It Might Just Be Dehydration

Medicare and Medicaid now tie nursing facility payment to quality. But what counts as “quality” for a frail older adult? Often it’s whatever matters most to that person and their family.Dr. Sally Brooks returns to SNF This. She’s an internist, geriatrician and physician leader with 30 years in post-acute care. We pick up where we left off and look at how CMS quality measures, value-based payment and goals-of-care conversations come together at the bedside.We cover:Why clinicians should think about post-acute and geriatrics: flexible practice, a back-to-basics “virtual black bag,” and the chance to help someone finish life wellThe CMS measures clinicians actually influence: readmissions, infections, long-stay hospitalizations, staff turnover, nursing hours, falls with major injury and antipsychotic useHow a step-by-step acute agitation protocol makes antipsychotics rarely necessaryWhy “do not resuscitate” is the wrong way to start the conversation, and how to explain what hospice addsThe “wind-up clock” explanation of natural death, and why feeding tubes don’t always mean better careA true story about a patient with severe COPD, a courtyard and one last cigarette, and what it taught her about granting wishesIf you’re a medical director, attending, DON or administrator who has to balance quality metrics with what residents actually want, this episode is for you.

Patients are coming to skilled nursing facilities sicker and quicker than ever. That changes what we need from everyone in the building, especially the physicians and clinicians.In this episode of SNF This, we sit down with Dr. Sally Brooks. She’s an internist, geriatrician, trained pharmacist and physician leader with 30 years in post-acute care. We talk about how the clinician’s role in the nursing home has moved from a name on the paperwork to a real seat at the quality-improvement table.We cover:How home deliveries at her hometown pharmacy led her to geriatrics, and why she’s stayedMedical director vs. attending: what each role actually involvesBuilding trust with hospital partners upstream and home health partners downstream. As she puts it, “it’s never about the people, it’s about the process.”Using INTERACT tools like Stop and Watch, plus SBAR, to help nurses catch changes earlyHer weekly 30-minute review of every unplanned ER transfer, which helps her organization cut rehospitalizations as they happen instead of finding out 90 days laterIf you’re a medical director, attending, DON or administrator working to keep residents out of the ER, this one is for you.

In this episode of SNF THIS Chance sits down with Dr. Karl Steinberg — a nursing home, hospice, and home health medical director in San Diego since 1995 and past president of PALTmed, CALTCM, and the National POLST Collaborative — to talk about what actually protects clinicians when a lawsuit comes. They cover why sloppy copy-paste documentation is a plaintiff's best friend, where ambient AI note-writing helps versus where it can hurt, and why keeping communication with families honest and compassionate — not clinically distant — may be the single most effective liability protection in long-term care.

In this episode of SNF THIS Chance talks with Dr. Noah Marco, Chief Medical Officer at Los Angeles Jewish Health and incoming president of CALTCM, about a career path almost no one plans for as a kid — and why he's stuck with long-term care for 38 years. Dr. Marco traces his family history (his parents were Holocaust survivors) to his lifelong pull toward advocacy, tells the surprisingly personal story behind why California's POLST form is pink, and lays out simple, concrete first steps for any clinician who wants a voice in policy but doesn't know where to start.

*This episode was recorded live at PALTC 26 in Anaheim CAWhat does it really look like to run a skilled nursing facility? In this episode of SNF This, a VitalCare podcast, host Chance welcomes Dena Muraski — a long-term care administrator who stumbled into this industry by chance and never looked back. Dena takes us inside the world of LTC administration: the unpredictability of every single day, the weight of regulatory surveys, and the very real tension between advocating for patient choice and navigating a compliance environment that keeps getting more stringent. She digs into how CMS star ratings work, how a single survey can ripple through a facility's finances, reputation, and ability to stay open — and why even well-intentioned regulations can sometimes get in the way of the care patients actually want. But Dena also speaks to the profound privilege of the role: the chance to shape culture, impact not just patients but the people who care for them, and show up every day to a job that is anything but routine. If you've ever wanted to understand what administrators are actually dealing with — this conversation is essential listening. 🎧 Subscribe to SNF This wherever you listen to podcasts. #SNFThis #VitalCare #LongTermCare #SNFAdministrator #PostAcuteCare #CMS #SurveyReadiness #SkilledNursing #PALTMED #HealthcareLeadership 

