ANNUAL CONFERENCE 2018

This session will highlight diagnostic challenges faced by providers when managing common infections (pneumonia, urinary tract infections and Clostridium difficile infections) in PA/LTC facilities, along with providing treatment updates. In addition, speakers will discuss strategies for prevention and early recognition of these infections. The audience will have the opportunity to seek answers for practical questions that they come across in their daily practice while managing common infections. This session will combine short presentations with interactive role-play session, small group case-based discussions, and an interactive panel discussion towards the end of the workshop.

Learning Objectives:
(1) Describe various clinical presentations of pneumonia, UTI and CDI in PA/LTC setting.
(2) Discuss the diagnostic challenges for pneumonia, UTI and CDI and the limitations of the available tests.
(3) Demonstrate practical steps that can be taken for prevention and early recognition of the common infections in the PA/LTC facilities.
(4) Review the treatment updates for pneumonia, UTI and CDI.

This popular session, by four experienced speakers from Saint Louis University and the University of North Carolina, will present an intensive session covering current and difficult clinical topic in the care of frail elders in the continuum of care. Topics will reflect best recent medical evidence, evidence-based guidelines, and current health care best practices.

Learning Objectives:
(1) Consider a multi-faceted approach to manage lower extremity mobility and polysubstance abuse in PA/LTC.
(2) Discuss treatment options for epilepsy and hepatitis management in PA/LTC.
(3) Use guidelines for management of anemia and vaccination in PA/LTC.
(4) Choose appropriate medications for joint pain and osteoporosis in PA/LTC.

Telemedicine is rapidly becoming a standard of care in modern medicine. By increasing access and responsiveness to care, telemedicine can improve clinical outcomes, reduce costs, and increase provider, patient, and family satisfaction. Despite these potential benefits, the technology and the requisite changes that it brings are relatively new in the PA/LTC setting. Many health care providers and leaders have expressed the need to build their knowledge and skills to reap the full potential value of this innovation. This half-day workshop will build attendee’s knowledge and skills in the standards for telemedicine care in PA/LTC through engaging lectures, roundtable interactive examples of telemedicine from PA/LTC settings, and facilitated discussions. Learners will leave with practical skills that are needed to “get started,” to advanced skills such as making the financial case for telemedicine in their PA/LTC system, to ensure that their program has the care processes and technology to accomplish their goals.

Learning Objectives:
(1) Discuss the opportunities to use telemedicine to enhance PA/LTC.
(2) Identify technical and environmental considerations for high quality telemedicine in PA/LTC.
(3) Develop a strategy for establishing telemedicine services in their practice or medical group.

This session will introduce participants to evidence-based, non-pharmacologic interventions that will expand knowledge and competence regarding strategies to address behavioral symptoms in persons with dementia and improve quality of life. Through three presentations, the interactive session will highlight non-pharmacologic interventions appropriate for the LTC setting with specific strategies for implementation of one, Cognitive Stimulation Therapy (CST), into the residential environment. The first presentation focuses on the evidence and options for interprofessional non-pharmacologic interventions with specific attention being devoted to Reminiscence Therapy, Validation Therapy, and Reality Orientation. The second and third presentations will focus on a well-researched non-pharmacologic intervention, Cognitive Stimulation Therapy (CST) which can be delivered by residential staff at multiple levels of clinical training to address behavioral symptoms and issues in persons with dementia.

Learning Objectives:
(1) Discuss the evidence for non-pharmacologic interventions for persons with dementia.
(2) Describe criteria for appropriateness to receive non-pharmacologic interventions for persons with dementia.
(3) Apply knowledge and skills gained to introduce Cognitive Stimulation Therapy within the residential care setting.
(4) Implement strategies for integration and evaluation of Cognitive Stimulation Therapy.

Back by popular demand, AMDA – The Society for Post-Acute and Long-Term Care Medicine (AMDA) will offer the Infection Prevention in Post-Acute and Long-Term Care Certificate Course in 2018. Developed in partnership with the Society for Healthcare Epidemiology of America (SHEA) and the Centers for Disease Control and Prevention (CDC), the course will address aspects of infection control and prevention that are unique to skilled nursing facilities, which must balance a home-like environment while minimizing the risk of infections. The course will review occupational health concerns in PA/LTC including outbreaks that affect both staff and residents, opportunities to improve antimicrobial use and strategies to reduce the transmission of infections, including multi-drug resistant organisms and Clostridium difficile.

