AMDA On-The-Go
         Podcast

 

"A world in which all practitioners can learn about post acute and long term care effortlessly as they live"

These podcasts are eligible for ABPLM medical director credits. If you are a physician and interested in obtaining ABPLM pre-approved certified medical director credits for certification or re-certification, please email cmd@paltc.org with your name and the podcast title.

 

Hosted by Dr. Wayne Saltsman

Explore the field of post-acute and long-term care, with expert interviews, journal article reviews, innovations news, and more.

 


 

Episode 41: Hypertension in the Nursing Home | Coming Soon!

Dr. Mike Rich

Michael W. Rich, M.D. is Professor of Medicine and Cardiology at the Washington University School of Medicine, and Director of the Cardiac Rapid Evaluation Unit at Barnes-Jewish Hospital in St. Louis.  Since completing his Cardiology Fellowship in 1984, Dr. Rich’s primary research focus has been the prevention and treatment of cardiovascular disease in the aging population.  Dr. Rich has participated in numerous investigator-initiated and multi-center clinical trials involving older cardiac patients, and he has published extensively on heart failure disease management, coronary heart disease, atrial fibrillation, and cardiovascular risk reduction in older adults.  He is an internationally recognized expert in geriatric cardiovascular disease, and he is past president of the Society of Geriatric Cardiology.  He currently serves on the Editorial Boards of numerous publications, and he is Senior Associate Editor for the Journal of Cardiac Failure, Associate Editor for the American Journal of Medicine, and Consulting Editor for the Journal of the American Geriatrics Society. Dr. Rich received the Edward Henderson Award from the American Geriatrics Society in 2014 and the Distinguished Service Award from the American College of Cardiology in 2015.

 

References:

 

 

 

Episode 40: Trauma Informed Care in LTC

Dr. Nancy Kusmaul

Nancy Kusmaul, PhD, MSW, received her MSW from the University of Michigan and received her PhD from the University at Buffalo School of Social Work. She is an assistant professor in the Baccalaureate Social Work program at the University of Maryland Baltimore County. Dr. Kusmaul was social worker in health care settings for more than a decade. Her research focuses on organizational culture, trauma informed care, and the impacts of culture on care recipients and the workforce. She is particularly interested in the experience of direct care workers in organizations, particularly Certified Nursing Assistants in long term care settings. She is a member of the Baltimore County Elder Abuse Coalition and the Maryland Nursing Home Culture Change Coalition.

References:

 

 

 

Episode 39: Pressure Injuries

Dr. Jeffrey Levine

Dr. Levine is a nationally recognized expert in wound care and pressure injuries. He is a faculty member of the Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, and an alumnus of the National Pressure Ulcer Advisory Panel (NPUAP). Dr. Levine’s Pocket Guide to Pressure Ulcers published by the New Jersey Hospital Association is in its 4th printing and has sold thousands of copies to Skilled Nursing Facilities across America. He is author of the chapter on Pressure Injuries and Wound Care in the Geriatric Review Syllabus published by the American Geriatrics Society (AGS). Dr. Levine also currently serves as wound care consultant for The New Jewish Home In Manhattan and Advantage Wound Care.   

 

References:

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Episode 38: Oral Health

Dr. Karin Arsenault

Dr. Karin Andrenyi-Arsenault graduated with a Bachelor of Science in Anatomy from McGill University. She earned her Doctor of Dental Medicine from Tufts University School of Dental Medicine in 1994 and went on to receive a Master’s in Public Health in Health Care Management from Harvard University. She completed a Mini-Residency in Geriatric and Long-Term Care at the University of Minnesota.
She held the position of Dental Director at the South Boston Community Health Center and later was involved in developing and implementing the group practice clinical system at Tufts University School of Dental Medicine. In January, she returned to academia to pursue her interests in geriatrics and public health as Clinical Director of the Geriatric Center Program.

 

References:

 

 

 

 

Episode 37: Challenges in Assisted Living Facilities

Dr. Steven Fuller

Dr. Steven Fuller earned his master’s degree and Ph.D. in physiology, and his D.O. in human medicine at Michigan State. He completed his internal medicine training at Henry Ford Hospital in Detroit, and completed his pulmonary and critical care training at Johns Hopkins Hospital, where he remained as an associate in the physiology department for several years. Fuller is the founder and president of House Calls, a service that delivers onsite primary care to retirement communities. Additionally, he is the founder and president of Illumination Analytics, a health analytics service that measures and tracks the health of assisted living residents. Fuller also founded and currently serves as the president of Straight Line Connect, an online program that teaches assisted living community staff how to prevent hospital readmissions.He is a triple board certified physician/entrepreneur who develops programs in support of an Integrated Care model of senior housing. This model includes 3 equal, interactive, and mutually supportive team members: real estate, hospitality, and healthcare.

