Determining the Benefits of Long-Term Care Placement

Deciding on long-term care (LTC) placement is difficult for patients and their families. Families may feel as though they have failed their loved one, leading to feelings of guilt, stress, and other emotional turmoil. Patients may have their own concerns, such as their ability to afford LTC services and reluctance to give up their homes. In many cases, healthcare providers are consulted to help with the decision. This issue of Annals of Long-Term Care: Clinical Care and Aging^® (ALTC) features two articles that outline two very different case scenarios, but each one highlights various factors that weigh in the decision.

In the first article, “Establishing a Treatment Plan for an Elder With a Complex and Incomplete Medical History and Multiple Medical Providers, Diagnoses, and Medications”, the authors report the case of a 73-year-old woman who had recently been admitted to an assisted living facility. The patient had a long history of anxiety and depression, but had been highly independent for most of her life. After experiencing cognitive decline and becoming completely dependent on others for her activities of daily living and instrumental activities of daily living, the patient’s children employed a caregiver to provide their mother with around-the-clock care, 7 days a week. However, the patient’s children lived far from her and the patient experienced challenges at home with her second husband, whose health was also declining. After the patient’s children consulted with a neurologist, they decided to move her to an assisted living facility closer to where they lived. This enabled the children to have more control over their mother’s care, which was a decision the patient’s husband agreed with. Although this article, which is part of our Difficult Case series, focuses on uncovering this patient’s complex clinical picture and determining the best treatment plan for her, it also serves to highlight a scenario in which LTC placement may be preferable to home care.

In the second article, “Decision-Making Capacity and Conservatorship in Older Adults”, the authors examine the complex issue of elder self-neglect. They report the case of a 91-year-old veteran who was admitted to their geriatric ward because of weight loss and failure to thrive. Before being admitted, he resided in a one-bedroom studio apartment in an independent, low-income, senior living facility. After receiving various interventions in the geriatric ward, including antidepressant therapy, meal supervision, and physical therapy, his condition significantly improved. As a result, his interdisciplinary care team recommended that he move into an assisted living facility, where such care could be continued. The patient oscillated between agreeing to move to an assisted living facility and wanting to move back into his studio apartment, but ultimately decided on the latter.  Because this decision differed from the healthcare team’s recommendations, and due to his high safety risks and limited self-care abilities, the patient’s decision-making capacity was assessed before discharge. This assessment determined that the patient was capable of making his own decisions, as he opted to return to his previous living arrangements as a means of maintaining his autonomy and preserving adequate funds for the remainder of his life. Because he could appreciate the risks of his decision, conservatorship was not pursued and he was discharged to his home, with follow-up by Adult Protective Services (APS).

As these case scenarios demonstrate, multiple factors weigh into the decision to place someone into LTC, including their physical condition, mental capacity, family and external support, and financial resources. The first patient clearly could not live independently, but had tremendous support from her children, making LTC placement near her children both feasible and the best possible living arrangement. The second patient may have benefitted from LTC placement, but he chose to continue living independently. He did not have the same financial or family support as the first patient. Because returning to his prior living arrangement appeared risky, he required follow-up by APS. Certainly, each case is unique and the decision needs to be made with the utmost of care.

As always, we welcome your thoughts on the articles contained in this issue of ALTC. Your feedback can be sent to our assistant editor, Allison Musante, at amusante@hmpcommunications.com. Letters may be published in an upcoming issue of the journal.

Thank you for reading!