Participants who attend this course will earn 10 CME credits and a certificate in Infection Prevention in Post-Acute and Long-Term Care. Certificates will be sent electrically to participants within three weeks of course completion. Participants must attend the course in its entirety to earn a certificate. Please be sure to scan your name badge at the beginning of each concurrent session time slot to verify your attendance. If you have questions or would like additional information, please contact AMDA’s education department at education@paltc.org.

Learning Objectives:
(1) Describe surveillance definitions and recognize differences in applying them in the PA/LTC settings.
(2) Identify opportunities for infection prevention, including those caused by multi-drug resistant organisms, in the PA/LTC settings.
(3) Discuss recognition and response to common outbreaks in the PA/LTC settings.
(4) Apply principles of occupational health and safety to healthcare workers and staff in the PA/LTC settings.
(5) Recognize the need for and opportunities to practice antimicrobial stewardship in the PA/LTC settings.

This session will review the components of the Serious Illness Program, an evidence-based, patient tested, structured approach to serious illness conversation. Participants will practice using the serious illness conversation guide and will receive feedback and advice for implementing the technique in patient care.

Learning Objectives:
(1) Recognize the need for a systematic evidence-based approach to discussing goals and values with seriously ill patients.
(2) Describe the seven steps of the Serious Illness Conversation.
(3) Demonstrate use of the Serious Illness Communication Guide to elicit preferences and patient goals of care.
(4) Provide feedback related to observed skills/techniques that facilitate exploratory conversations with patients and family members.

This interactive, case-based session will engage participants in problem solving commonly reported electrolyte abnormalities encountered in LTC. The cornerstones of understanding altered physiology, astute clinical assessment, and application of logical diagnostic and therapeutic strategies will be highlighted.

Learning Objectives:
(1) Interpret the BMP accurately, Diagnose and manage hyponatremia and hypernatremia.
(2) Identify causes work up and treatment of hyperkalemia and hypokalemia and acid base imbalance.
(3) Describe the differential diagnosis of hypercalcemia and hypocalcemia and appropriate management.

Apathy is a common disorder, but can be easily overlooked. Treatment requires multidisciplinary approaches based on the understanding of apathy from the biomedical, psychological, and socio environmental aspects. This session reviews the definition of apathy, its effects, physiological implications, and approaches used to detect, treat, and manage elderly patients experiencing apathy in LTC facilities. The goal of this session is to increase the recognition of apathy and enhance the role and functions of the interdisciplinary team caring for patients dealing with apathy in LTC facilities.

Learning Objectives:
(1) Define, and discuss the diagnostic criteria and effects of Apathy on patients in LTC facilities.
(2) Describe the physiological implications of Apathy: Differential Diagnosis, Frontotemporal Dementia and Apathy.
(3) Discuss approaches and demonstrate the use of screening tools used to detect, treat and manage patients experiencing apathy in LTC facilities.
(4) Demonstrate strategies to foster effective communication, role and functions of the interdisciplinary team, patients, families and caregivers.

If a picture is worth 1,000 words and video shoots at 30 frames per second, every second of video is worth 30,000 words and a whole minute of video could be worth 1.8 million words. Regardless of the metrics, videos are an excellent tool for showing some of the many highly variable presentations of common issues associated with Parkinson's, especially motor manifestations such as tremor, bradykinesia and freezing of gait. During this session, the presenters will make extensive use of video to highlight presentations of common phenomena associated with Parkinson's over the course of the disease. When available, videos will demonstrate similar phenomena at early and later stages to help illuminate how common symptoms such as tremor and gait deficits change over time. Additional video will demonstrate possible compensatory approaches for difficult to treat issues such as freezing of gait and swallowing issues as well as the significant gains that can be achieved by the simple speech and physical therapy approaches to many issues. All topics, however, will be accompanied by a discussion of both pharmacological and nonpharmacological treatment approaches.

Learning Objectives:
(1) Recognize key components of primary motor symptoms of Parkinson's, tremor, rigidity, akinesia/bradykinesia and postural instability.
(2) Highlight potential complications of dopaminergic therapy, including dyskinesias, motor fluctuations and off-period symptomatology.
(3) Implement strategies to address freezing of gait.
(4) Identify manifestations of voice and swallowing issues associated with Parkinson's and possible treatment approaches.