 

References:

 

Episode 36: Impact of Delirium in PALTC

Dr. James Rudolph

Dr. James Rudolph is a Professor of Medicine at the Warren Alpert School of Medicine at Brown University, Director, Center of Innovation in Long-Term Services and Support at the Providence V.A. His area of expertise is the relationship of atherosclerosis to functional (cognitive and physical) deficits in older persons, particularly after surgery. His research accomplishments include: identification of which patients will develop delirium (acute change in cognitive function) after surgery, survival of nursing home patients who are admitted to the Intensive Care Unit, and the development and validation of the Anticholinergic Risk Scale. He has authored more than 20 publications on this topic.

References:

 

Episode 35: The Evolving Role of the APP in PALTC

Debra Bakerjian, PhD, APRN, FAAN, FAANP

Dr. Debra Bakerjian is a clinical professor, at the Betty Irene Moore School of Nursing at UC Davis and the former senior director for nurse practitioner and physician assistant clinical education and practice. She currently teaches interprofessional education and team-based care in areas of quality improvement, geriatrics, and patient safety. Previously, Dr. Bakerjian was a Betty Irene Moore School of Nursing Postdoctoral Fellow with specialties in health policy and system change.

 

 

 

References:

 

Episode 34: Suicide Prevention in Long-Term Care Facilities

Elizabeth Conti, Ph. D.

Dr. Conti is staff Psychologist at the Michael E. DeBakey VA Medical Center, and Assistant Professor at Baylor College of Medicine. She is licensed psychologist in the state of Texas and the embedded psychologist in the Cancer Center and outpatient palliative care at the Houston VA. She is passionate about suicide prevention (particularly for older Veterans), late life mental health, and improving the well-being of medically ill populations. Her post-doctoral training included health services research and quality improvement in large healthcare systems.

 

References:

  1. U. S. Surgeon General Report;"2012 National Strategy for Suicide Prevention: Goals and Objectives for Action", PubMed, 2012.
  2. Stanley, B., et. al. "Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk", Cognitive and Behavioral Practice, May, 2012.
  3. Choy, C., "Suicide in palliative care setting", Annals of Palliative Medicine, Dec. 2017.
  4. Mezuk, B., PhD., et. al."Suicide Among Older Adults Living in or Transitioning to Residential Long-term Care, 2003 to 2015", JAMA, June, 2019.

* Opinions expressed are solely the responsibility of Dr. Conti and do not necessarily represent the views of the Department of Veterans Affairs or the U.S. government.

 

 

Episode 33: Are SNFs Dealt an Impossible Hand?

Arif Nazir, MD, FACP, CMD, AGSF

Arif Nazir is Chief Medical Officer, Signature Healthcare; President, SHC Medical Partners, and is the president of AMDA – The Society for Post-Acute and Long-Term Care Medicine. Dr. Nazir is also the past chair of its Innovations Platform Advisory Council.
He has received many professional awards, most notably the Louisville Business First’s 20 People to Know: Healthcare award in 2018, and the Indiana Hulman Health Achievement Award for Public Health in 2015. He has published his research in several peer-reviewed journals and frequently presents at regional and national platforms on geriatric care issues.

 

References:

  1. Walshe, K., MD, "Regulating U.S. Nursing Homes: Are We Learning From Experience?", Health Affairs, Nov, 2001.
  2. Nazir, Arif, "Time to bet on SNF providers", McKnights Long-Term Care News, March, 2019.
  3. Nazir, Arif, et. al., "No One Cares When Planes Don't Crash: The Message for Long-term Care", JAMDA, May 2019.

 

Episode 32: PDPM

Rajeev Kumar, MD, FACP, CMD

Dr. Kumar, an honors graduate from Bangalore Medical College in 1993, is the Medical Director for Transitions Hospice (Illinois Region) since April of 2017.
Board certified in Geriatric Medicine, Palliative Care as well as Internal Medicine. Doctor is also the President of Midwest Geriatrics, LLC, a physician group that provides medical leadership and clinical services to 40 nursing homes, 20 assisted living facilities and 5 outpatient clinics located in the western suburbs of Chicago.
Dr. Kumar is chief medical officer for Symbria, providing pharmacy services for 150 nursing homes across America. Dr. Kumar is also a Certified Medical Director from AMDA and is the immediate past president of Illinois Medical Directors Association. He serves as the medical director for two skilled nursing facilities and is AMDA’s representative on the Professional and Technical Advisory Committee to the Joint Commission and serves as AMDA’s Secretary.

References:

  1. Kumar, R., MD, "SNF Medical Directors and Clinicians in PDPM Have Vital Role", Caring for the Ages, May. 2019
  2. Spanko, Alex, "Cheat Sheets and Timely Visits: How SNFs Can Support Doctors’ Larger PDPM Role", Skilled Nursing News, May, 2019.

 

Episode 31: Leadership in Skilled Nursing Homes

Michael Wasserman, M.D.