*This episode was recorded live at PALTC 26 in Anaheim CAWhat does it actually take to keep a skilled nursing facility running — and who's responsible for what? In this episode of SNF This, a VitalCare podcast, host Chance sits down with nurse practitioner Adair Moore, whose group partners with VitalCare across Oregon and Washington, for a candid conversation about the often-misunderstood layers of the post-acute care world. Adair breaks down the distinct roles of facility owners, operators, medical directors, and APPs — and why understanding that ecosystem is critical for anyone working in or with SNFs. She talks about the day-to-day reality of being a provider in long-term care: the flexibility that draws people in, the overnight call dynamics that keep you humble, and why treating nurses with kindness at 3 a.m. matters more than you think. The conversation also touches on AI and technology in LTC, what it really takes to recruit and retain physicians in this space, and why company culture is the secret weapon for employee retention. If you've ever wondered how the pieces of a SNF fit together — and how to thrive inside that system — this one is for you. 🎧 Subscribe to SNF This wherever you listen to podcasts. #SNFThis #VitalCare #SkilledNursingFacility #PostAcuteCare #LongTermCare #PALTMED #MedicalDirector #NursePractitioner #HealthcareLeadership #SNF 

*This episode was recorded live at PALTC 26 in Anaheim CAIn this episode of SNF This, Dr. Eileen Gonzalez joins us for a thoughtful, clinically grounded conversation about what it really means to treat pain in the elderly — and why the answer is rarely found at the bottom of a prescription pad.Dr. Gonzalez walks us through the importance of truly listening to patients — because pain is not just a symptom to be suppressed, it is a signal that something deeper may be going on. She makes a compelling case for adjunctive approaches, from physical and occupational therapy to mindfulness and non-pharmacological interventions, and explains how these tools can work alongside — or even in place of — medication to address the root cause rather than just the complaint.She also tackles one of the most critical and often overlooked dimensions of pain management in older adults: side effects. What works in a 40-year-old can be dangerous in an 80-year-old, and Dr. Gonzalez lays out a clear, stepwise approach to treatment that starts conservative, honors the whole person, and escalates thoughtfully — rather than defaulting to the most aggressive option first.At its core, this episode is a reminder that behind every pain score is a person. And treating that person well means taking the time to understand them, hear them, and meet them where they are — not just where the chart says they should be.Essential listening for physicians, nurses, and care teams navigating the very human challenge of pain in post-acute care.

*This episode was recorded live at PALTC 26 in Anaheim CAOne of the most important and most overlooked moments in a patient's care journey is the transition. From hospital to SNF. From SNF back to the hospital. And everything that happens in between.In this episode of SNF This, we sit down with Dr. Vimmi Panchal for an honest and eye-opening conversation about transitions of care in the post-acute setting. For hospital providers, discharging a patient to a skilled nursing facility can feel like handing off responsibility. But what that patient is walking into, the staffing realities, the clinical capabilities, the after-hours limitations, and the communication gaps, is something every hospital provider should understand before they write that discharge order.Dr. Panchal brings a perspective that bridges both worlds. We talk about what SNFs can and cannot do, what a realistic care plan looks like in that setting, and what happens when a patient deteriorates and needs to come back. It is the kind of conversation that changes how you think about the discharge conversation with your patient and their family.If you work in a hospital and you discharge patients to SNFs, this one is for you.

*This episode was recorded live at PALTC 26 in Anaheim CADeath is one of the most certain parts of life — and yet in healthcare, it's often the hardest conversation to have. In this episode of SNF This, we sit down with Dr. Alfonso Gonzalez for an honest, compassionate, and long-overdue discussion about end-of-life care in the post-acute setting. Dr. Gonzalez walks us through how to approach conversations about death with patients and families — when to have them, how to frame them, and why avoiding them often does more harm than good.He also clears up one of the most misunderstood areas of care: hospice. What it actually is, what it isn't, and why so many patients and families come to it too late — or not at all — because of fear and misinformation.At the heart of this episode is a simple but urgent reminder: medicine is not just a clinical practice. It is a deeply human one. And when we strip away the paperwork, the protocols, and the pressure to treat at all costs, what remains is the responsibility to walk alongside our patients with honesty, dignity, and compassion — all the way to the end.A must-listen for physicians, nurses, administrators, and anyone who has ever sat across from a family that needed someone to just tell them the truth.

*This episode was recorded live at PALTC 26 in Anaheim CAIn this episode of SNF This, we sit down with Dr. Irene Hamrick, gerontologist and Supervising Physician for VitalCare Connect, for a deep dive into one of the most underdiagnosed culprits in post-acute care: dehydration. Dr. Hamrick breaks down how something as seemingly simple as fluid balance can drive some of the most serious acute presentations in elderly patients — from kidney dysfunction and blood pressure instability to altered mental status. If you're caring for seniors and not thinking about hydration first, this episode will change how you approach the workup.