July 2021
Aspiring Leaders Wanted for the PMDA Board of Directors

The PMDA Board of Directors manages the business and affairs of the association. Each year, at the annual business meeting held in conjunction with the annual meeting, PMDA members elect two new members to the 13-membered Board of Directors. This year’s business meeting and elections will be held virtually, on Friday afternoon, October 22, 2021, during the PMDA Virtual Annual Meeting.
Those elected to the PMDA Board serve a maximum of two, consecutive three-year terms that commence on January 1 of the year following their election and end on December 31 of the third year of the term. Our directors meet at least twice a year, once in the fall in conjunction with the annual meeting, and once in the spring in conjunction with the Spring Symposium. Additional meetings may be called as needed.

The time commitment averages between 1 – 2 hours per month. Director’s chair and energize our committees, provide oversight and foresight for PMDA operations, steward the finances, and keep our organization of long-term care professionals focused on our mission to provide quality care for Pennsylvanians residing in the full continuum of long-term care facilities.

If you are an aspiring leader with an interest in meeting new people, learning new skills, and navigating PMDA towards the brightest of futures, please click the button below and submit your nomination.

We look forward to hearing from you!
From a Different View
Gary B, Bernett, MD, CMD 

When I initially offered to write this article for the newsletter, I was gainfully employed full-time as a Senior VPMA with a large post-acute care company. I had moved up in the ranks in the course of 24 years from an attending and medical director. I had weathered the worst of the storm of COVID from the safety of a home office, directing other people in their roles and attempting to ensure that the clinical needs of our patients and residents were being met. The company was now focusing on vaccinating both residents and staff and trying to bring some form of normalcy back to our centers.  I didn’t know at the time that I would be held to my 2019 mumblings about retiring in the summer of 2021. So here I sit, musing on the last 40 some odd years in practice, the bulk of which was devoted to LTC.

So I would like to share my perspective, which has certainly changed and taken shape over four decades. When I first started out in practice, geriatrics, and more especially LTC was a backwater. I fell into it. I started out covering on weekends and vacations for a nursing home doc, strictly as a way to earn some income early in my practice. Nursing home work was something that some primary care docs did as a part of their practices. There were not many clinicians dedicated to it, and the standards of care were not well established. Medical Directorship was not necessarily a respected or sought after position, and in many instances was not compensated, the tradeoff being the referral of new admits in place of a salary. The role of the medical director was defined by the individual facility, and as I liked to say, in some instances was nothing more than the “designated signature.”

Maybe I was a little different, I actually enjoyed the work, and felt a sense of accomplishment treating residents in place and not constantly sending them back to the hospital. Some really experienced nurses certainly helped me out. I was even able to “grandfather” in and take the Geriatric CAQ, despite not having had a fellowship.  There were not a lot of Geriatric fellowships in those days. Eventually, I became a Medical Director, but that is a tale for another time.

With the passage of the Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987, things began to change. There were expectations placed on the medical directors, including meeting attendance, and the expectation that they be paid. More importantly, Required Resident Services were stipulated, The Residents’ Bill of Rights was established, and surveys and certifications became a requirement.

Physician visits and documentation were still loosely scrutinized and monitored depending on the facility. Templated H&Ps were common requiring little in the way of significant documentation or review of records. In fact, hospital records were a prize if you got them since the rules related to discharge summaries required that they be completed in 30 days. It was not uncommon for a LTC follow up visit to consist of the comment “no change from previous,” followed by a physician’s signature.  EMR was unknown, and handwritten “cloning” was the standard. Medication reconciliation as we know it was unheard of. Physicians typically signed and approved the residents’ orders every month, and the use of antipsychotics and tranquilizers was the standard. After all, we were just told that we couldn’t use physical restraints anymore! OH, and what was a Nurse Practitioner?

But I am fortunate. Though retired from full-time work, I am continuing to see patients in SNFs. The work is a lot more difficult than I remember it, but the opportunity to positively impact patients’ lives is a lot greater and certainly more rewarding. Whereas benign neglect was the unspoken standard, the current ability to improve outcomes and improve quality of life really exists. The work is a little harder. The volume of medical records that I can access electronically is occasionally daunting. EMRs force me to document in more than a cursory fashion and in a manner that is consistent with the welfare of our most frail and dependent elderly. I empathize with my fellow clinicians. It is not easy. Time and technology have made what was once thought to be mundane and everyday more difficult, but it really feels like I am doing the right thing. It’s what I went to med school for, taking care of people.

To paraphrase an ancient saying (taken out of context): "The day is short, the labor is vast, but the reward is great.”

