This session will provide a framework for recognizing, assessing, and treating spasticity. The session will highlight the impact spasticity can have on functional mobility, ability to perform ADLs, pain and skin integrity, making it essential to the PALTC provider. The importance of recognition and anticipation of the development of spasticity will be discussed, as well as key positive and negative effects of spasticity that should be initially considered. There will be a discussion on how to determine the best time to begin treatment of spasticity within a clinical framework. An introduction to the various treatment methods will allow attendees to begin developing a treatment continuum for spasticity to better guide their treatment decisions.

This presentation will focus on the differentiation between the late effects of poliomyelitis and the post-polio syndrome, both conditions involving the anterior horn cell motor neuron. Amyotrophic lateral sclerosis – another anterior horn cell motor neuron condition often encountered at the PALTC setting – will be briefly compared for neurophysiologic clarity. The severe psychosocial stress of having polio, aging, and the post-polio syndrome will be acknowledged. The discussion will unfold through epidemiology, pathophysiology, natural history, definition, diagnosis, management, and rehabilitation. Emerging practice and gaps in evidence-based knowledge will also be discussed.

This session presents how patients who were referred to an adapted integrative medical group visit program describe their experience with long COVID. Exploratory, qualitative data from semi-structured interviews will be used to describe the symptoms and illness experiences of long COVID patients in the Southeastern United States, detailing how symptoms have influenced patients’ lifestyles, activities, personal identities, and social relationships. The authors will discuss the emotions patients felt regarding these changes and their perspectives on the health care they have received. Complementary and integrative health care modalities utilized to support patients while navigating their long COVID symptoms will also be described, as well as patients’ attitudes towards them.

This package includes a selection of three technology recorded sessions from PALTC24.

This package includes a selection of four practice management recorded sessions from PALTC24.

This package includes a selection of three clinical recorded sessions from PALTC24.

This presentation will coherently cover the new risk-sharing payment model by CMS. On January 1st, 2023 CMS will launch this new model morphing existing Direct Contracting Entities and ACOs into one structure. ACO REACH presents a unique opportunity for practice groups to take on global risk and participate in up to 100% of the savings, functioning as a health plan. Traditional commercial health plans were not able to participate, putting clinicians in the captain chair for managing Medicare risk. There were 270 new applications with nearly 50% approved, of which 38% were risk-bearing programs for high-needs members. The high-needs population is often the focus of clinical practice providers for PALTC members. The panel presentation will describe the design, overview and requirements to operate this new program. The presentation addresses the vital role of Clinicians in ACO REACH.

This session will provide an overview of the revised evaluation and management criteria, including the medical decision-making tables. In addition, this session will provide an overview of codes beyond the usual nursing home set and how they may be appropriate for your practice. Advance care planning, chronic care management, complex chronic care management, non-face-to-face prolonged services, behavioral health integration, and other codes that have been established since 2016 will be examined. This session will provide examples of how and when to use these codes as the payment system moves from volume to value based. It also will cover the latest changes proposed by the Centers for Medicare & Medicaid Services for evaluation and management services.

Four experienced geriatricians experts in wound care will address the components of a high performing PALTC wound care team. The physician and nurse practitioner speakers include the the director and graduates of a wound care fellowship program and leader of PALTC wound care services. Presenter will review QI measures and expected outcomes of a high performing wound care program, discuss the benefits and liabilities of contracted wound care services, and review the regulatory, billing, documentation, and compliance requirements in wound care management. The speakers will describe the roles, responsibilities, and contributions of key members of the wound care IDT. The session will also review the recently changed nomenclature of pressure injury and staging, describe advanced wound care techniques that may be offered by facility IDT members , discuss pain management during the wound care and dressing changes, and review offloading techniques to assist with wound healing.

The session is designed to help the audience see beyond implicit social stereotypes and to better understand the unique stories of the stakeholders they work with. This interactive session will provide opportunities for the audience to develop and enhance their communication skills with individuals with diverse backgrounds. Attendees will learn about the People Library model, an innovative, hands-on approach to diversity, equity, and inclusion training, and have opportunities to practice their communication skills in small groups. Attendees will be equipped with skills to engage in respectful, productive conversations with residents and staff from diverse backgrounds. A toolkit will be provided for the audience to implement similar exercises to improve multicultural communication in their facilities.

There is growing acceptance in the medical community for medical aid in dying (MAID), according to multiple surveys. The issue of MAID is controversial and at times places physicians on the horns of a dilemma, especially given the Hippocratic Oath. This session will explore the medical, psychological and legal implications of MAID with a focus on various state laws, case reviews and suggestions for how practitioners can navigate their way through the maze of medical, ethical and legal issues, regardless of their position on MAID. This session does not advocate for or against MAID, but is educational in nature. Related topics including voluntary stopping of eating and drinking (VSED), stopping eating and drinking by advance directive (SED by AD), and euthanasia will also be discussed.

