PALTessentials: Navigating Clinical Practice

This course equips clinicians with the specialized knowledge and skills required to excel in post-acute and long-term care (PALTC) settings, including skilled nursing facilities (SNFs) and nursing facilities (NFs). Participants will explore the unique clinical and professional competencies necessary to manage medically complex patients, enhance care quality, and navigate the distinct challenges of PALTC practice. Featuring 16 interactive on-demand modules, along with valuable resources and tools, this course blends practical guidance with real-world application to prepare clinicians to deliver effective, patient-centered care in dynamic and challenging environments.

View the course syllabus.

Learning Objectives

At the completion of this activity, learners should be able to:

Develop the practical skills needed to fulfill the role and responsibilities of a PALTC clinician.
Discuss how regulatory, legal, and financial factors inform the appropriate level of care and clinical decision-making.
Utilize the interdisciplinary care team to develop and apply a person-centered care plan.
Discuss strategies to assess palliative and end-of-life care preferences when managing change in condition, medication prescribing, and transitions of care.
Utilize data to improve safety, quality, and delivery of clinical care.
Develop communication skills for culturally sensitive, ethical, trauma-informed, and person-centered care.

Course Access

Once registered, learners will have access to the course for 12 months after the date of initial registration.

Graciously funded by the Foundation for Post-Acute and Long-Term Care Medicine.

Course Modules

Domain 1: Systems of Care

1 | Introduction to PALTessentials: Navigating Clinical Practice
Estimated Length: 10 minutes
Section 1: Navigating PALTC Clinical Practice
Section 2: PALTmed’s Competencies for PALTC Medicine

2 | Levels of Care Across the Geriatric Care Continuum
Estimated Length: 45 minutes
Section 1: Geriatric Care Continuum
Section 2: Community Setting Services
Section 3: Inpatient Care Services
Section 4: Payor Sources for Care Services

3 | Regulatory Environment of Post-Acute and Long-Term Care
Estimated Length: 50 minutes
Section 1: Brief History of Laws, Regulations, and Government Oversight
Section 2: A Bird’s Eye View of Regulations and Interpretive Guidelines
Section 3: Types of Surveys and the Survey Process
Section 4: Relevant Clinical Regulatory Groups and Grading Deficiencies
Section 5: Regulations Specific to Physician Services

4 | The Interdisciplinary Team
Estimated Length: 50 minutes
Section 1: PALTC IDT Regulations
Section 2: Nursing Direct-Care IDT
Section 3: Medical IDT
Section 4: Leadership IDT
Section 5: Other Direct-Care IDT
Section 6: Ancillary IDT
Section 7: Advocate IDT
Section 8: IDT Collaboration

5 | Developing a Person-Centered, Evidence-Based Medical Care Plan
Estimated Length: 25 minutes
Section 1: What is Patient-Centered Care and Why Does it Matter?
Section 2: Interdisciplinary Team Care in PALTC
Section 3: Understanding Resident and Family Values
Section 4: Person-Centered, Clinical Decision-Making

6 | Transitions of Care
Estimated Length: 35 minutes
Section 1: CMS PALTC Definitions, Regulations, and Legislation
Section 2: Care Transition Barriers, Facilitators, and Quality Markers
Section 3: Fractured Care, Vulnerability, Efforts to Close Gaps in Care
Section 4: Age-Friendly Care – Quality, Efficiency, Sustainability

Domain 2: Medical Knowledge and Care Delivery

7 | Overview of the Care Delivery Process
Estimated Length: 20 minutes
Section 1: The Care Delivery Process
Section 2: Applying the Care Delivery Process

8 | Developing Palliative and End-of-Life Care Plans
Estimated Length: 30 minutes
Section 1: Identifying and Incorporating Prognosis into Care Decisions
Section 2: Developing Effective Palliative and End-of-Life Care Plans

9 | Identifying and Managing Changes of Condition
Estimated Length: 40 minutes
Section 1: Defining and Identifying Acute Change of Condition
Section 2: Managing Acute Change of Condition

10 | Optimizing Medication Prescribing and Pain Management in PALTC
Estimated Length: 40 minutes
Section 1: Prescribing Medications
Section 2: Deprescribing Medications
Section 3: Pain Assessment
Section 4: Non-Pharmacologic and Pharmacologic Approaches to Pain

Domain 3: Ethics, Communication, and Professionalism

11 | Ethical Principles in Clinical Decision-Making
Estimated Length: 25 minutes
Section 1: Which Ethical Principles are Used to Evaluate Decision-Making Capacity?
Section 2: What Elements are Used to Evaluate Decision-Making Capacity?
Section 3: How are Surrogates Involved When Someone Lacks Decision-Making Capacity?
Section 4: How do Clinicians Apply Theory in Real-Life Cases?

