May 2022
Is It Time to Change the Definition for Orthostatic Hypotension?
Sean Heffelfinger, MD, CMD

Falls are the bane of our existence for most of us working in long-term care. I am sure all of us frequently get approached by members of our interdisciplinary team when a patient falls and they hound us for a new intervention to stop them from falling. Besides ordering a PT evaluation and reviewing the med list, most of us will probably order a set of orthostatic blood pressures (and then probably need to educate the nurses how to properly do them).

Orthostatic hypotension has been classically defined as a decrease in blood pressure of 20 mmHg or more of systolic or 10mmHg or more of diastolic after three minutes of standing from the supine position. As we age, our baroreceptors become less sensitive and there is an increase in autonomic neurodegenerative disease. This effect leads to orthostatic hypotension affecting approximately 50% of nursing home residents and 68% of those in geriatric inpatient units.

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.
PMDA Spring Symposium – We Can’t Wait to See You in Williamsport!
Join us in Williamsport, May 21, from 7:30 a.m. to 4:00 p.m. at the Williamsport Hospital for a day of education and celebration!
After a pandemic hiatus of nearly three years, PMDA is pleased to announce a return to in-person meetings and the camaraderie and networking we have all missed since COVID-19 became a household word.
The full day of education and celebration features outstanding clinical sessions, tips to improve your next QAPI review, and the recognition of our certified nursing assistants, the pillars of the interdisciplinary health care team in PALTC.
Job Board:


Suburban Outpatient Pavilion

M-F 8a -5p

Physicians at Lancaster General Health are often found collaborating with their peers and team members to provide a coordinated and holistic approach to care through our patient centered medical home model. We believe that care must incorporate all needs of the patient. This includes medically necessary before and after care services, as well as access to socio-economic resources in the community, to ensure their wellbeing as the ultimate path to recovery. Our belief in this type of approach allows our physicians the opportunity to participate in clinical and organizational improvement huddles, committees and other initiatives, providing opportunities to innovate within their own practices as well as the overarching health system. 
Penn Medicine Lancaster General Health is seeking a full-time BC/BE Geriatrician to join a large and well-established geriatrics practice in Lancaster County. Join a collaborative group of sixteen Geriatricians and sixteen Advanced Practice Providers located within three office locations all with a mission of educating patients and meeting the needs of vulnerable older adults. Our group provides long-term and comprehensive medical direction while ensuring the best quality for a long-term care environment at eight facilities throughout the region.

Fall Regional Meeting - September 21, 2022
30th Annual Symposium – October 14-15, 2022
CMS Clarifies Use of Telehealth After Waivers Lifted

On April 7, CMS announced its intention to end the use of some 1,135 pandemic waivers that allowed physician visits to the nursing home to be conducted via telehealth. Amid some confusion from members, the Society asked CMS to clarify which visits this announcement affects. CMS confirmed that beginning May 7, 2022, all federally mandated physician visits (every 30 days for the first three months and 60 days thereafter) will have to be done in-person again. However, all other nursing home visits are still under the public health emergency waiver and may still be used as needed without limitations. After the public health emergency ends—currently set for July 15, 2022—the subsequent nursing home visits (99307-99310) will return to the 14-day limitation frequency. Initial visits will not be permitted to be used via telehealth (99304-99306). CMS noted that the use of telehealth in the setting is an additive to the required in-person care.
The Society continues to advocate that CMS permanently remove all limitations for the use of telehealth in the nursing home setting and allow telehealth to be used as medically necessary.
Report Shows Long-Term Care Staffing Shortages by State

A recent report from the Seniorly Resource Center breaks down long-term care facility staffing shortages by state and notes that an average of about one-quarter of long-term care facilities have reported shortages in nursing staff so far in 2022, an increase from 16% in 2020.
A Framework to Grow and Strengthen the PALTC Workforce

AMDA invites you to join a FREE series of virtual roundtable discussions, called More of a Good Thing: A Framework to Grow and Strengthen the PALTC Workforce.
Guided by the themes of the 4Ms for Staff, these focused, collaborative discussions will lead to the development of action plans to include concrete, practical steps that PALTC facilities can start taking immediately to build trust with current staff and recruit and retain new staff to grow and strengthen the PALTC workforce.
Upcoming Webinar:

Assisted Living: Current Issues from Infection Prevention to Clinical Management of Residents
Date: Wednesday, May 25
Time: 7:00–8:00 PM ET
Honor Your Frontline Practitioners with a Gift to the Foundation for PALTC Medicine and Our Future Workforce!

Help the PALTC Foundation advance workforce development initiatives, current clinical resources, research grants that advance innovations in care, and to educate healthcare professionals of the unique pride and rewards that come from serving PALTC patients.
Join us in celebrating National Nursing Home Week by honoring a colleague, mentor or friend with your gift to the Foundation for PALTC Medicine. 
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