This workshop will bring together LTC leaders from Asia, Canada, Europe and the USA to look at PALTC organizational models including legislative frameworks, funding, quality assessments, improvement activities and inspections. This session will examine quality assessment matrix and related regulatory interventions present in different countries. We will place special emphasis on evidence of outcomes of assessments and regulatory interventions to further quality care in PALTC. The goal of this session is to enrich understanding on best practice models of measuring and enhancing quality are in PALTC and start building an international framework on how to optimally measure and drive quality in PALTC. While our goal is for all panel members to attend in person, due to uncertainty of the global pandemic we will include brief pre-recorded videos in addition to the in person panelists.

This symposium will feature 4 recognized leaders in PALTC, each discussing a different aspect of leadership. The first presenter will discuss various styles of leadership and review the literature on the effectiveness and impact of leadership styles on outcomes in PALTC settings. The second presenter will explore how leadership manifests itself in the daily work of the medical director. The third speaker will discuss how adversity and leadership are often intertwined, linking the concept to examples within PALTC settings. The fourth presenter will discuss opportunities for PALTC medical directors to expand their leadership experience and capacity within local, state, regional and national venues. The over arching theme of the symposium is that opportunities for leadership are ubiquitous. The capacity for leadership is inherent, but needs conscious development. Several case studies will be presented, with audience polling questions and time for robust discussion.

This session will discuss how to evaluate indications, efficacy, and side effects for and individual patient, who is prescribed multiple CNS medications. Specific talking points will be presented to assist providers in conversations with consultants, patients, and family members. Algorithms will be utilized to demonstrate how and when to reduce medications. Case-based scenarios for commonly used CNS medications (gabapentin, tramadol, sertraline, amitriptyline) will be utilized for an interactive session discussing best approaches to drive medication optimization. A geropsychiatrist and pharmacist will provide additional perspectives.

AMDA & Foundation Awards Presentation The Funny Thing About Stress Keynote Speaker: Kay Frances, MBA We all know that we should manage stress for peak performance in all areas of our lives, but we don't necessarily practice what we know to be true. It's Kay Frances to the STRESS-cue! In the frenzied world of post-acute and long-term care, you need to be reminded of the importance of managing your stress, embracing change, and maintaining a positive attitude for peak performance and success in all areas of your life.

This PALTC23 General Session IV features two presentations: Anne-Marie Filkin Lecture: From Physician to Caregiver to Care-Partner: COVID and Beyond Speaker: Rebecca Elon, MD, MPH, CMD Everything Will Be Alright Speaker: Leonard Hock, DO, CMD

This session will explore disparities, quality measurement, ethical issues, and educational interventions to improve care for persons with OUD/SUD who receive care in NHs.

This session will discuss five papers related to COVID-19 complications in nursing home patients.

In this session, participants will gain hands-on experience with spiritual care tools and activities that may be utilized in the care of both patients and PALTC staff.

This session will present a recent study that demonstrates that the Antipsychotic Stewardship Program, which was developed in conjunction with Indiana's largest SNF operator, shows a highly material reduction in the antipsychotic rate.

This session will present an integrated, team-based approach to managing complex medical and behavioral patients led by the primary medical provider with the assistance of a behavioral health team.

This session will discuss polypharmacy in assisted living communities (ALCs) regarding all medications.

This session will present known data on physician and APC supply in PALTC. There will be a particular focus on identifying where data are lacking and barriers to data collection. Presenters will highlight areas of specific concern, including shortages in rural areas, a need for diversity in the workforce, and opportunities to ensure PALTC is well represented in training programs.

Core concepts and modalities of documentary and narrative medicine will be reviewed. A QI project using documentary in medical education to tell residents’ life stories will be presented, including the positive impact the project had on the staff in PALTC.

This session will concentrate on current and potential anticoagulation strategies for residents in the PALTC setting.

This session, based on our recent Journal of Clinical Ethics article, presents an Interdisciplinary Ethics Panel approach to end of life (EOL) decision-making for unbefriended nursing home (NH) residents, lacking decisional capacity, via a 9-step algorithm, developed for this purpose.

This presentation will focus on using adaptive solutions to change the culture around the way we view antibiotics in long-term care.

The goal of this session is to familiarize the audience with clinical challenges faced by people with intellectual and/or developmental disability (IDD), and to discuss how the use of value-based outcome measures and home-based primary care (HBPC) may improve outcomes in this vulnerable population.

This session will address four common myths regarding the role of APPs in PALTC.

“Care Coordination" is a buzzword in post-acute care. This ill-defined word has many definitions for providers, administration, insurance companies, and other care stakeholders, including the resident. As a result, there is little alignment in the goal of coordinating care and thus measurable poor outcomes for the resident. Our goal is to share tools created out of the need to better coordinate care during a resident’s discharge from nursing or therapy services at a skilled nursing facility.