As the scope of end-of-life diagnoses has broadened to people with dementia and adult failure to thrive, more residents of group homes, assisted living, and skilled nursing facilities are receiving hospice care.This has always led to questions about which care tasks are the responsibility of the nursing facility versus the hospice, but Medicare has laid out... »

Even an extended interdisciplinary team couldn't keep this resident from harmful decisions. »

We were pleased at our facility to hear that Mr. ST, a 90-year-old retired businessman, had chosen our facility for his postoperative rehabilitation. Mr. ST is prominent in our community, and even 25 years after his retirement his name and photo appear regularly in the local newspaper.

Since we are a small medical community, no one was surprised when Mr.... »

Mrs. QR, a 92-year-old, long-term resident, suffered from a multitude of medical problems. She was legally blind from macular degeneration. She had had coronary angioplasty, twice. Because of chronic stable atrial fibrillation, she was receiving anticoagulation therapy. She had mild to moderate dementia and worsening cardiac function and renal... »

This month's column offers you, the reader, an opportunity to express your opinion on a difficult clinical situation that remains unsettled at the facility where I serve as medical director. The case below is that of Mrs. OP, who has an indwelling urinary catheter though no current medical indication for it. Yet she refuses to have the catheter removed. How... »

Mrs. MN, a 74-year-old female, was admitted for short-term rehabilitation after an inpatient hospitalization for treatment of her ongoing small-cell lung carcinoma. She was anemic, neutropenic, and markedly deconditioned. Her plan was to return home with her husband of 47 years and her adult son. She had another son who lived about 300 miles away.There was... »

Mrs. KL is a petite 95-year-old woman with advanced dementia. She is a pleasant woman who smiles easily and answers yes-or-no questions. But beyond those simple answers, her conversation is unintelligible.Her favorite activity is propelling herself around our building, using her feet to move her wheelchair forward. She makes laps around the building, she... »