The American Association of Long Term Care Nursing (AALTCN) serves as a significant resource for long-term caregivers by providing professional development opportunities through continuing education and certification programs as well as representing and advocating for long term care nursing nationally.

By: John Parkinson, Clinical Content Coordinator,

Traditionally speaking, long-term care facilities such as nursing homes may have been previously thought of only as places to care for elderly persons who went there as permanent residents. While that is still a vital part of long-term care, the specialty has expanded with an emerging segment: patients who are being discharged from acute-care hospitals in need of rehabilitation and convalesce in transitional care before being medically cleared to go home.

In addition, other forces are at work that may grow this transitional care need even further. For example, a restructuring to the reimbursement fees in acute-care hospitals beginning next year will have a direct impact on these long-term care facilities. Acute-care hospitals will be seeing a decrease in Medicare reimbursement, and thus will likely cause a rippling effect having patients discharged sooner from acute-care hospitals and into these long-term care facilities. However, the hospitals will be responsible for these patients up to 30 days after they have been released, so long-term care facilities will play a more significant role in the near future in the care of these patients.

Yet, within these facilities not much consideration has been given to frontline caregivers. Often overlooked, the nurses in these facilities lack the representation and resources they deserve. Looking to step in and fill that void, the American Association of Long Term Care Nursing (AALTCN) has developed a unique association that includes membership for everyone in the long-term care nursing continuum from certified nursing assistants (CNAs) to licensed practical nurses (LPNs) to directors of nursing (DONs).

AALTCN (pronounced All-Can) has a three-fold mission: the association wants to create a community amongst all caregivers in these facilities; serve as an advocate and voice for them; and most importantly, educate these nurses, providing them the opportunities to further enhance competencies and professional development.

Education is the main thrust for the organization and it helps its members attain professional development through webinars as well as offering numerous certifications. For example, AALTCN recently partnered with an online nursing continuing education company to launch its Director of Nursing Certification Program. In addition, understanding the importance of diabetes treatment in long-term care, AALTCN offers webinars on the disease, and has a consulting CDE who sits on their management team and can help nurses by answering care questions.

AALTCN also provides other educational and professional resources through its website, and it is getting ready to host its annual conference, which will be held September 8-9 in Las Vegas. At this year’s conference, AALTCN is offering three different certification programs for attendees.

At the helm of AALTCN are Executive Director Charlotte Eliopoulos, RN, MPH, ND, PhD (pictured, below, left), and Director of Professional Services Ron Romano, RN (pictured below, right). They have put together a management team of professionals with varied backgrounds to create a group of leaders who have excellent insights into the long-term care sphere, and are guiding AALTCN towards serving the needs of caregivers in this ever-evolving industry. spoke to Eliopoulos and Romano recently about AALTCN’s overall organizational focus, its educational initiatives including creating diabetes-related competencies, and how long-term care nursing is preparing for the possible influx of transitional-care patients due to the anticipated reimbursement changes to acute-care hospitals. Can you provide an overview of what the AALTCN is and who it looks to serve?

Romano: We serve everyone in the nursing department in a long-term care nursing facility, from administrative nurses to the bedside caregiver. In looking at the people we serve, it is not just about one person in the department but the nursing team. We are trying to remove barriers and silos and build a community in these settings.

Education for various levels of staff is also provided. For example, we offer 140 different CNA educational modules related to various aspects of long-term care. The professional development of everyone in the nursing department is encouraged. Our mission is education and creating competencies among the caregivers. You had mentioned education as one of the benefits of being an AALTCN member. What are some of the other benefits for members?

Romano: In addition to taking advantage of free education on our website, we also have different specialty forums so that if our members have questions related to these areas, they can ask one of our experts.

Members can receive a monthly e-newsletter and weekly “E-Seeds,” which provide encouraging and motivational messages. Members have said that they post these E-Seeds in the nurses’ lounges in their facilities.

In addition, AALTCN developed written core competencies for each major position in the nursing department, which had never been done in long-term care. These competencies have proved highly beneficial to nursing staffs and their employers in understanding the unique competencies demanded in different roles. One of the more interesting developments in the healthcare industry is that in 2012 Medicare reimbursement for acute-care hospitals is expected to slightly decrease. How will this affect the long-term nursing industry?

