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Week 1 discussion

Changes in Sites of Care

Since the culture and practices of care settings are
inherently different, changes in sites of care are often difficult for
geriatric patients. Efforts should be made to limit changes to only those
necessary; however, sometimes a patient’s situation might require multiple
changes in sites of care. When selecting sites of care, such as home, assisted
living, rehabilitation facilities, and hospitals, many factors must be
considered by patients, their families, and their health care providers. Health
status, ability to perform self-care, financial limitations, and patient
preferences are all factors that might influence a patient’s site placement. As
an advanced practice nurse who recommends sites of care and facilitates
changes, you must evaluate factors and consider sites that limit the impact of
these changes on geriatric patients.

To prepare:

Review this week’s media presentation, as well as Chapters 4
and 7 of the Flaherty and Resnick text.

Reflect on your personal experiences, observations, and/or
clinical practices from the last 5 years. Select a case from the last 5 years
that involves an elderly patient who has been in two different sites of care
such as home, assisted living, hospital, etc. Note: When referring to your
patient, make sure to use a pseudonym or other false form of identification.
This is to ensure the privacy and protection of the patient.

Reflect on issues that occurred because of the change in the
patient’s sites of care. Think about the impact of differences in the settings
themselves, inherent cultures of the settings, and ethical practices of these
sites on the patient.

Consider whether the patient had an advanced directive in
place at the time of the change in sites of care. Reflect on whether any
difficult treatment decisions had to be made as a result.

Think about the impact of financial issues on site placement
and treatment decisions.

Post on or before Day 3 a description of a case from your
personal or clinical experiences in the last 5 years that involves an elderly
patient who has been in at least two different sites of care. Explain the
impact of differences in the settings themselves, inherent culture of the
settings, and ethical practices of these sites on the patient. Then, explain
whether the patient had an advanced directive in place at the time of the
change in sites of care, and if so, whether any difficult treatment decisions
had to be made as a result. Finally, explain the impact of financial issues on
site placement and treatment decisions.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your
colleagues on two different days in one or more of the following ways:

Suggest community resources that may assist with related
cases in the future.

Recommend appropriate alternative site placements for your
colleagues’ patients based on your geographic location.

Provide insights on policy implications of your colleagues’
cases (i.e., Medicare, Medicaid, Veteran’s Affairs, etc.).

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