Michael Wasserman, M.D., is president of the California Association of Long Term Care Medicine (CALTCM). He recently served as CEO for Rockport Healthcare Services. He was formerly the Executive Director, Care Continuum, for HSAG, the QIN-QIO in California. Dr. Wasserman is a graduate of the University of Texas, Medical Branch. He completed an Internal Medicine residency at Cedars-Sinai Medical Center and a Geriatric Medicine Fellowship at UCLA. He spent five years with Kaiser-Permanente in Southern California where he developed a Consultative Geriatric Medical model. Dr. Wasserman was a co-founder and owner of Common Sense Medical Management (CSM2), a case management company that helped manage high risk beneficiaries of Cover Colorado. He is past chair of the American Geriatrics Society’s Managed Care Task Force and presently serves on the Public Policy Committee. He also serves on AMDA's Public Policy Committee, and was formerly a Public Commissioner for the Continuing Care Accreditation Commission.

References:

  1. Wasserman, M., MD,  "A tectonic shift in nursing homes", McKnights, Feb. 2019.
  2. "The Nursing Home Medical Director: Leader & Manager", AMDA, March, 2011.
  3. Steven Fuller, DO, PhD, Medical Directors: Why do you Abdicate Your Advocacy with Nursing Homes?", Caring for the Ages, January, 2019.
  4. https://twitter.com/wassdoc

 

 

Episode 30: Appropriate Use of Antipsychotics in LTC Facilities

Lea Watson, MD

Dr. Watson is a board certified adult and geriatric psychiatrist with a lifelong commitment to caring for vulnerable populations, and two decades of academic and leadership experience. Her passion is creating a culture of appropriate psychotropic prescribing in long-term care settings to achieve quality outcomes for all stakeholders. She prioritizes common sense, avoiding harms and keeping the patient’s and family’s goals of care at the heart of all endeavors.  Because of the shortage of geriatric psychiatrists in the United States, she developed a model of consultation and training to extend the reach of this highly needed, but limited specialty.  Dr. Watson is a published author, a recipient of numerous local and national awards for research and teaching, and a multi-year recipient of the Denver 5280 Top Doc award.

References:

  1. Olfson M, King M, Schoenbaum M., "Antipsychotic treatment of adults in the United States.", J. Clin. Psychiatry, 2015
  2. Eva Tan, MD, et. al."Importance of Social Supports Within the Nursing Staff on Agitation in Residents with Dementia", JAMDA
  3. "Reducing Antipsychotic Medication Use in Long Term Care", CFHI, 2014
  4. leawatsonmd.com

 

Episode 29: Advance Care Planning

Karl Steinberg, MD, HMCD, CMD

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Dr. Karl Steinberg has been a nursing home and hospice medical director in the San Diego area since 1995 and is currently chief medical officer for Mariner Health Central, a 20-facility California corporation, and is medical director at Life Care Center of Vista, Carlsbad by the Sea Care Center, and Hospice by the Sea. He also makes home visits on behalf of Scripps Healthcare. Dr. Steinberg received his bachelor’s in biochemistry from Harvard and studied medicine at The Ohio State University College of Medicine, then did his family medicine residency at UC San Diego.

Dr. Steinberg is past chair of AMDA’s Public Policy Committee in addition to being editor in chief of Caring for the Ages. He is currently Society vice president.

References:

  1. T. Fulmer, PhD, et. al. "Physicians' Views on Advance Care Planning and End-of-Life Care Conversations.", JAGS, July, 2018
  2. Gillick, M. R., M.D. "Advance Care Planning" NEJM, 2004
  3. Prater, L. PhD., "Examining Age Inequalities in Operationalized Components of Advance Care Planning: Truncation of the ACP Process With Age", JPSM, April, 2019
  4. National POLST Paradigm

 

Episode 28: Deprescribing

Daniel Haimowitz, MD, CMD

Dr. Daniel Haimowitz is a board-certified internist and geriatrician. He earned his Doctor of Medicine from Jefferson Medical College and completed his residency at Thomas Jefferson University Hospital. He received his Bachelor of Science degree from Pennsylvania State University. Haimowitz has been in private practice in Levittown since 1986. An active state physician at St. Mary Medical Center, Haimowitz is the medical director of St. Mary’s Geriatric Assessment Program and several area nursing homes and assisted-living communities. He served as the medical director of the Genesis PACE, LIFE at Home in Delaware County.

Watch live broadcast here!

Episode 27: The State of Geriatric Medicine Education

Heidi White, MD

Dr. White's clinical expertise involves the care of older adults, especially care transitions, long-term care, and post-acute care. She services as the Vice-Chief of Clinical Affairs in the Geriatrics Division At Duke University. She has worked with peer faculty to develop clinical programs including Peri-operative Optimization of Senior Health (POSH) and Health Optimization Program for Elders (HOPE) which is a transitional care program from the hospital to skilled nursing facilities.

 

 

References:

  1. M. Tinetti, MD, Mainstream or Extinction: Can Defining Who We Are Save Geriatrics?, JAGS, 2018
  2. GERIATRICS WORKFORCE BY THE NUMBERS, AGS, 2017
  3. M. Castellucci, Geriatrics still failing to attract new doctors, Modern Healthcare, 2018

 

Episode 26: A Practical Guide to Telehealth

Suzanne Gillespie, MD, RD, CMD

Suzanne Gillespie MD, RD, CMD, is Associate Professor of Medicine in the Division of Geriatrics/Aging and Associate Professor of Emergency Medicine at the University of Rochester School of Medicine and Dentistry. She is board-certified in Internal Medicine, Geriatric Medicine and Hospice & Palliative Medicine.