Back by popular demand, AMDA – The Society for Post-Acute and Long-Term Care Medicine (AMDA) will offer the Infection Prevention in Post-Acute and Long-Term Care Certificate Course in 2018. Developed in partnership with the Society for Healthcare Epidemiology of America (SHEA) and the Centers for Disease Control and Prevention (CDC), the course will address aspects of infection control and prevention that are unique to skilled nursing facilities, which must balance a home-like environment while minimizing the risk of infections. The course will review occupational health concerns in PA/LTC including outbreaks that affect both staff and residents, opportunities to improve antimicrobial use and strategies to reduce the transmission of infections, including multi-drug resistant organisms and Clostridium difficile.

Participants who attend this course will earn 10 CME credits and a certificate in Infection Prevention in Post-Acute and Long-Term Care. Certificates will be sent electrically to participants within three weeks of course completion. Participants must attend the course in its entirety to earn a certificate. Please be sure to scan your name badge at the beginning of each concurrent session time slot to verify your attendance. If you have questions or would like additional information, please contact AMDA’s education department at education@paltc.org.

Learning Objectives:
(1) Describe surveillance definitions and recognize differences in applying them in the PA/LTC settings.
(2) Identify opportunities for infection prevention, including those caused by multi-drug resistant organisms, in the PA/LTC settings.
(3) Discuss recognition and response to common outbreaks in the PA/LTC settings.
(4) Apply principles of occupational health and safety to healthcare workers and staff in the PA/LTC settings.
(5) Recognize the need for and opportunities to practice antimicrobial stewardship in the PA/LTC settings.

This session provides a review and update of legal issues of special importance to PA/LTC medicine providers participating in Medicare and Medicaid. The speakers will discuss key legal issues and concepts, and will guide the participants to develop and practice an approach to evaluating cases as part of ongoing quality assurance and compliance activities. This session will focus on the issues of medical necessity, false claims, and worthless care. The history and philosophy of these concepts and their application to PA/LTC settings will be discussed, along with illustrative cases, which participants will evaluate together.

Learning Objectives:
(1) Review the concepts of 'medical necessity', 'false claims', and 'worthless care', and their relationship to quality of care.
(2) Apply the concepts of “medical necessity”, “false claims”, and “worthless care”, and their relationship to quality of care to specific case examples to evaluate medical necessity and quality of care in individual cases.
(3) Describe the processes by which CMS and other government-related entities evaluate 'medical necessity', potentially 'false claims', and potentially 'worthless care' in PA/LTC settings, what SNFs and other providers do in response, and develop strategies for how PA/LTC practitioners and Medical Directors may be asked to participate productively in these processes to provide clinical insight and interpretation and help to resolve concerns.
(4) Discuss proactive strategies that will empower the physician/Medical Director to provide quality care to the patients at the SNF, assist the facility to be successful in the current increasingly challenging health care environment and assist the facility team to avoid – and successfully to refute if/when necessary – any unfounded allegation from any source of providing “worthless care” or of faling to meet the requirements of medical necessity.

This session will demonstrate the benefits of integrating the National PACE Association (NPA) model practices in discussion of goals of care in LTC facilities. The three presenters will discuss how the NPA model practice was developed and the synergies that these model practices bring to LTC facilities. The presenters will also detail the “nuts and bolts” in implementing these goals of care discussion including approaches to staffing, training, care coordination, as well as with challenges and opportunities. This session will provide an opportunity for attendees to explore with presenters the details of the program and identify elements applicable to their own programs.

Learning Objectives:
(1) Describe a process to identify goals of care utilizing the National PACE Association Model Practice and how they may be utilized for advanced care planning.
(2) Explain how integrating goals of care discussion increases the quality of care of all residents in nursing home.
(3) Describe the fundamentals of shared decision making in the application of person-centered care.
(4) Utilize effective communication with patients, staff, families and caregivers.

This session will provide an update on the current practice guidelines and recommendations for delivery of wound care in the post-acute setting. Various etiologies, assessment, and treatments will be discussed. Additionally, information on the development of a wound care team and establishing a center of excellence in wound management will be addressed.

