2017 AMDA Conference

This session will lay the foundation for understanding, appreciating, and improving the compromised relationship that has existed between the emergency room and the skilled nursing facility. Experts from the American College of Emergency Physicians (ACEP) and AMDA – The Society for Post-Acute and Long-Term Care Medicine will describe the current state of affairs and how these two institutions can begin to work together in a meaningful and collaborative way as advocates for their mutual patients, based on enhanced communication, education, and the recognition of common goals.

Learning Objectives:
(1) Describe the challenges that exist in the transitions of care environment that act to compromise a purposeful relationship between the skilled nursing facility (SNF) and emergency department (ED).
(2) Realize how the ED, through the work of ACEP, is understanding how it needs to re-define itself in it's care of patients and it's relationship to PA/LTC providers,
(3) Consider how "best practices" in transitioning patients between the ED and SNF can be implemented in both locales
(4) Appreciate how the "geriatric" emergency room can augment the care of patients and positively impact Population Health programs and the Triple Aim.

This session will discuss key factors leading to ineffective care transitions, emphasize the need for a new approach to delivering transitional care, and describe an integrated approach to achieve optimal transitional care. This approach is based on best practices of different models of care transitions and has not been implemented yet. It has seven key elements based on factors that can help achieve effective care transitions: (1) effective communication among providers; (2) discussion of goals of care and advance directives; (3) functional assessment; (4) medication reconciliation; (5) co-ordination and effective implementation of a care plan; (6) timely and quality discharge summaries; (7) patient-centered instructions and risk-related education.

Learning Objectives:
(1) Implement key elements of an effective care transitions into patient care.
(2) Establish strong communication and collaboration with community physicians, and hospital, and home care teams to provide optimal patient care during care transitions.
(3) Implement strategies for effective communication with patients, families and care teams during care transitions.

This session will discuss the special care needs of the actively dying resident, the special care needs of those in the last few hours to days of life, and review the barriers to meeting those needs. An interdisciplinary protocol developed at the Gouverneur Skilled Nursing Facility will be presented as an example of a successful model to overcome these barriers.

Learning Objectives:
(1) Identify four common physical findings associated with active dying.
(2) Recognize five common institutional barriers to provision of optimal care for the actively dying.
(3) Strategize solutions to overcome these barriers in their institutions.
(4) Recognize how the actively dying phase may affect the care planning for different members of the interdisciplinary team.

This session will present the results of a 2-year improvement project to improve pain management for LTC residents among 12 senior care organizations in Canada and the United States. Beginning in January 2014, the Seniors Quality Leap Initiative (SQLI) initiated an improvement project to improve site and average performance on a number of quality improvement measures related to pain in LTC. Using the evidence-based InterRAI Clinical Assessment Protocol (CAP) for pain as well as the Registered Nurses Association of Ontario (RNAO) best practice guideline for pain, the SQLI developed a method to conduct an in-depth gap analysis based on best practice to develop an improvement plan based on individual gaps. This novel, collaborative approach is the first of its kind in the long-term care sector.

Learning Objectives:
(1) Define the organizational based interventions that have shown to lead to significant improvement in quality measures related to pain in LTC in both Canada and the US.
(2) Describe the best practice approaches to pain management in post-acute and LTC,
(3) Describe the elements of the gap analysis and how it can be applied other quality improvement projects in the LTC sector.
(4) Identify strategies, resources and supports necessary to drive change and success and the impact of this quality improvement approach on LTC policy.

The purpose of this session is to present a diverse panel of experts who will discuss the development of programs, policies, and clinical interventions at the Hebrew Home at Riverdale involving sexual expression and medical marijuana. This is a very unique opportunity for conference attendees to gain the perspectives of a CEO, CMD, and LTC consulting attorney in a fascinating 90-minute session that should not be missed.

Learning Objectives:
(1) Describe three novel programs at the Hebrew Home of Riverdale which may be used as models for change in participant facilities.
(2) Discuss strengths and limitations to use of medical marijuana in LTC.
(3) Review current or pending legislation which may impact the use of medical marijuana in LTC.
(4) Discuss leadership skills which facilitate change in the LTC environment.

This session will provide guidance on starting and sustaining an antibiotic stewardship program (ASP) in their facilities. This will be achieved by introducing the core elements that are essential to a successful ASP. The presenters will provide practical tips on implementing all the core elements using easily available free resources. The audience will also have the opportunity to interact with experts, including those who are currently helping various LTC facilities in developing their own ASP. The ultimate goal of this session is to prepare medical directors, other clinical practitioners, and nursing home administrators for implementing a sustainable ASP at their facilities, based on the Centers for Disease Control and Prevention (CDC) recommended core elements.