Romano: In 2012, hospitals are going to be responsible for the care of the patient discharged to a nursing home for 30 days after they are discharged. If that patient has to be readmitted to the hospital, then the hospital is not going to be reimbursed for the care of that patient.

As a result, hospitals will have to invest greater efforts into discharge planning. They will also have to give greater consideration to the abilities of nursing homes to take care of these discharged patients.

I was recently talking to a hospital system about this and they said, ‘the nursing homes to which we discharge our patients need to have a competent nursing staff.’ So competencies for nurses are going to be that much more important. Will acute-care hospitals be developing relationships with nursing homes because of this development?

Romano: That is exactly what is going to happen. The nursing homes that are not able to take care of these patients are not going to get the referrals. For those nursing homes that are not able to care for these acute rehab patients, you will see these homes go to strictly Medicare resident nursing home models. As a result of this legislation, you are going to see a bigger divide in the nursing homes providing care. Often when people think of long-term care, they think solely of the geriatric specialty. However, the convalescence and rehabilitation from acute conditions is part of the long-term nursing continuum. Can you explain the important role long-term nursing plays there?

Romano: Nurses have to make sure these patients are prepared to go home safely by making sure their medications are correct and the care these patients need to commit to doing themselves at home is understood. This challenges them to be clinically competent in both acute and chronic care nursing. The nursing industry has a large responsibility in taking care of people with chronic conditions and diseases like diabetes. What is AALTCN’s philosophy on diabetes care overall?

Romano: Diabetes is a critical area and long-term care nurses must be aware of best practices and competent to care for persons with this condition. Many patients have multiple disease processes going on that impact their diabetes. Older adults are more fragile or could be cognitively impaired, as compared to a younger patient who may just have diabetes and no co-morbidities.

Eliopoulos: One factor that must be considered in the care of persons with diabetes who reside in long-term care facilities is the growing culture change movement and its emphasis on resident-directed care. This has been supported by the Centers for Medicare and Medicaid Services (CMS) who view resident choice as an important right of residents. This can be challenging for nursing staffs to balance residents` choice rights with optimum clinical management of a condition like diabetes. For example, giving residents with diabetes a choice of when they want to eat or the option to eat inappropriate foods can create new risks. Education and guidelines are needed to allow for new flexibility in the care of these individuals while assuring safety. In thinking about the day-to-day responsibilities, what kind of a clinical role do long-term care nurses play with patients with diabetes?

Eliopoulos: Through my experience with AALTCN and some of my consultation work, I have seen that some nurses lack an understanding of current care practices for individuals with diabetes. One of the things we need to do is keep nurses briefed on best practices and encourage their implementation.

The reality is that nursing homes find it challenging to find the time to do in-service education programs. We have had success in developing tool kits, fact sheets, and presentations that have equipped nursing homes to easily provide relevant, practical education. Our experience not only allows us to provide “turnkey” formats to assist with staff education, but also to develop materials that are at an appropriate level and speak to the real concerns of caregivers.

We have also been considering a diabetes certification program that we can provide through an online channel that can provide nurses with the competencies needed to effectively care for this population. The annual AALTCN conference is coming up soon. What are going to be some of the important themes and trends for this year?

Romano: We want to enhance competencies for long term care nurses and have them walk away with good, practical information that they can share with other caregivers in their facilities.

This year, AALTCN is offering three of its certification programs at the conference: Director of Nursing, Staff Development Specialist, and Safety Specialist. Upon completion of the conference program, nurses will be able to take a certification exam and receive their certificate in that area. What are AALTCN’s bigger goals for this coming year?

Romano: One of our goals is making our education more accessible. We are in the process of developing our certification programs in an interactive, online format. We are looking for additional strategies to deliver education to nursing staffs because we are hearing over and over again, that time and money are scarce, reducing their ability to get away from their facilities to attend longer conferences or workshops.

AALTCN consistently hears the common refrain that there is a need to have competent caregivers in long term care facilities to take care of an increasingly complex patient population. That is what we are here to provide.

To learn more about AALTCN, go to their website at:


Originally posted by on September 2, 2011.