12 | Optimizing Communication with Patients and Families
Estimated Length: 20 minutes
Section 1: Patient-Centered Communication
Section 2: Family Considerations
Section 3: Opportunities and Tools for Effective Patient/Family Communication

13 | Recognizing and Supporting Culturally Competent Care and Special Communication Needs
Estimated Length: 25 minutes
Section 1: Recognizing and Addressing Special Communication Needs
Section 2: Providing Culturally Competent Care
Section 3: Creating a Trauma-Informed Care Environment

Domain 4: Pursuit of Excellence

14 | Effective Clinical Practice and Personal Professional Development
Estimated Length: 30 minutes
Section 1: Clinician Visits in PALTC
Section 2: Clinician Availability and Communication
Section 3: Developing a Professional Development Plan
Section 4: The Role of the Facility Medical Director

15 | Leveraging Data for Better Clinical Practice
Estimated Length: 40 minutes
Section 1: Understanding the Resident Assessment Instrument (RAI)
Section 2: Supplemental Data to Enhance Patient Care
Section 3: Accessing and Interpreting Data

16 | Changing Clinician and Facility Practices to Improve Outcomes
Estimated Length: 25 minutes
Section 1: Improving Personal Performance
Section 2: Improving Practice Structure
Section 3: Improving Clinical Practice
Section 4: Examples of Personal Performance Improvement

8.5 CME
8.5 CMD Clinical
8.5 MOC

Release Date: 01/16/2026 | Expiration: 1/16/2029

Credit Statements

Accreditation: Post-Acute and Long-Term Care Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CME Designation: Post-Acute and Long-Term Care Medical Association designates this enduring material for a maximum of 8.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CMD Credit Hours: This CME activity has been pre-approved for up to 8.5 clinical hour(s) toward certification or recertification as a Certified Medical Director (CMD) in post-acute and long-term care medicine. Each physician should claim only those hours of credit actually spent on the activity. The CMD Program is administered by PALTmed. For further information, contact PALTmed at 410-992-3115 or at certification@paltmed.org.

ABIM MOC: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 8.5 Medical Knowledge MOC points and patient safety MOC credit in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Financial Disclosure Statement

No one in control of content disclosed any relevant financial relationships with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Julie Gammack, MD, CMD, FACP

Julie Gammack, MD, CMD, FACP, is a Professor of Medicine at Saint Louis University School of Medicine. She is the Associate Dean for Graduate Medical Education, past Program Director for the Geriatric Medicine Fellowship, and a Medical Director at a teaching nursing home. She is a member of the PALTMed Education Committee and past Chair of the PALTMed Advanced Curriculum program.

Susan Elliott, DNP, APRN, FNP-C

Susan Elliott, DNP, APRN, FNP-C, is a doctorally prepared Family Nurse Practitioner who practices at Saint Louis University in the Division of Geriatric Medicine. She provides care to older adults across the care continuum and works on the HRSA Geriatric Workforce Enhancement Program (GWEP) Grant, where she leads the Nursing Home Initiative, including a partnership with the University of Missouri, Sinclair School of Nursing, a CNA Geriatric Specialist Registered Apprenticeship Program, and Project ACT-ON to increase Age-Friendly care.

Kristin Hueftle, MD, CMD

Kristin Hueftle, MD, CMD, is an assistant professor in the Division of Geriatrics at the University of Utah. Dr. Hueftle received her M.D. from Creighton University School of Medicine in Omaha, NE. She then completed her residency in internal medicine, followed by fellowship training in geriatrics at the University of Utah. Dr. Hueftle serves as medical director at the William E Christoffersen Salt Lake Veterans Home, where she oversees both post-acute and long-term care in the skilled nursing home setting. Dr. Hueftle's current clinical practice is in the University of Utah Geriatric Clinic located in the Madsen Health Center. She provides primary care for the geriatric population using a multidisciplinary team-based approach. She also performs comprehensive evaluations focusing on a variety of common geriatric syndromes such as cognitive impairment, frailty, and polypharmacy.

Michael Nash, MD, CMD

Michael Nash, MD, CMD, is a board-certified family medicine practicing primarily in the post-acute and long-term care setting since 2011. He has served as medical director at many skilled nursing and assisted living facilities, mostly in the St. Louis, Missouri area, and has served as a physician leader for post-acute provider groups. Dr. Nash has been the president of the Missouri Association of Long-Term Care Physicians (now PALTMed Midwest) since 2022, and is an active member of the Post-Acute and Long-Term Care Medical Association since 2017. He has served on the PALTMed Assisted Living Subcomittee, the Clinical Practice Committee, and given presentations at two PALTMed national meetings. Dr. Nash has given numerous lectures on medical direction in nursing homes and clinical practice in post-acute and long-term care throughout the midwest.