 

 

 

References:

  1. S. Gillespie et. al, Standards for the Use of Telemedicine for Evaluation and Management of Resident Change of Condition in the Nursing Home", JAMDA, 2019
  2. Telehealth-PALTC-Guide, Westhealth, 2019

 

 

Episode 25: Acute Care Readmissions

Joseph G. Ouslander, MD

Joseph G. Ouslander, M.D., is Professor and Senior Associate Dean for Geriatric Programs at the Charles E. Schmidt College of Medicine at Florida Atlantic University and Professor (Courtesy) at the Christine E. Lynn College of Nursing at FAU in Boca Raton, Florida. He is a graduate of Johns Hopkins University and the Case Western Reserve School of Medicine. Among Dr. Ouslander’s many achievements and contributions in the field of geriatric medicine and care is the creation and dissemination of Interventions to Reduce Acute Care Transfers (INTERACT), a quality improvement program that assists long-term care facilities and programs in improving care, and reducing unnecessary hospitalizations and their related complications and costs.

 

References:

  1. J. Ouslander, et. al., "Evaluation of Nursing Facility Resident Safety During Implementation of the INTERACT Quality Improvement Program", JAMDA, 2018
  2. Jencks, SF, et. al., "Rehospitalizations among Patients in the Medicare Fee-for-Service Program", NEJM, 2009
  3. Gozalo, P, et. al., "End-of-Life Transitions among Nursing Home Residents with Cognitive Issues", NEJM, 2011
  4. Ouslander, JG, et al, "Interventions to Reduce Hospitalizations from Nursing Homes: Evaluation of the INTERACT II Collaborative Quality Improvement Project", JAGS, 2011
  5. Ouslander, JG, et al, "Hospital Transfers of Skilled Nursing Facility (SNF) Patients Within 48 Hours and 30 Days After SNF Admission", JAMDA, 2016
  6. Flint, LA, et al, "Perspective: Rehabbed to Death", NEJM, 2019

 

Episode 24: Personalized music listening for assisted living residents with dementia

Winston Liu, BS, Duke Univ.

Winston Liu, BS is an MD/PhD student at the Duke University School of Medicine. He graduated from the University of Maryland in 2015 with a degree in bioengineering. He recently joined the Bohórquez Laboratory for his PhD training, and he is dissecting a neural circuit that transduces sensory cues from gut luminal microbes to brain areas that control behavior. During his first two years of medical school, he helped to develop a personalized music listening program for assisted living residents with dementia. Winston aims to become an independent physician-scientist focused on the interactions between our mind and other organ systems.

 

References:

  1. Kelly Murphy MD, Winston Liu BS, et al, "Implementation of personalized music listening for assisted living residents with dementia", Geriatric Nursing, 2018
  2. Cohen, Dan MSW "More Music, Fewer Meds", AMDA 2016 Conference
  3. CDC.gov
  4. American Music Therapy Association
  5. Linda Gerdner, Stanford geriatric education center

 

Episode 23: Treating and Preventing C Diff

Milta Little, DO, CMD

Milta Little, DO, CMD, is an Associate Professor of Medicine at St. Louis University in the Division of Geriatric Medicine. She is board certified in General Internal Medicine, with added qualifications in Geriatric Medicine. She serves the division as Program Director of the Geriatric Medicine Fellowship. Her primary scholarly interest is interprofessional health education to improve the care of the frail geriatric patient. Dr. Little has been on the St. Louis Magazine Best Doctor list since 2013. She is a Certified Medical Director and as such, has been a medical director at a number of Skilled Nursing Facilities. She served AMDA on the board of directors from 2012-2016 and from 2017 to present.

 

References:

  1. M. Little, "TREATING AND PREVENTING CLOSTRIDIUM DIFFICILE INFECTION IN LONG-TERM CARE FACILITIES", Managed Healthcare Connect, Nov, 2018
  2. C. McDonald, et. al."Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)", Clinical Infectious Diseases, Volume 66, Issue 7, 19 March 2018

 

Episode 22: Ethics - SED by AD

James Wright, MD, PhD, CMD

James Wright, MD, PhD, CMD, is a member of AMDA Ethics committee. He holds a Masters of Arts in Theological Studies from Union Presbyterian Seminary and a Certificate in Bioethics from Loyola University, Chicago. Dr. Wright is currently writing a book addressing the theological, medical and ethical implications of dementia, called “Love Endures”. He is medical director of three facilities in Richmond, Virginia, and Vice Chair of AMDA-PALTC’s Ethics Committee.

