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Settings of Care Board Game

Settings of Care Board Game. Vignettes. 90 y/o, lives alone in home; fell, couldn’t get up No family in area; has close neighbor who checks on her daily and found patient on floor Sent to ED; no fractures, rhabdomyolysis, infection

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Settings of Care Board Game

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  1. Settings of Care Board Game Vignettes

  2. 90 y/o, lives alone in home; fell, couldn’t get up No family in area; has close neighbor who checks on her daily and found patient on floor Sent to ED; no fractures, rhabdomyolysis, infection Dehydrated, soft tissue musculoskeletal injuries, pain, and unsteady gait Admitted to you because unsafe to go home In hospital; working with PT; pain & gait better What is the ideal discharge setting for her? Case #1

  3. Case #2 • 84 y/o widower • Cognitive deficits (MMSE 22/30) • Lives in senior independent living building • One daughter lives nearby and checks him regularly (but not daily) • Patient diabetic, treated with OHGA • Admitted: Hyperglycemia and worse CRI • Insulin added with accuchecks (at least daily) • Daughter can give insulin and assist with accuchecks, but can not do this every day • Patient has some financial resources • What is the ideal discharge setting for him?

  4. Case #3 • 69 y/o female • Lives alone in low income housing; no family • Hospitalized with recurrent MRSA in 2nd Total Knee Replacement • Knee joint removed; needs antibiotics • Allergic to vancomycin • ID suggests daptomycin daily IV X 6 weeks • Currently ambulating by pushing herself around in a wheelchair • What is the ideal discharge setting for her?

  5. Case #4 • 78 y/o male living at home with family • Severe Parkinson’s disease and some dementia • Admitted for 3rd episode of aspiration pneumonia in 3 months • Responding to therapy, but hospitalization is traumatic for him • Family feels that, after this episode, patient should not be re-hospitalized if he gets pneumonia again • Family says they couldn’t handle having patient at home if he aspirated and got short of breath. • Patient’s health insurance is Medicare / Medicaid • What is the ideal discharge setting for him?

  6. Case #5 • 87 y/o female with baseline cognitive deficits (MMSE 22/30) • Lives in house with multiple extended family • Falls and sustains pelvic fracture • In hospital, is able to work with PT • Improvement in endurance and gait is slow • Family and patient have a long standing agreement that patient will never go to a “nursing home” • What is the ideal discharge setting for her?

  7. Case #6 • 85 y/o female living alone in apartment • No family in area • Slowly progressive cognitive decline; now with paranoia • Eats and drinks little because she fears people are trying to poison her • Admitted with dehydration • Now hydrated and stabilized on psych meds • She has no significant financial resources • What is the ideal discharge setting for her?

  8. Case #7 • 75 y/o lived in own home caring for frail spouse • Long hospitalization due to complications after CABG, including respiratory failure • Off ventilator, has PEG tube • Beginning to eat • Slowly works with PT (sits on edge of bed) • Has a large sacral pressure ulcer requiring wound vac therapy • What is the ideal discharge setting for her?

  9. Case #8 • 80 y/o female lives alone in own home • Admitted with first episode of CHF • Cognitively intact and only other medical problem is poor vision • One daughter who lives in the area, but frequently out of town on business • What is the ideal discharge setting for her?

  10. Case #9 • 82 y/o widower • Lives in senior independent housing • Admitted; 3rd episode of CHF, felt secondary to poor medication compliance • Patient admits he often forgets to take some of his medications or he gets them confused; MMSE 21/30 • Has 2 children, but both live more than 30 miles away • Patient has some financial resources • What is the ideal discharge setting for him?

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