Any views or opinions presented in this article are solely those of the author and do not necessarily represent any policy or position of PAMED, PMDA, AMDA, its affiliates, and members.
Now’s the Time to Nominate Your Long-Term Care Clinician of the Year Candidate

The Long-Term Care Clinician of the Year Award is conferred on the clinician who demonstrates excellence in providing and/or promoting quality clinical care in the long-term care arena. The recipient’s vision, passion, leadership, knowledge, and commitment take patient care to exceptional levels of quality, excellence, and innovation in the facilities in which he/she serve.

And NOW, nominating your candidate is easier than ever. Just follow the link below to our online nomination form.  
PMDA's Job Bank

Current Postings

WellSpan Health, York PA

BC/BE Geriatrician
Part-Time | Penn Medicine, Lancaster General Health
The PMDA Trainee Education Fund supports PMDA’s efforts to educate, recognize and inspire post-acute and long-term care clinicians in training in the benefits and rewards of a career in the PALTC continuum. Your contribution will allow us to continue to offer complimentary registration to the Annual Symposium for fellows, residents and students and support PMDA’s contribution to AMDA’s Futures Program. Help us invest in the future of practice in PALTC medicine.
PMDA's Winter Webinar Now Available
The PMDA Winter 2021 Webinar is now available for purchase! A recording of the webinar can be purchased using the form linked below.
Each recording is $15 plus 6% sales tax. You will need access to www.dropbox.com to receive the recordings.
AMDA Statement on Aducanumab
After studying the recent trials of Biogen’s controversial Alzheimer’s Dementia (AD) medication, aducanumab (Aduhelm), AMDA – The Society for Post-Acute and Long-Term Care Medicine has concluded that the trials did not adequately demonstrate safety and efficacy. In addition, the drug needs to be tested in a population representative of nursing home residents before it is prescribed in post-acute and long-term care (PALTC) facilities. Read AMDA’s complete statement.
Register for EDGE21
The EDGE21 Virtual Symposium on August 27 from 10:00 AM-6:30 PM ET will give you the opportunity to discuss and debate provocative topics in the PALTC setting, such as alternative medicine use, systemic societal ageism, racism and unconscious bias, and more. The objective is to improve patient care and outcomes by familiarizing participants with current and emerging issues in the PALTC setting to prepare them for potential leadership and ethical challenges. 
Have you registered for AMDA’s new initiative, called Drive to Deprescribe – Optimizing Medication Use in PALTC (D2D)?
Who should participate?
Prescribers, pharmacists, DONs, CNOs, CMOs, and CEOs in the long-term care setting.

Next Meeting: D2D Progress Check-In
Sharing Strategies, Successes, and Secrets
Date: Thursday, July 15
Time: 4:30 PM – 5:15 PM ET

Access the D2D Meeting Archives, which includes the call playback and slide deck.
Upcoming Webinars:
Update on the Use of Monoclonal Antibody (mAb) Therapies for COVID-19: A Review of New Treatments and At-Risk Populations
A Federal COVID Response Team collaboration with AHCA, AMDA, and LeadingAge
Date: June 15, 2021
Time: 3:00 PM ET
Clinical Laboratory Testing in PALTC: More Than A Black Box
Date: June 16, 2021
Time: 7:00 – 8:00 PM ET
Submit an Abstract for PALTC22
Please contribute an abstract to PALTC22, our Annual Conference held in Baltimore, March 10-13, 2022. Visit the abstract submission site for a complete list of topic areas. The deadline to submit your abstract is July 20, 2021. 
Upcoming Webinar:
The History of Long-Term Care: Insights of a Nursing Home Medical Director Pre and Post Covid
Date: July 14, 2021
Time: 7:00 – 8:00 PM ET
Paige Hector, LMSW will kick off AMDA’s Healing Together campaign by presenting practical, effective strategies for addressing the grief and trauma that medical directors and other leaders in PALTC settings are feeling as a result of the COVID-19 pandemic. Join us for this first in a series of webinars developed by AMDA's Behavioral & Mental Health Advisory Council to help us all heal together.
Date: July 22, 2021
Time: 6:30 PM ET
AMDA On-The-Go
Podcast Series
A survey of more than 8 million nursing home residents found approximately 10% have epilepsy, and 1.6% have their first seizure after admission. Another survey conducted this spring indicated there was no uniform approach to treatment and that development of evidence-based standards and education of staff would be welcomed. 
To gather information regarding the current state of practice to help develop needed educational resources, we have developed a short survey.