 

References:

  1. AMDA White Paper, "The Role of a Facility Ethics Committee in Decision-Making at the End of Life", March, 2008
  2. Paula Span, "The VSED Exit: A Way to Speed Up Dying, Without Asking Permission", York Times, 2016
  3. Ivanovic, N., et al, "Voluntary stopping of eating and drinking at the end of life - a 'systematic search and review' giving insight into an option of hastening death in capacitated adults at the end of life.”, BMC-Palliative Care, 2014
  4. Wax, J. et al, "Voluntary Stopping Eating and Drinking”, Journal of the American Geriatrics Society, 2018

 

Episode 21: SNF/ER Transition Process

Dr. Adam Perry

 

Adam Perry, MD, is an emergency physician and fellowship trained geriatrician. He is Assistant Professor of Medicine at the Geisinger Commonwealth College of Medicine. He is also a faculty member of the Geriatric Emergency Department Collaborative, in which capacity he presents nationally on clinical and quality improvement topics at health systems implementing emergency department geriatric initiatives.

 

References:

  1. Gettel et. al. The Impact of Incomplete Nursing Home Transfer Documentation on Emergency Department Care", JAMDA, October, 2018
  2. Adam Perry, MD; Firas Saidi, MD, CMD "The Emergency Department Joins the Interdisciplinary Team: Strategies to Improve Acute Care Transitions and Reduce ED Capture", AMDA Annual Conference, Grapevine, TX
  3. Robert Burke, et al. "Identifying Potentially Preventable Emergency Department Visits by Nursing Home Residents in the United States", JAMDA, 2015

 

 

Episode 20: Physical Therapy

Dr. Timothy Swenson PT, DPT, OCS, CMTPT

 

Dr. Swenson holds a doctorate in Physical Therapy. He is a Board Certified Orthopedic Clinical Specialist, and certified to perform dry needling.

 

 

References:

  1. Barbara Resnick, PhD, CRNP, FAAN, FAANP Interdisciplinary Interventions and Teams Are Good…Can We Move Beyond That? JAMDA, July, 2013
  2. Physical Activity Guidelines Health.gov

 

Episode 19: Fall Risk Reduction

Dr. David Smith. M.D., FAAFP, CMD

 

Dr. Smith is President at Geriatric Consultants of Central Tx, P.A., an Area MHMR Board Member. He serves on various state committees and stakeholder taskforces. He is a Texas Medical Directors Assn. Board Member, and Past President of the American Medical Directors Assn.

 

References:

  1. Dr. David Smith, Documented, Systematic and Individualized Communication With the Attending Physician for Fall Risk Reduction/Injury Mitigation Care Planning, JAMDA 8/18
  2. Tinetti, ME, “Risk factors for serious injury during falls by older persons in the community”, JAGS, 1995
  3. Soriano, TA, et al, “Falls in the community-dwelling older adult: a review for primary-care providers” Clin Interv Aging, 2007

 

 

Episode 18: The Care of LGBT Persons in PALTC Setting

Tim Johnston, PhD

Tim R. Johnston, PhD is the Director of National Projects at Services and Advocacy for GLBT Elders (SAGE) and the National Resource Center on LGBT Aging. He is responsible for directing SAGE’s national training initiatives, developing training curricula, and providing consulting services to both aging and LGBT service providers. Before coming to SAGE Tim taught Philosophy and Women’s and Gender Studies at Stony Brook University. He has written scholarly and popular articles on gender and LGBT identity, and his first book Affirmation, Care Ethics and LGBT Identity will be published by Palgrave Macmillan in 2016. In addition to facilitating LGBT cultural competency trainings, Tim is a frequent speaker at national and international conferences.

References:

  1. In The Care of LGBT Persons in The Long-Term Care Setting", AMDA White Paper

Episode 17: An Approach to UTI Prevention, Management, and Treatment

David A. Nace, MD, MPH, CMD

Dr. Nace is an Associate Professor whose research focuses primarily on infectious disease in long-term care. His interest in antibiotic stewardship is funded by three AHRQ studies: two, for which he serves as co-investigator, are designing and testing a national antimicrobial stewardship toolkit for nursing facilities; the third, for which he serves as PI, will update guidelines for urinary tract infection (UTI) management and then implement a program to improve its management in 40 nursing homes in four states.

 

 

References:

  1. Dr. Theresa Rowe, 2018 NHSN LTCF Training - Epidemiology and Prevention of UTI
  2. Cohen CC, Choi YJ, Stone PW., Costs of Infection Prevention Practices in Long-Term Care Settings: A Systematic Review., Nursing Economics, 2016
  3. Dr. David A. Nace, et. al. The Improving Outcomes of UTI Management in Long-Term Care..., JAMDA, 2018

Episode 16: Opioids and Pain Management in PALTC

Jeffrey Nichols, MD, CMD

Dr. Jeffrey Nichols, CMD, is Chief Medical Officer of the Gouverneur Skilled Nursing Facility, a division of New York City Health + Hospitals. Dr. Nichols teaches both Geriatrics and Palliative Care fellows and is an Associate Professor at the NYU Langone Medical School as well as the Icahn Mount Sinai School of Medicine. Dr. Nichols is Board Certified in Hospice and Palliative Care as well as Geriatrics. A long time AMDA leader, he currently serves as AMDA's Treasurer and Finance Committee Chair and writes the Dear Dr. Jeff column for Caring for the Ages.

