Match each clinical scenario to the most appropriate disposition or care setting.
- 72-year-old man, 5 days post-ischemic stroke; medically stable with severe left-sided hemiparesis. He is highly motivated and able to actively participate in 3 hours of physical, occupational, and speech therapy daily.Inpatient Rehabilitation Facility (IRF)
- 85-year-old woman, 7 days post-hip fracture repair; medically stable but significantly deconditioned. She requires physical therapy but can only tolerate 45 to 60 minutes of activity per day due to fatigue.Skilled Nursing Facility (SNF)
- 65-year-old man evaluated in the emergency department for community-acquired pneumonia. He has acute confusion, BUN 35 mg/dL, respiratory rate 32/min, and blood pressure 85/50 mmHg.Intensive Care Unit (ICU)
- 58-year-old woman, 4 days into treatment for vertebral osteomyelitis. She is medically stable, fully ambulatory, independent in all activities of daily living, but requires 6 weeks of intravenous antibiotics.Home with Home Infusion Services
- 78-year-old man, 10 days post-COPD exacerbation. He is medically stable but remains bedbound and requires total assistance for all activities of daily living. He has advanced dementia, no rehabilitation potential, and his family cannot provide care at home.Long-Term Care Facility (Custodial Care)
Answer
The correct matches are based on strict clinical guidelines and Medicare criteria for facility transitions, prioritizing therapy tolerance, acuity scores (like CURB-65), and the distinction between skilled vs. custodial needs.
Matching each patient to the correct disposition setting requires applying specific criteria: IRFs strictly require 3 hours of daily therapy tolerance, SNFs are for skilled needs with lower therapy tolerance, ICUs are for critical illness (indicated by high prognostic scores like CURB-65), home infusion is optimal for stable patients needing only prolonged IV therapy, and custodial care is reserved for those lacking skilled needs but requiring ongoing ADL support.
Step-by-Step Solution
Key Concept
Appropriate care setting disposition depends on synthesizing medical acuity (e.g., CURB-65 score), functional status, rehabilitation potential, daily therapy tolerance (3-hour rule for IRF), and the need for skilled vs. custodial care.