AMDA to Administration: Be Broad, Innovative, and Practical in Efforts to Reform PALTC

March 4, 2022

Columbia, MD – AMDA – The Society for Post-Acute and Long-Term Care Medicine applauds the Biden Administration’s continued focus on patients and residents in post-acute and long-term care (PALTC). The proposals presented during this week’s State of the Union (SOTU) address aim to move the PALTC setting toward a better, more equitable health-care system that provides quality care to millions of vulnerable older adults who require these services.

In response to the SOTU, AMDA has released a statement with several suggestions for reforming PALTC:

  • We welcome some of the proposed initiatives the President has outlined, including reduced occupancy or single-occupancy resident rooms, full-time infection preventionists, launching a Nursing Home Career pathway, and greater ownership transparency in our setting.
  • Unfortunately, some of the proposed policies appear to double down on the same punitive measures that for the last three decades have not materially improved the patient or resident experience in PALTC. We strongly urge the Administration to seize this critical moment and take bold action to move our health-care system into the 21st century, starting with a reimagining of PALTC.
  • The Society has embraced its bold vision and strategy in a special issue of our JAMDA medical journal focused on thoughtful, evidence-based, and innovative solutions to the many challenges being faced in PALTC. We urge the Administration to review these ideas, and we stand ready to engage with the White House and federal agencies to explore their implementation.
  • The nursing home medical director is responsible for coordination and oversight of the overall clinical care in the facility, and yet, after the more than 30 years since the OBRA 1987 law passed, this vital position remains a sadly underutilized and invisible role to most patients and families. The Administration can easily change this, for a start by compiling and disseminating a public listing of medical directors of every Medicare/Medicaid-certified nursing facility in the country.
  • A medical license alone does not confer knowledge of nursing homes' complex regulatory framework, or of basic geriatric medicine and bioethics principles. Thus, another step would be to require nursing home medical directors to have a minimum level of training and knowledge in order to carry out the many tasks required to fulfill this complex leadership position well as is being done in a few states in the union.
  • We must strengthen the PALTC workforce by ensuring a safe work environment for direct care staff that provides adequate compensation and benefits, plentiful training and career advancement opportunities, and engaged and competent clinical leadership. This must also include training and growing physician expertise in this complex field. The Administration can start by immediately issuing a self-identifying specialty code for PALTC, as the Society requested from the Centers for Medicare & Medicaid Services (CMS) nearly four years ago.

“Those responsible for clinical care in PALTC have spent the last two years battling the worst pandemic in recent history, with a disproportionate burden of disease, suffering, hospitalization, and death being borne by residents and staff of nursing home, assisted living, and other PALTC settings,” says Christopher E. Laxton, CAE, AMDA’s executive director. “It’s important to point out that we have seen a stark contrast in the response to COVID-19 in facilities where the medical director is well-trained, fully engaged, and knowledgeable about geriatric medicine and infection prevention and control practices, versus those where they are not. This is truly a pivotal moment for those in our settings. As always, we stand ready to work with CMS to enact and implement our suggested changes as well as to train medical directors.”

Read the complete AMDA statement.




AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.