Angela Sanford, MD, CMD

Angela Sanford, MD, CMD, is an Associate Professor of Medicine at Saint Louis University School of Medicine and is currently serving as the Interim Division Director of the divsion of Geriatric Medicine. She is clinically active in a teaching nursing home, outpatient clinic, and assisted living community. Dr. Sanford supervises medical residents and geriatric medicine fellows in the geriatric continuum of care.

Jamie Smith, FNP-C, CPMA

Jamie Smith, FNP-C, CPMA, is a Clinician Training Specialist for Eventus Wholehealth. She has served as an educator and nurse practitioner for a total of eleven years. Her passion for educating extends beyond just to those in the organization. She is an advocate for education to all those involved in the care of patients. She has served as an author of Geriatric Notes alongside Dr. Brad Goad with Premier Geriatric Solutions (now a part of Eventus WholeHealth), and served at PGS in the capacity of Chief Education Officer.

Jean Storm, DO, CMD

Jean Storm, DO, CMD, is a graduate of the Erie College of Osteopathic Medicine and is Board Certified in internal medicine. She has served as medical director of five long-term care facilities in Erie, PA, and throughout WV. She has also served as the program director for the internal medicine residency program at LECOM Health. She is currently a clinical support physician for Optum/United Healthcare and medical director for a quality improvement organization focused on improving care in long-term care facilities throughout PA and WV. Dr. Storm's interest is in developing policies and strategies that change the way providers view the care delivery process in LTC.

Lina Toledo-Franco, MD, FACP

Lina Toledo-Franco, MD, FACP, is the inaugural Division Director of Palliative Care at SSM-Saint Louis University Hospital, Program Director of the Hospice and Palliative Medicine Fellowship, Program Director of the Geriatric Medicine Fellowship, and Geriatric Medicine attending. She is board certified in Internal Medicine, Geriatrics and Hospice and Palliative Medicine. Dr. Toledo-Franco, completed her medical training in Pontificia Universidad Javeriana in Bogota, Colombia where she was born. Her Internal Medicine and Geriatrics training was completed at Yale Medical School (St. Raphael Campus), and she also received Palliative Care training at SLU. She has practiced as a geriatrician at Yale New Haven Hospital, and Patient Experience Officer and Geriatrics Director at Fundacion Cardioinfantil in Bogota, before coming back to the United States to complete her fellowship in HPM at SLUH in 2019-2020, the year to get the most out of palliative care training. The combination of geriatrics, palliative care, and patient experience reinforced her passion for communication, which is her primary interest for education in health care. Patient-centered care and empathy at the bedside are her main objectives in medical education.

Barbara Tommasulo, MD, CMD, LNHA, CWSP

Barbara Tommasulo, MD, CMD, LNHA, CWSP, has devoted her career to caring for older adults, particularly in PALTC. She is certified in internal medicine and geriatric medicine, is a certified wound specialist physician, and is a licensed nursing home administrator in NY. Medical education has been a mainstay throughout Dr. Tommasulo’s career. Her many years of experience in medical direction have included a variety of settings with various medical staff models. Currently, she is the medical director of Northwell Orzac Center for Rehabilitation and assistant professor of medicine at Hofstra North Shore – LIJ School of Medicine.

Vicki Walker, MD, CMD, FAAFP

Victoria Walker, MD, CMD, FAAFP, is the Clinical and Medical Officer for Avel eCare Senior Care. She also serves as the medical director for Avera Health Long Term Care, the community of Morningside Heights in Marshall, Minnesota and clinical faculty for the Sanford School of Medicine. She is a former PALTmed board member and past Chair of the Public Policy Steering Committee and current member of the Governance Task Force, Vice President of the North Central Society of Post Acute and Long Term Care Medicine and Chair of the Executive Committee for Advancing Excellence coalition.

Course Pricing

	Price
Member	$299
Non-Member	$499

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Interested in bulk order discounts or licensing? Please contact PALTmed's Education Department at education@paltmed.org.

Course Refund Policy

Refunds are available under the following conditions and rates:

A refund of the full registration fee if the request is sent to registration@paltmed.org within 7 calendar days of registration and no progress has been made in the course.
A refund of 50% of the registration fee less a $100 administrative fee if the request is received by registration@paltmed.org within 30 calendar days of registration and no more than 50% progress has been made in the course.
No refund is available if 80% of the course has been completed.
No refunds will be granted after 30 calendar days of registration.
No refunds will be granted for individuals who claim continuing education credits or do not complete the course modules within the 12-month period given.
No refunds will be granted to individuals who experience technical difficulties. If you have questions about the system requirements to participate in this online education program or the refund policy, contact the Education Department at education@paltmed.org or 410-992-3122.

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