 

References:

  1. M C Reid, et al. "Pain Management in Long-Term Care Communities: A Quality Improvement Initiative”, Annals of Long Term Care, 2015
  2. Laura B. Farless, MD; Christine S. Ritchie, MD, MSPH / ”Challenges of Pain Management in Long-Term Care”, Annals of Long Term Care, 2012
  3. Brat, GA, et al, “Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study”, British Medical Journal, 2018
  4. “Aging and Addicted”: The Opioid Epidemic Affects Older Adults, Too”, Kaiser Health News, 2016
  5. CMS Roadmap to Address the Opioid Epidemic, CMS.gov, June, 2018

Episode 15: Optimistic Project

Kathleen Unroe, MD, MHA

Research Scientist, Regenstrief Institute
Assistant Professor of Medicine, Indiana University School of Medicine
Center Scientist, Indiana University Center for Aging Research
Dr. Unroe is focused on health policy relevant research in long term care, including the use of palliative care and hospice in this setting, transitions of care, quality of medical care in nursing homes, and staffing models in long term care. She is co-PI of the Optimistic model project

References:

  1. Unroe KT, Nazir A, Holtz LR et al. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care approach: preliminary data from the implementation of a Centers for Medicare and Medicaid Services nursing facility demonstration project. J Am Geriatr Soc 2015;63:165-169.
  2. Hickman, S. E., Unroe, K. T., Ersek, M. T., Buente, B., Nazir, A., & Sachs, G. A. (2016). An Interim Analysis of an Advance Care Planning Intervention in the Nursing Home Setting. Journal of the American Geriatrics Society, 64(11), 2385–2392.
  3. Unroe, et. al., “Improving Nursing Facility Care Through an Innovative Payment Demonstration Project: Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care Phase 2”, Journal of the American Geriatrics Association, 2018

 

 

Episode 14: Management of LTC Residents with Diabetes

Naushira Pandya, MD, CMD

Dr. Pandya is board certified in internal Medicine, Geriatrics, and Endocrinology. She is also a certified medical director of long-term care facilities, and a recognized authority in diabetes management in the elderly. In addition, she oversees the training of medical students, residents and fellows in Geriatrics, and is a research mentor students, residents and faculty. She has over 20 publications and is a national and international speaker. Dr.Pandya has held several state and national leadership positions, including the presidency of AMDA, Society for Post-Acute and Long-Term Care Medicine. She holds the distinction of being a Fulbright Senior Specialist Scholar in Geriatrics in Slovakia in 2009. 

 

References:

  1. Centers for Disease Control Diabetes Data, cdc.org
  2. Munshi, M., et. al., Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association, Diabetes Care 2016 Feb; 39(2): 308-318.
  3. Haas, Linda, Special Considerations for Older Adults With Diabetes Residing in Skilled Nursing Facilities, Diabetes Spectrum 2014 Feb; 27 (1): 37
  4. McKnight’s Long Term Care News, August 5, 2015, profile on Naushira Pandya MD
  5. Pandya N, et. al., Optimizing insulin delivery for patients with diabetes, Geriatric Nursing, 2018, 39:138

 

Episode 13: Through the Eyes of an Administrator

Richard Bane

 

“The world of long-term care is changing very quickly,” says Richard Bane, president of BaneCare Management. "We are not what people typically associate with a nursing home". This episode looks at the past, present, and future of Skilled Nursing Facilities through the eyes of an administrator with 35 years of experience.

 

References:

  1. Code of Federal Regulations on Administration:  42 CFR 483.7, cms.gov
  2. Code of Massachusetts regulations on Administration: 105 CMR 150, mass.gov
  3. McKnights Long Term Care News, August, 2018–5 Star ratings and readmissions
  4. “The Five-Star Rating System for Skilled Nursing: Perceptions and Effects”, www.lancasterpollard.com, June 10, 2017
  5. “Skilled Nursing Facility Star Rating, Patient Outcomes, and Readmission Risk After Total Joint Arthroplasty”, Journal of Arthroplasty, June, 2018
  6. American Health Care Association, ‘Quality Initiatives’, www.ahcancal.org

 

Episode 12: Management of Sepsis

Dr. Bernardo Reyes Fernandez

Bernardo Reyes, MD., is a board-certified internist and geriatrician, he serves as Assistant Director of the Internal Medicine Residency Program and Associate Director of the Geriatric and Palliative Rotations and Assistant Professor of Clinical Biomedical Science in the Charles E. Schmidt College of Medicine at Florida Atlantic University (FAU).

