(P07) Multidisciplinary Approach to Reducing Nursing Home Hospitalizations Amid Family Mistrust

Introduction: Older nursing home residents with complex chronic conditions often face difficult decision making when deciding between disease oriented interventions and palliative care. These issues are exacerbated when family harbors distrust towards the healthcare system or lacks medical literacy. We present the case of a resident with GOLD Group E COPD, whose family’s mistrust of medical staff led to frequent hospitalizations.

Case Description : 80 y/o African American male with GOLD Group E COPD, chronic respiratory failure requiring supplemental oxygen, OSA, HFpEF, BPH, vascular dementia, and anxiety residing in a nursing home due to advanced COPD and dementia. Both the patient and family had previously hesitated in pursuing palliative options. Of note, the patient had wanted bronchoscopic lung volume reduction to prevent recurrent hospitalizations for COPD exacerbations but was deemed not stable enough for candidacy.


His condition was worsening due to increased fatigue and confusion. This was attributed to non-adherence of his BiPAP, sleep disturbances, nocturia, and polypharmacy. His family was frustrated at the presumed lack of care of his comorbidities and requested for hospital admission; despite the patient’s wish of not wanting any further hospitalizations. A multidisciplinary team discussion, including geriatrician, nurses, physical therapist and case manager, took place to determine unified goals of care for the patient. Once infectious workup came back negative; in order to deliver the optimal care to prevent hospitalization as per patient’s request, multiple therapeutic interventions took place. The case manager coordinated a more suitable fitting BiPAP mask. This improved adherence, sleep-wake cycle and daytime fatigue. To avoid polypharmacy, physicians reviewed medications and de-prescribed redundant BPH meds, reducing nocturia and nighttime awakenings; thereby improving nighttime sleep quality. Nursing staff were educated on administering Morphine and Lorazepam for dyspnea and anxiety, improving patient comfort, and reducing symptom exacerbation. Breathing treatments were also increased to prevent possible COPD exacerbations. Lastly, physical therapist implemented a fall prevention program with strengthening and gait stability exercises. These interventions significantly improved patient’s fatigue and baseline functional status. Whereas transparent communication and involvement in care decisions led to greater family satisfaction, and alignment with the patient’s care preferences.

Discussion: Distrust in post-acute and long-term care facilities often stems from lack of understanding, miscommunication, unmet expectations, and caregiver burnout from short staffing. This case demonstrates the effectiveness of a multidisciplinary approach in addressing both clinical and psychosocial challenges in nursing home care. By involving various healthcare disciplines, effective patient-centered care was achieved; with fewer hospitalizations and rebuilding of family’s trust.