Learning Objectives:
(1) Understand various wound types and classifications.
(2) Recognize the importance of correct etiology identification.
(3) Identify various roles of the wound care team.

Back by popular demand, AMDA – The Society for Post-Acute and Long-Term Care Medicine (AMDA) will offer the Infection Prevention in Post-Acute and Long-Term Care Certificate Course in 2018. Developed in partnership with the Society for Healthcare Epidemiology of America (SHEA) and the Centers for Disease Control and Prevention (CDC), the course will address aspects of infection control and prevention that are unique to skilled nursing facilities, which must balance a home-like environment while minimizing the risk of infections. The course will review occupational health concerns in PA/LTC including outbreaks that affect both staff and residents, opportunities to improve antimicrobial use and strategies to reduce the transmission of infections, including multi-drug resistant organisms and Clostridium difficile.

Participants who attend this course will earn 10 CME credits and a certificate in Infection Prevention in Post-Acute and Long-Term Care. Certificates will be sent electrically to participants within three weeks of course completion. Participants must attend the course in its entirety to earn a certificate. Please be sure to scan your name badge at the beginning of each concurrent session time slot to verify your attendance. If you have questions or would like additional information, please contact AMDA’s education department at education@paltc.org.

Learning Objectives:
(1) Describe surveillance definitions and recognize differences in applying them in the PA/LTC settings.
(2) Identify opportunities for infection prevention, including those caused by multi-drug resistant organisms, in the PA/LTC settings.
(3) Discuss recognition and response to common outbreaks in the PA/LTC settings.
(4) Apply principles of occupational health and safety to healthcare workers and staff in the PA/LTC settings.
(5) Recognize the need for and opportunities to practice antimicrobial stewardship in the PA/LTC settings.

This session will address the presentation of sepsis in older adults, early recognition of sepsis in PA/LTC residents and realistic expectations for managing sepsis based on the staff, training, and resources available in most PA/LTC settings.

Learning Objectives:
(1) Describe the clinical presentation of sepsis in older adult.
(2) Discuss initial assessment and management of an older adult with possible sepsis.
(3) Recognize the risks and benefits of attempting to manage sepsis in the PA/LTC setting.

In this session, we present 8-15 articles published in the past year which have the potential to impact the practice of medicine and the processes of care for frail elders in the continuum of care. All articles are chosen through a Modified-Delphi approach and critically appraised by experienced, multidisciplinary practitioners and educators. This presentation has been well-received each year and is often the site of spirited discussion.

Learning Objectives:
(1) Consider changes in your practice based on recent publications.
(2) Identify publications that are controversial and/or may affect the direction of research.
(3) Describe techniques for critiquing publications.

This session, presented by an attorney, bioethicist, and a long time medical director, will detail and reinforce the use of the interprofessional bioethics committee format in skilled nursing facilities, with a specific eye toward promoting resident-centered care and autonomy, and taking into account risk management principles. The session will also review determination of decisional capacity, and includes content on working with incapacitated, unrepresented patients. In addition to didactic content, case presentations and small group discussion will be utilized.

Learning Objectives:
(1) Implement an interprofessional ethics evaluation framework to support resident-centered care decisions in PA/LTC, including the medical director as a vital participant.,
(2) Assess decision-making capacity for nursing home residents with respect to a variety of situations. ,
(3) Apply the principles of bioethics to direct resident-centered care in light of risk management concerns.,
(4) Formulate strategies to improve medical decision-making for incapacitated unbefriended (unrepresented) nursing home residents.

This session will provide attendees with an in-depth understanding of the issues affecting the care of patients with heart failure in skilled nursing facilities (SNFs). It is intended to provide attendees with expert insight into improving quality of care provided to this complex subset of patients. The speakers will review the clinical factors contributing to poor outcomes among these patients, provide insight into optimizing the medical management, and developing algorithms of care for these patients within their goals of care and expected discharge status, and discuss the indications, importance, and emerging use of palliative care and hospice consultation to patients with advanced/end stage heart failure.

