Transitioning Patients

Transitioning patients always has challenges, whether it is a relatively simple transition, such as changing a patient’s medication regimen, or a more complex one, such as moving a patient from one level of care to another. In long-term care settings, transitioning patients is a common occurrence. For example, a nursing home resident with advancing dementia may eventually be moved to a dementia unit, and an individual who temporarily requires a feeding tube may eventually be transitioned back to oral feedings. In this issue of Annals of Long-Term Care: Clinical Care and Aging (ALTC), two articles tackle patient transition issues and their concomitant challenges.

The first article, “Moving a Noncompliant Patient to Long-Term Care Against Her Wishes,” also launches a new section that will appear in ALTC, dubbed Difficult Case. This section focuses on real-world, difficult cases that clinicians have encountered in their practices, and it is fitting that the premier article in this section tackles the complex issue of whether to transition a patient to long-term care. As the elderly population continues to grow, this is a dilemma that will be encountered with increasing frequency, and healthcare providers will have to make some tough decisions. In the article, the authors outline the case of an older patient who is nonadherent with her medication regimen (especially insulin) and potentially has a mental health diagnosis, and they discuss with other clinicians whether this patient would benefit from being placed in an assisted living facility or would be better served at home through various home-care services. To get a better handle on the case, the authors use the “Wisconsin Star Method,” which is also outlined.

In the second article, “Transitioning Nursing Home Patients With Dementia to Hospice Care: Basics, Benefits, and Barriers,” the authors explore the benefits of transitioning residents with advanced dementia to hospice care, outline the barriers that often prevent this transition, and offer suggestions on how these barriers may be overcome. For example, many people think that hospice is reserved for individuals whose death is imminent, but educational efforts may help change this viewpoint by showing that hospice offers a level of care that may otherwise not be provided. As the authors note, with the increasing elderly population, growing nursing home use, and the prevalent diagnosis of dementia among deceased residents, hospice should become a more utilized option for residents with advanced dementia.

In long-term care, patients aren’t the only ones making transitions. Often, facilities need to make transitions as well. In “Antibiotic Stewardship Programs in Long-Term Care Facilities,” the authors discuss antibiotic stewardship programs, which can be crucial in preventing outbreaks of infection and colonization by multidrug-resistant organisms in the long-term care setting. Transitioning staff to such programs can be challenging, but various approaches are possible. The authors outline a stepwise approach, which can make the task less daunting and also allows successes to be built upon.  

If you are attending the American Geriatrics Society Annual Meeting, be sure to visit ALTC. We will be located in the AGS Marketplace. Thank you for reading!