Match each of the following clinical scenarios (Patients 1-4) to the most appropriate post-acute care disposition setting.
- A 61-year-old woman on hospital day 22 for severe acute respiratory distress syndrome. She is hemodynamically stable and follows commands but remains ventilator-dependent via tracheostomy. She requires aggressive, daily weaning protocols and complex respiratory care that cannot be provided on a general medical floor.Long-Term Acute Care Hospital (LTACH)
- A 58-year-old man on hospital day 8 after an acute middle cerebral artery ischemic stroke. He has dense hemiparesis and moderate expressive aphasia. He requires assistance with most activities of daily living but is medically stable. He actively participates in therapy and can tolerate 3 hours of combined physical, occupational, and speech therapy daily.Inpatient Rehabilitation Facility (IRF)
- A 76-year-old woman on hospital day 5 for methicillin-resistant Staphylococcus aureus bacteremia secondary to an infected diabetic foot ulcer. She is medically stable but requires 4 more weeks of intravenous daptomycin and daily complex wound care. She requires maximum assistance for transfers, lives alone, and cannot tolerate more than 45 minutes of physical therapy daily.Skilled Nursing Facility (SNF)
- A 82-year-old man on hospital day 4 for recurrent aspiration pneumonia. He has advanced dementia, is nonverbal, and is bedbound. The family has elected to forgo artificial nutrition or future hospitalizations, focusing strictly on symptom management. His daughter, who lives with him, is dedicated to providing his daily personal care.Home with Hospice Services
Answer
Patient 1 matches to LTACH, Patient 2 matches to IRF, Patient 3 matches to SNF, and Patient 4 matches to Home with Hospice Services.
Disposition matching requires mapping specific clinical and functional needs to Medicare guidelines. Patient 1's need for complex ventilator weaning dictates an LTACH. Patient 2's ability to tolerate 3 hours of daily therapy for neurological recovery mandates an IRF. Patient 3's skilled nursing needs (intravenous antibiotics), combined with poor therapy tolerance and lack of home support, necessitate a SNF. Patient 4's end-stage disease, comfort-focused goals, and available family caregiver make Home with Hospice the optimal choice.
Step-by-Step Solution
Key Concept
Appropriate disposition requires synthesizing a patient's medical acuity, physical rehabilitation tolerance (e.g., the 3-hour IRF rule), ongoing skilled nursing needs, and available home support.
Estimated Time:2m 0s