Learning Objectives:
(1) Describe core elements of an antibiotic stewardship program and the related CMS regulations.
(2) Discuss the need for implementing antibiotic stewardship program with all seven CDC recommended core elements and the role of medical director in the implementation.
(3) Demonstrate practical steps that can be taken to implement each element of antibiotic stewardship program using easily available resources.
(4) Review the available resources needed to successfully start and sustain an antibiotic stewardship program.

Health care is changing fast and no setting is being affected more than the PA/LTC setting. Stakeholders are demanding high quality, and so are patients and their families. In the context of these changes and funding constraints, the value of innovation and implementation has been amplified. Last year, the Society conducted an Innovations Forum that provided members a platform to voice their ideas around the Society's role in PA/LTC innovations. The message was clear: the Society needs to be the leader in PA/LTC innovation and change. In response, the Board of Directors nominated the Innovations Platform Advisory Committee (IPAC) that consists of clinicians, entrepreneurs, and academicians to promote the Society as an innovations leader in the PA/LTC setting. In this session, IPAC leaders will provide an overview of the IPAC charter and initial projects undertaken by the group. The session will also invite several PA/LTC innovators to present their work to the audience who will then select the two winners of the first ever Society Innovations Challenge.

Learning Objectives:
(1) Describe the Innovations Platform Advisory Committee (IPAC) Charter for AMDA Innovations.
(2) Discuss next steps to incorporate Innovations in to AMDA's culture.
(3) Review finalists selected by the IPAC to compete in the Shark Tank competition.

By reviewing the quality improvement (QI) process, this session will offer the PA/LTC health care provider evidence-based and practical suggestions to implementing deprescribing, or more specifically a deprescribing initiative, into clinical practice. It will also review communication techniques for deprescribing utilizing case-based vignettes.

Learning Objectives:
(1) Review the role of deprescribing in management of polypharmacy or potentially inappropriate medications in PA/LTC residents.
(2) Explore and debate the elements of a successful PA/LTC deprescribing initiative within the QAPI format.
(3) Practice communication strategies for deprescribing with residents, family and caregivers, and other practitioners.

This panel will discuss how changes in our care delivery systems across the country are integrating medical and social supports services for better outcomes for patients and families living in the community and skilled nursing facilities A range of models will be discussed to better deliver care such as case managers for high risk patients and how different states are moving to managed LTC services and supports (MLTSS) which include services for those living in nursing homes. Topics include: 1) how different states are changing how LTC services are delivered and financed, 2) how high risk patients are being managed more in the community with waiver programs, 3) how one state is using a social justice model to help older adults live at home, and 4) how a state is making accountable care organizations and incorporating LTC into the medical system.

Learning Objectives:
(1) Describe how different states are changing how long term care services are delivered and financed.
(2) Discuss how high risk patients are being managed more in the community with waiver programs.
(3) Explain how one state is using a social justice model to help older adults live at home.
(4) Review how one state is making Accountable Care Organizations and incorporating LTC.

For many providers, passion drives the desire to implement person-centered practices in their community. For others, the driver may not be passion, but the need to comply with the new regulatory requirements imposed by the Centers for Medicare & Medicaid Services (CMS). We know that passion alone will not assure sustainable practices and certainly we have all seen attempts at regulatory compliance which are short lived, more of a band aid than a cure. Pioneer Network has long supported the need to create processes and systems to support passion and provide the foundation needed to sustain person-centered practices. In this session, we will explore some foundational practices that can support your passion and drive the implementation and sustainability of person-centered practices. We will identify resources to help build and develop the processes and systems, discuss how to use quality assurance performance improvement (QAPI) to help in the development and sustainability of the person-centered practices, and discuss the role of the medical director in assuring that person-centered practices are the standard in the community.

Learning Objectives:
(1) Identify practices that are based on a medical model and describe ways to replace them with person-centered practices as required by CMS and consumers.
(2) Explain how to develop processes and systems that will support the sustainability of person-centered practices.
(3) Implement strategies within QAPI to implement PCC practices in a systematic way to ensure sustainability.
(4) Find resources to help in the development of processes and systems supporting person-centered practices and recognize how medical practitioners can serve as leaders in this change effort.

This session will examine differing needs and risks associated with younger residents in LTC. Speakers will discuss reasons for the growth of this population, and associated challenges as LTC facilities and staff adapt to individuals who may be very long-term residents whom are tech savvy, may retain considerable physical or cognitive capacity, and also may retain interests or personality traits that can be very difficult to manage in a traditional SNF setting.

Learning Objectives:
(1) Describe common medical conditions affecting younger residents and psychosocial correlates of these conditions.
(2) Identify risks that may be associated with younger residents and a strategy to mitigate them.
(3) Develop a care plan to address psychosocial issues of younger residents including activity and risk management components.