 

 

References:

  1. Fernandez, "Early Identification and Management of Sepsis", JAMDA, June 2018
  2. Sloane, P, et al, “Can sepsis be detected in the Nursing Home Prior to the Need for Hospital Transfer?”, JAMDA, June, 2018
  3. Dantes R and Epstein L, “Combatting Sepsis: A Public Health Perspective”, Clinical Infectious Diseases, May, 2018

Episode 11:  Predictive Models of Care

   Dr. Robert Burke, MD, MS, FHM

 

Dr. Burke is the first Director of Research for the Hospital Medicine Section at the University of Pennsylvania and an Assistant Professor of Medicine at the Perelman School of Medicine. Dr. Burke's research seeks to improve the outcomes associated with transitions from the hospital to post-acute care in vulnerable populations. 

References:

  1. Burke et. al., "Predicting Potential Adverse Events During a Skilled Nursing Facility Stay: A Skilled Nursing Facility Prognosis Score" JAGS, 2018
  2. Jencks, M.D., M.P.H., Williams, M.D., and Coleman, M.D., M.P.H., "Rehospitalizations among Patients in the Medicare Fee-for-Service Program" NEJM, April 2009
  3. Burke et. al., "Hospital Readmission From Post-Acute Care Facilities: Risk Factors, Timing, and Outcomes", JAMDA, March 2016

 

Episode 10: Innovations

   Dr. Steven Buslovich and Adam Sobol

 

Dr. Steven Buslovich is Geriatrician and Medical Director for several post-acute/LTC facilities in Western NY and co-founder, CEO of Patient Pattern. Also, on faculty at University of Buffalo, School of Medicine. 

 

 

Adam Sobol is founder and CEO of CareBand, an innovative, patent-pending wearable technology for senior citizens that are experiencing a decline in their mental and physical health. CareBand aims to increase the safety and independence of senior citizens giving caregivers and family members peace of mind.

 

 

 Episode 9: Core Competencies

   Paul Katz, MD, CMD

 

Dr. Katz is Professor of Medicine and Director of the Department of Geriatric Medicine, Florida State University, and a Past President of the American Medical Director's Association. He is the lead physician of the Working Committee of the Seniors Quality Leap Initiative, representing Baycrest Centre for Geriatric Care.

 

References:

  1. Katz, “A Call to Action” JAMDA, 2010
  2. Katz and Pfell, “Nursing home physicians and the credibility gap”, JAMDA, 2012
  3. Katz, et. al., “Examining the rationale and processes behind the development of AMDA’s competencies for post-acute and long-term care", Annals of Long Term Care, 2014

 

 Episode 8: Public Policy

   Dr. Karl Steinberg, MD, CMD, HMDC

Dr. Karl Steinberg currently chairs AMDA's Public Policy Committee, serves on the AAHPM's Public Policy Committee, and is also immediate past chair of the Coalition for Compassionate Care of California. Dr. Steinberg has worked as a geriatrician, family physician and hospice physician in San Diego County since 1992. He is a Past President and current President-Elect of the California Association of Long Term Care Medicine (CALTCM), which is the state chapter of AMDA--The Society for Post-Acute and Long-Term Care Medicine (formerly the American Medical Directors Association). He also is editor-in-chief of AMDA's periodical, Caring for the Ages.

References:

  1. “Why Health Care Policy is so Hard”, New York Times, 7/28/17
  2. “The future of US health care”, RAND Health, 2017
  3. "Nursing home reform act of 2017"

Episode 7: Frailty

  Philip D. Sloane, MD, MPH

Dr. Sloane is the Elizabeth and Oscar Goodwin Distinguished Professor of Family Medicine at the University of North Carolina at Chapel Hill. Recently selected as Co-Editor in Chief of JAMDA, Dr. Sloane has authored over 200 peer-reviewed publications and co-authored two popular text books.
He is particularly noted for his work around the management of behavioral symptoms in Alzheimer’s disease, for which he received the prestigious Pioneer Award from the US Alzheimer’s Association. An advocate for change and improvement in primary care medical practice, he founded the North Carolina Family Medicine Research Network and the North Carolina Network Consortium, which conduct research statewide.

References:

  1. Philip Sloane, MD, MPH; Matteo Cesari, MD, PHD "Research on Frailty: Continued Progress, Continued Challenges" JAMDA, 2018
  2. Philip Sloan et. al., "Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial" The Amereican Journal of Medicine, 2015
  3. Llibre Rodriguez et. al. "The Prevalence and Correlates of Frailty in Urban and Rural Populations in Latin America, China, and India: A 10/66 Population-Based Survey"JAMDA, 2018
  4. Liu et. al., "Joint Trajectories of Cognition and Frailty and Associated Burden of Patient-Reported Outcomes"JAMDA, 2018
  5. Alegre et. al. "An Easy Assessment of Frailty at Baseline Independently Predicts Prognosis in Very Elderly Patients With Acute Coronary Syndromes" JAMDA, 2018
  6. Ntanasi et. al. "Adherence to Mediterranean Diet and Frailty", JAMDA, 2018
  7. Fried, et. al., "Frailty in older adults: evidence for a phenotype", Journal of Gerontology, 2001
  8. Jones, et. al., "Evaluation of a Frailty Index based on a comprehensive geriatric assessment in a population based study of elderly Canadians", Aging Clinical and Experimental Research, 2005
  9. Rockwood, et. al., "A Global Clinical Measure of Fitness and Frailty in Elderly People", CMAJ, 2005

 

Episode 6: Telemedicine

Thomas Edmondson, MD, CMD

Tom Edmondson, MD, CMD, AGSF, FACP, is a native Texan who graduated from the University of Texas Medical School at Houston, and he completed his residency training in internal medicine at the University of Texas Southwestern Medical Center and Parkland Memorial Hospital.

