Care Facilities for the Elderly) led me to favor referral of friends and family to this setting. While these homes are not as closely supervised and regulated as SNFs or even larger ALCs, I believe these homes can provide more personalized and appropriate care than provided for long-stay residents in SNFs and the larger ALCs, and at a lower cost. I realize these are generalities, but here are some advantages of this model.
People often ask me which AI tool they should use. I wish there were one clean answer, but my own daily routine suggests otherwise. I move between several tools, sometimes within the same hour, because each one is useful for a different kind of job.
We certainly don’t lack access to information these days. As healthcare professionals, we can attend national conferences, participate in virtual webinars, listen to podcasts, read journals, and with just a few clicks and a well-written AI prompt get access to information almost instantly.
State chapter programs deliver focused, locally relevant education, practical tools, and direct access to peers who understand the day-to-day realities of post-acute and long-term care in your state. The 2026 CALTCM Summit for Excellence brings together physicians, advanced practice providers, nurses, pharmacists, administrators, and interdisciplinary team members to translate evidence into action, strengthen leadership skills, and navigate California-specific regulatory and medicolegal challenges. Here's why attending your state chapter meeting matters—and what you'll take home.
In my career as an internist, I purchased high-quality audio CME programs to help me stay current on my areas of medical practice. In recent years though, during walks, I have enjoyed and valued free podcasts like PALTtalk (previously AMDA-on-the-Go), with free CMD credits. There are also great resources at, GeriPal, JAMA Clinical News, Annals-On-Call, Cor IM, and DOC Updates. Adapting information from these podcasts and traditional sources of information (webinars, literature reviews, PALTmed CPGs) to team learning for healthcare workers has been a challenge. CME for team learning is usually an add-on to an already busy schedule. This means it must be clinically relevant, concise, and ideally, brief (< 20 min.).
Healthcare reimbursement continues to evolve, and while annual Medicare payment updates often dominate the conversation, they tell only part of the story. The more significant trend is the continued shift toward value-based care, a movement that has remained remarkably consistent across administrations and continues to shape how providers are paid and evaluated.
As summer winds down, CALTCM is looking ahead to a busy season of educational opportunities designed to support healthcare professionals across post-acute and long-term care.
California’s emergency hospice regulations, which became effective July 1, 2026 and will be in place for six months before reassessment, represent one of the most significant state-level regulatory efforts in recent years. They are meant to strengthen hospice oversight, improve accountability, and respond to serious concerns about hospice quality, ownership, billing practices, and patient care. For post-acute and long-term care (PALTC) providers, these regulations matter not only because many residents receive hospice services in nursing homes, assisted living, and residential care settings, but because hospice access and quality directly affect resident comfort, family satisfaction, facility operations, and end-of-life outcomes.
As most of our readers and members know, on October 1, 2019, the Patient-Driven Payment Model (PDPM) replaced the Resource Utilization Groups Version IV (RUG-IV) reimbursement system in skilled nursing facilities (SNFs). The intention was to implement a budget-neutral system that promoted patient-centered care. The Minimum Data Set (MDS) 3.0 and Resident Assessment Instrument User’s Manual v 2.201, and its prior iterations, constitute the document and guidelines used for determining reimbursement.
As skilled nursing facilities care for increasingly complex patients, consistency in clinical workflows is essential. Differences in admission orders, laboratory notification parameters, medication holding instructions, and sliding-scale insulin protocols can create confusion for nursing staff and generate unnecessary calls to providers.
The Post-Acute and Long-Term Care Medical Association (PALTmed, CALTCM’s national affiliate) was well represented at the 2026 Annual Meeting of the American Medical Association House of Delegates, held June 6–9 in Chicago. I had the honor of serving with Dr. Leslie Eber, current PALTmed president, as our delegates. This year marked an important milestone for the organization: after several years with one delegate and one alternate delegate, PALTmed was granted two voting delegate seats for 2026.
Building on the energy and enthusiasm generated at this past weekend's Leadership and Management in Geriatrics (LMG) course, we are thrilled to shift our focus to the next major event on CALTCM’s calendar—the 2026 CALTCM Summit for Excellence.
A valid POLST Form on a resident with dementia living in a memory unit (licensed as a Residential Care Facility for the Elderly {RCFE}), called for DNR, comfort-focused treatment, meaning generally do not transfer to the hospital. Yet when he developed acute altered mental status (AMS), his wife was surprised and dismayed that the facility could not provide comfort-focused care and needed to send him to the ER. To those working in the PALTC space, this is not a surprise, since most ALFs (Assisted Living Facilities) do not have the expertise or quick access to palliative care meds. By Title 22 regulations, they must transfer their residents to the ER for potentially serious changes of condition. In addition, AMS has many potential causes, some of which are potentially reversible like a systemic infection or electrolyte abnormality. Of course, in the case above, the resident was not suffering any significant symptoms that were bothering him; he was just more lethargic. With comfort-focused treatment preferences, no workup or changes in therapy would typically be warranted.
We are living in a post-pandemic respiratory landscape where seasonality is less predictable than in years past. After COVID-19 began to recede in 2022, many facilities experienced the so-called “tripledemic” winter with influenza and RSV surging again. Since then, respiratory viruses have continued to circulate in less predictable patterns, with norovirus adding further complexity in many long-term care settings.
Senate Bill 1088, sponsored by the Coalition for Compassionate Care of California (CCCC) and authored by Sen. Catherine Blakespear of Encinitas (D-38), is working its way through the Senate with very little opposition. This bill will improve processes around POLST in several ways.
