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Navigating the Road Ahead


Annals of Long-Term Care: Clinical Care and Aging. 2014;22(11):12.


Gregg Warshaw, MD; Medical Editor

The holiday season is upon us once again. In addition to spending time with friends and family, take time to look back on the steps forward that you’ve taken as a long-term care (LTC) professional in the past year. Perhaps you implemented successful quality improvement programming, reduced the incidence of infection at your facility, or simply provided service above-and-beyond to a resident and his or family—whatever your achievements, big or small, let them be a guide to continued success in 2015. This issue of Annals of Long-Term Care: Clinical Care and Aging® (ALTC) offers several articles and resources to prepare you for the challenges ahead. 

There are several important regulatory and practice changes expected to impact LTC providers in 2015. One shift, in particular, is the potential for LTC providers to share in substantial healthcare savings as part of an Accountable Care Organization (ACO). As the competition grows among providers to align with an ACO, those who have a clear understanding of these changes and have established processes for delivering effective, efficient care under these new rules will not only succeed but will be the ones who are sought out as partners. Richard Stefanacci, DO, MGH, CMD, continues his Medicare Update series with an overview of these changes and how they may affect care, quality, and access.

Dr. Stefanacci’s discussion is especially relevant to providers in skilled nursing facilities (SNFs) as they strive to improve care by reducing length of stay and avoidable hospital readmissions. As Arif Nazir, MD, CMD, and colleagues explain in our second feature article, hospital-to-SNF discharge is often a rushed process for patients and families; poor discharge planning and a lack of communication with the patient and family often lead to selection of an SNF that is not well equipped to meet the patient’s individual medical needs. This, in turn, contributes to poor patient outcomes and drives up healthcare costs. In the article, Nazir and colleagues offer evidence- and experience-based strategies for coordinating care through hospital discharge and educating patients and their families about appropriate SNF selection.

Our third feature article discusses the core skill sets that are essential for effective practice. Paul Katz, MD, CMD, and colleagues discuss the rationale for the competencies developed by AMDA – The Society for Post-Acute and Long-Term Care Medicine. Although many studies show that good outcomes are associated with a highly trained nursing staff at facilities with low turnover and good nurse-to-resident ratios, Katz and associates explain how attention is shifting toward improving the quality and continuity of attending physicians in nursing homes, with an emphasis on increasing commitment and improving nurse-to-physician communication and medical staff organization.

In this issue you will also find two clinical handouts that we encourage you to tear out of the journal and share with your staff and colleagues. The first is our Quick Guide to preventing the spread of Clostridium difficile in LTC facilities via conscientious application of infection control guidelines and antibiotic stewardship, an increasingly important goal with the growing concerns of antibiotic resistance. The second Quick Guide introduces our Diabetes Roadmap series with an overview of the safety and efficacy of GLP-1 receptor agonists and a discussion of prescribing considerations in older adults provided by Joshua J. Neumiller, PharmD, CDE. With a plethora of agents that are available to treat type 2 diabetes, we hope that the resources provided in our new Diabetes Roadmap series will help you navigate judicious prescribing in your older adults with diabetes.

We hope that you find the articles and resources included in this month’s issue of ALTC helpful as you prepare for 2015. Please send us your feedback and tell us about the challenges you’re facing in a letter to the editor, which can be e-mailed to Allison Musante, interim managing editor, at

Thank you for reading!

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