 

 

Suzanne Gillespie, MD, RD, CMD

Suzanne Gillespie MD, RD, CMD, is Associate Professor of Medicine in the Division of Geriatrics/Aging and Associate Professor of Emergency Medicine at the University of Rochester School of Medicine and Dentistry. She is board-certified in Internal Medicine, Geriatric Medicine and Hospice & Palliative Medicine.

 

 

 

Murthy Gokula, MD, CMD

Murthy Gokula, MD, CMD, is CEO of STAYHOME IWILL PC and Clinical Associate Professor of Family Medicine at the University of Toledo, College of Medicine. He teaches medical students, residents and fellows in the long term care setting. Dr. Gokula is the current president of Ohio Medical Directors Association (OMDA), former board member of OMDA, former program director of Geriatrics Fellowship Program at University of Toledo. He serves on the editorial board for Journal of American Medical Directors Association (JAMDA).

 

 

Steven Handler, MD, PhD, CMD

Steven Handler, MD, PhD, CMD, is an Associate Professor with a primary appointment in the Division of Geriatric Medicine, where he serves as the Director of Geriatric Telemedicine Programs. He has secondary appointments in the Department of Biomedical Informatics, and Clinical and Translational Research.

 

 

 

 

Episode 5: Deprescribing

  Kamal Wagle, MD, MPH, CMD; Dheeraj Mahajan, MD, CMD; John Derr, RPh

References:

  1. Papanicolas, et. al., “Health care spending in the United States and other high-income countries”, Special Communication, JAMA, 2018
  2. Ezekiel Emanuel, “The real cost of the US health care system”, Editorial, JAMA, 2018
  3. Monane, et. al., “Optimal medication use in elders. Key to successful aging”, Western Journal of Medicine, 1997
  4. Loganathan, et. al., “Interventions to optimise prescribing in care homes: systematic review”, Age Ageing, 2011

 

Episode 4: Antibiotic Stewardship

  University of Maryland Nurse Practitioner Doctoral candidates: Nadia Khan, MPH, BSN, RN, Lauren Meekins, RN, and Venessa Ohakam, NP

References:

  1. Daneman, et. al., “Variability in antibiotic use across nursing homes and the risk of antibiotic-related adverse outcomes for individual residents”, JAMA Int Med, 2015
  2. “Nursing homes need improved antibiotic stewardship”, News from the Centers for Disease control and prevention, JAMA, 2015
  3. Jump, et. al., “Template for an antibiotic stewardship policy for post-acute and long-term care settings, JAMDA, 2017
  4. Castle, et. al., “Hand hygiene deficiency citations in nursing homes”, Journal of Applied Gerontology, 2012
  5. Harris, et. al., “Appropriate antibiotic use of acute respiratory tract infection in adults: advice for high-value care from the American college of physicians and the centers for disease control and prevention”, Annals of Internal Medicine, 2016

 

Episode 3: Home Based Primary Care

  Suzanne M. Gillespie MD, RD, CMD, FACP, AGSF

References:

  1. Papanicolas, et. al., “Health care spending in the United States and other high-income countries”, Special Communication, JAMA, 2018
  2. Ezekiel Emanuel, “The real cost of the US health care system”, Editorial, JAMA, 2018
  3. Monane, et. al., “Optimal medication use in elders. Key to successful aging”, Western Journal of Medicine, 1997
  4. Loganathan, et. al., “Interventions to optimise prescribing in care homes: systematic review”, Age Ageing, 2011

 

Episode 2: The Prevalence of Burnout Among Nursing Home Physicians

  Arif Nazir, MD, FACP, CMD, AGSF

References:

  1. Schaufeli, et. al., “Burnout: 35 years of research and practice”, Career Development International, 2009
  2. Shanafelt, et. al., “Burnout and Satisfaction with work-life balance among US physicians relative to the general US population”, Archives of Internal Medicine, 2012
  3. Nazir, et. al., “The prevalence of burnout among nursing home physicians: an international perspective”, JAMDA, January 2018
  4. Shanafelt, et. al., “addressing physician burnout—the way forward”, Viewpoint in JAMA, March, 2017

 

Episode 1: Effects of Legal Access to Cannabis on Scheduled II-V Drug Prescriptions

  Cari Levy, MD, PhD, CMD

References:

  1. Stith, et. al., “Effects of legal access to cannabis on Scheduled II-V Drug prescriptions”, JAMDA, January, 2018

*An AMDA Innovation Project

AMDA-on-the-Go Editorial Board

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