Learning Objectives:
(1) Describe the SNF patient with CVD as a distinct high-risk patient with significantly increased morbidity, mortality, and risk for hospital readmission, and the importance of providing high quality care to these patients in the current regulatory environment.
(2) Discuss principles of cardiovascular disease management within the context of multimorbidity and goal directed patient care in the skilled nursing facility setting.
(3) Explain the need and methods for developing algorithms of care for complex heart failure patients in the SNF setting to improve patient outcomes, quality, and value of care.
(4) Discuss the importance of utilizing palliative care in patients with advanced heart failure in the SNF setting.
(5) Review the principles guiding patient selection for palliative care consultation, and medical management for refractory symptoms related to cardiovascular disease.

This session will review a paradigm for treating two separate groups of people living in the PA/LTC setting. The session will focus on how to maintain stability for those who live with chronic mental illness who now live long enough to age into multiple comorbidities. There may be a history of homelessness, substance abuse, and intermittent institutionalization. Next, Maureen Nash, MD, MS, will review an evidence-based approach to managing dementia with behavior disturbance with an emphasis on treating aggression and sexual disinhibition.

Maureen Nash, MD, MS, is the medical director of the Providence ElderPlace Oregon Program of All-inclusive Care for the Elderly (PACE). As the medical director, she has increased the integration of behavioral health in the primary care clinics of the ElderPlace Oregon health care system, improving the quality of care while decreasing inappropriate utilization of health care services for dual eligible frail older adults. Prior to that she was the medical director of two different geriatric psychiatry inpatient units, one in upstate New York and one in Oregon. She is Board Certified in Internal Medicine and Psychiatry and is active in the American Association for Geriatric Psychiatry and the American Psychiatric Association Council on Geriatric Psychiatry. Dr. Nash is an affiliate assistant professor in psychiatry at Oregon Health and Sciences University School of Medicine.

Learning Objectives:
(1) Describe three reasons why those with chronic mental illness are likely to end up living in long-term care settings.
(2) Discuss the risks and benefits of behavioral and nonpharmacological interventions as part of the overall approach to working with people who have chronic mental illness.
(3) Explain an evidence based approach to considering risks and benefits of pharmacological interventions.
(4) Use an evidence based algorithm for treating those with behavior disturbance in the context of moderate to severe dementia.
(5) Discuss the evidence for treating sexual disinhibition and differentiate that from intimacy seeking behaviors.

There is an additional fee to participate in this session and pre-registration is required. Breakfast will be provided and will be served from 6:00 AM - 6:30 AM. The presentation will start promptly at 6:30 AM. To ensure an optimal learning experience, space is limited. Be sure to sign up as soon as possible by checking the session on the conference registration form.

Registration Fee:
Early Bird (11/1/17 - 1/17/18): $65
Regular (1/18/18 - 2/28/18): $75
Late/On-Site (3/1/8 - 3/21/18): $85

In this session, participants will learn a practical approach to addressing the concerns that arise for families and staff members when a person with a dementia diagnoses stops eating or develops dysphagia. The presentation emphasizes an approach that alleviates guilt and grief of the caretakers, makes sense of the natural process occurring and allows informed decision making on options of alternate nutrition.

Learning Objectives:
(1) Review the science of aging/dementia and anorexia.
(2) List the stepwise progression of anorexia that occurs in dementia diagnoses in a manner that makes sense.
(3) Use communication techniques that alleviates guilt of caregivers.
(4) Allow informed decision making in regards to potential alternate nutritional methods.

This session will address problems associated with polypharmacy in PA/LTC setting and provide strategies to address these problems. The speakers will offer practical tools that can be helpful in deprescribing in the PA/LTC setting.

Learning Objectives:
(1) Discuss current evidence from deprescribing interventions in PA/LTC.
(2) Explain how to overcome barriers to deprescribing in PA/LTC setting.
(3) Explore deprescribing strategies for antipsychotics and opiates in PA/LTC setting.
(4) Describe how to engage interprofessional team members in addressing deprescription in PA/LTC setting.

This session will provide a clinical introduction to caring for adults with intellectual and developmental disabilities in PA/LTC settings, based on literature review and the presenter's 25 years of experience as a clinician, medical educator, and researcher in developmental disabilities medicine. The content material presented will be applied to four case scenarios which exemplify the breadth and complexity of health care in this population. Participants will develop and share proposals for a quality improvement initiative aiming to improve care of this population, tailored to the facilities where they practice.

