Competencies for Post-Acute and Long-Term Care Medicine

AMDA - The Society for Post-Acute and Long-Term Care Medicine has developed Competencies for Post-Acute and Long-Term Care (PALTC) Medicine to provide practitioners with evidence-based framework for the unique set of knowledge and skills necessary to facilitate quality outcomes in this setting. The development of the Competencies began in 2011, when the Society convened a committee of 25 physicians who either practice exclusively in the nursing home setting or spend a significant portion of their time working in this setting. During the following year, the committee worked to finalize the list of competencies. The initial draft was finalized in March 2013 and evaluated via a survey distributed to more than 5,000 Society members. Survey feedback resulted in a second draft of the Competencies, which was vetted by several stakeholder organizations: American Academy of Family Physicians, American College of Healthcare Administrators, American College of Physicians, American Geriatrics Society, American Health Care Association, American Society of Consultant Pharmacists, Leading Age, National Association of Directors of Nursing Administration, and Society of Hospital Medicine. Based on this feedback, the competencies were finalized. To date, the following organizations have signed on with formal support: Advancing Excellence, American Academy of Family Physicians. American Academy of Home Care Physicians, American College of Healthcare Administrators, American Health Care Association, American Society of Consultant Pharmacists, Consumer Voice, Gerontological Advanced Practice Nurses Association, Leading Age, and National Association of Directors of Nursing Administration. 

The Competencies Curriculum online training program was developed to support the competencies and disseminate education on cornerstones of knowledge needed to practice as an attending physician in PALTC. Click here for more information or to participate.

For More information about the Competencies for Post-Acute and Long-Term Care Medicine, view:

Competencies for Post-Acute and Long-Term Care Medicine:

I. Foundation (Ethics, Professionalism and Communication)

1.1 Addresses conflicts that may arise in the provision of clinical care by applying principles of ethical decision-making
1.2 Provides and supports care that is consistent with (but not based exclusively on) legal and regulatory requirements
1.3 Interacts with staff, patients, and families effectively by using appropriate strategies to address sensory, language, health literacy, cognitive, and other limitations
1.4 Demonstrates communication skills that foster positive interpersonal relationships with residents, their families and members of the interdisciplinary team (IDT)
1.5 Exhibits professional, respectful and culturally sensitive behavior towards residents, their families and members of the IDT
1.6 Addresses patient/resident care needs, visits, phone calls and documentation in an appropriate and timely fashion

II. Medical Care Delivery Process

2.1 Manages the care of all post-acute patients/long-term care residents by consistently and effectively applying the medical care delivery process including recognition, problem definition, diagnosis, goal identification, intervention and monitoring progress
2.2 Develops, in collaboration with the IDT, a person-centered, evidence-based medical care plan that strives to optimize quality of life and function, within limits of an individual’s medical condition, prognosis, and wishes
2.3 Estimates prognosis based on a comprehensive patient/resident evaluation and available prognostic tools, and discusses the conclusions with the patient/resident, their families (when appropriate) and staff
2.4 Identifies circumstances when palliative and/or end-of-life care (e.g., hospice) may benefit the patient/resident and family
2.5 Develops and oversees, in collaboration with the IDT, an effective palliative care plan for patients/residents with pain, other significant acute or chronic symptoms, or who are at the end of life

III. Systems

3.1 Provides care that uses resources prudently and minimizes unnecessary discomfort and disruption for patients/residents (e.g. limited nonessential vital signs and blood sugar checks)
3.2 Can identify rationale for, and uses of key patient/resident databases (e.g., the Minimum Data Set), in care planning, facility reimbursement, and monitoring quality
3.3 Guides determinations of appropriate levels of care for patients/residents including identification of those who could benefit from a different level of care
3.4 Performs functions and tasks that support safe transitions of care
3.5 Works effectively with other members of the IDT, including the medical director, in providing care based on understanding and valuing the general roles, responsibilities, and levels of knowledge and training for those of various disciplines
3.6 Informs patients/residents and their families of their healthcare options and potential impact on personal finances by incorporating knowledge of payment models relevant to the post-acute and long-term care setting

IV. Medical Knowledge

4.1 Identifies, evaluates, and addresses significant symptoms associated with change of condition, based on knowledge of diagnosis in individuals with multiple comorbidities and risk factors 4.2 Formulates a pertinent and adequate differential diagnosis for all medical signs and symptoms, recognizing atypical presentation of disease, for post-acute patients and long-term care residents
4.3 Identifies and develops a person-centered medical treatment plan for diseases and geriatric syndromes commonly found in post-acute patients and long-term residents
4.4 Identifies interventions to minimize risk factors and optimize patient/resident safety (e.g. prescribes antibiotics and antipsychotics prudently, assesses the risks and benefits of initiation or continuation of physical restraints, urinary catheters and venous access catheters)
4.5 Manages pain effectively and without causing undue treatment complications
4.6 Prescribes and adjusts, medications prudently, consistent with identified indications and known risks and warnings

V. Personal QAPI

5.1 Develops a continuous professional development plan focused on post-acute and long-term care medicine, utilizing relevant opportunities from professional organizations (AMDA, AGS, AAFP, ACP, SHM, AAHPM), licensing requirements (state, national, province) and maintenance of certification programs
5.2 Utilizes data (e.g. PQRS indicators, MDS data, patient satisfaction) to improve care of their patients/residents
5.3 Strives to improve personal practice and patient/resident results by evaluating patient/resident adverse events and outcomes (e.g., falls, medication errors, healthcare acquired infections, dehydration, return to hospital)