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: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.