Learning Objectives:
(1) Describe how the etiologic diagnosis for the developmental disability guides clinical care of this population.
(2) Apply a literature-based, culturally- sensitive model of health care to persons with IDD in PA/LTC.
(3) Outline key elements of a quality improvement initiative addressing the health care for persons with IDD in facilities where they practice.

This session will describe the current functional and physical activity of assisted living (AL) residents and the importance of addressing function and activity among these individuals to prevent further decline. A theoretically based, practical approach using a four-step process will be shared as a way to implement a function focused care approach into any AL setting. The steps include: (1) Assessment of the environment and policies; (2) education of staff; (3) development of appropriate service plans based on resident capability; and (4) mentoring and motivating. Exemplars will be shared as well from real world implementation activities. Participants will receive the necessary tools and techniques to implement a function focused care approach into their settings as well as the ways in which to over the barriers commonly encountered.

Learning Objectives:
(1) Describe the current functional status of older adults in AL settings.
(2) Define Function Focused Care and provide examples of this type of care.
(3) State the four steps to implementing Function Focused Care in AL environments.
(4) Describe three challenges and the ways to overcome those challenges and successfully implement Function Focused Care in AL settings.

This session will explain how PA/LTC nurses, providers, and administrators can partner with receiving emergency departments (EDs) to improve the transitions between their sites, enhance resident safety in the ED, and reduce potentially avoidable hospitalizations.

Learning Objectives:
(1) Design a program to enhance collaboration with the emergency department.
(2) Evaluate their site's PA/LTC to ED transition process and identify areas of improvement.
(3) Explain the unique challenges of treating PA/LTC residents in the emergency department.
(4) Discuss the Geriatric ED Guidelines as they relate to the PA/LTC to ED transition.

People with dementia lose expressive and receptive language ability and become verbally disabled over time. Clinicians and caregivers rely heavily on language and open-ended questions to connect with patients, assess their needs, and intervene. Without intact language skills, people with dementia have difficulty connecting with others and making their needs known. This session will introduce curricula developed to teach learners from multiple disciplines how to connect, develop a relationship, and communicate with people who have dementia using both verbal and nonverbal skills. These skills are useful in the office, hospital, and PA/LTC setting. And they could potentially help clinicians (from physicians and therapists to CNAs) coach and counsel families about 1) what to expect, 2) how to avoid, and 3) how to respond to challenging situations in dementia care. The speakers will present a brief overview of our curricula and role play learner-coach interactions and skill assessment in this interactive session.

Learning Objectives:
(1) Describe how to connect and develop a relationship with a cognitive-impaired older adult.
(2) Evaluate an individual’s ability to connect and develop a relationship with a cognitively-impaired older adult.
(3) Identify a need or opportunity to develop a dementia care conversations curriculum in their home institutions.

This session will discuss the epidemiology, classification, risk factors, and pathophysiology of urinary incontinence (UI) and fecal incontinence (FI) in persons living in the PA/LTC environment. The talk will cover evidence-based recommendations for assessment, treatment, and management of these conditions within the framework of patient-centered goals of care in PA/LTC. Pharmacologic and non-pharmacologic treatment strategies will be reviewed. Psychosocial implications of UI and FI and the importance of patient-provider communication will be highlighted. Interactive case-based scenarios will be utilized. Innovative and emerging treatment techniques such as tibial neuromodulation and a patient-learning community research project will also be presented. < br />
Learning Objectives:
(1) Describe the epidemiology, risk factors, classification, and pathophysiology of urinary and fecal incontinence in the PA/LTC environment.
(2) Discuss evidence-based recommendations for the assessment of urinary and fecal incontinence in the context of patient-centered care in PA/LTC.
(3) List pharmacologic and non-pharmacologic treatment strategies for urinary and fecal incontinence in older adults in the PA/LTC continuum.
(4) Describe patient-oriented goals of care for the interprofessional management and improvement of quality of life for persons with urinary and fecal incontinence in PA/LTC.

This breakfast panel is an opportunity for attendees to engage leaders in medical direction in a dialogue on best practices. The focus of this panel is on geriatric clinical care and management from a clinical perspective.

Learning Objectives:
(1) Discuss the newest trends and developments in clinical care of the frail elderly.
(2) Implement recommendations for best practices in clinical medicine for the frail elderly.