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Invited Commentary
December 9/23, 2013

The Right Care in the Right Place

Author Affiliations
  • 1Division of Geriatrics, University of Rochester School of Medicine and Dentistry, Highland Hospital, Rochester, New York
JAMA Intern Med. 2013;173(22):2053-2054. doi:10.1001/jamainternmed.2013.8592

You are cross-covering patients for a colleague over a weekend night and a call is routed to you from a long-term care facility. The nurse informs you that a resident is indicating nonspecific discomfort and the nursing home administrator wants permission to send the patient to the local emergency department to be evaluated for admission to the hospital. The patient is an 88-year-old woman who has been in the nursing home for the past 6 months with a primary diagnosis of long-standing dementia and failure to thrive. She had been hospitalized twice previously with similar signs of discomfort and no source had been established. The patient has profound memory deficits. She is incapable of verbal communication and is incontinent and nonambulatory. You cannot verify a record of a do-not-hospitalize directive. What criteria do you use to decide on the need for hospital transfer for acute care vs care in the nursing home facility?

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