Pain Management in the Post-acute and Long-Term Care Setting: A Clinical Practice Guideline (CPG) from the Society for Post-acute and Long-Term Care Medicine (AMDA).

This comprehensive clinical guideline addresses pain issues that arise in care of patients commonly seen in post-acute and long-term care settings, including very old and frail individuals with multiple chronic medical and psychiatric conditions, short-stay patients needing posthospitalization care, and younger adults with chronic diseases and disabilities. Its sections proceed along the steps of the clinical process, and hence include pain definition, recognition, and assessment; diagnosis and cause-effect analysis; identification of care objectives; selection of interventions from the wide range or potential options, including a discussion of appropriate and rational use of opioids; and monitoring of the progress and outcomes of management decisions. The guideline emphasizes treating pain in the context of each patient's overall condition and not as a separate issue. It includes discussion of such challenging issues as responsibilities and capabilities of the staff and practitioners, what to do when patients persistently experience high pain levels despite substantial doses of analgesics, and how best to address the expectations of relevant regulations and surveyor guidelines. By including numerous hypertext links within the document, the CPG facilitates finding related information in different sections as well as external references and resources that provide additional support.

Academy of Nutrition and Dietetics: Revised 2018 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Post-Acute and Long-Term Care Nutrition.

In a climate of change, the elevation of post-acute and long-term care (PALTC) services offered through community-based settings has optimized health care delivery. With the population age increasing, there is a growing need for community-based and residential care services, including for older inmates in the prison system. The Dietetics in Health Care Communities Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has updated the Standards of Practice (SOP) and Standards of Professional Performance (SOPP), which describe three levels of practice (competent, proficient, and expert) for registered dietitian nutritionists (RDNs) working in PALTC nutrition. The SOP uses the Nutrition Care Process and clinical workflow elements for care and management of clients/residents in PALTC settings (eg, long-term acute care hospitals, skilled nursing facilities, inpatient rehabilitation facilities, home health agencies, hospice, assisted living facilities, and corrections facilities). The SOPP describes six domains of professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within the SOP and SOPP standards, specific indicators provide measurable action statements that illustrate how the standards apply to practice. The SOP and SOPP are complementary resources for RDNs providing nutrition care and services for individuals receiving PALTC services, or in other PALTC nutrition-related areas, including research. The SOP and SOPP provide RDNs with a self-evaluation guide for assuring competence, identifying knowledge and skills to enhance expertise and advance level of practice in PALTC nutrition.