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Am Fam Physician. 2022;106(5):567-570

This is part 1 of a two-part Curbside Consultation on care transition for older adults. See part 2, The Physician's Role in Transitioning Older Adults Into Long-term Care Facilities.

Author disclosure: No relevant financial relationships.

Case Scenario

My 83-year-old patient, E.P., with a history of Alzheimer disease, hypertension, hypothyroidism, and mild chronic obstructive pulmonary disease, has received care from a home health aide and family support in the home for two years. Although their comorbidities are stable, E.P. is now falling frequently, is experiencing delusions and hallucinations, has bowel and bladder incontinence, and is unable to dress and bathe properly. E.P. is no longer able to direct medical and executive affairs; however, their daughter (E.P.’s power of attorney) would like to look at options other than a long-term care facility and has asked for assistance in finding care alternatives for her parent. Financial resources are running out.

What are alternatives to long-term care facility placement? What are the critical issues I need to understand and what actions should I take to assist the patient and family in finding the most appropriate alternatives?


The goal of care transitions for older adults is to promote the best possible safe functioning for the individual in the least restrictive environment throughout their late life. Some needs of older adults for assistance due to normal aging, medical comorbidities, or disablement may be anticipated if the physician and caretakers attend to the changing medical, psychosocial, and goals of care needs of the patient.

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Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Send scenarios to Materials are edited to retain confidentiality.

This series is coordinated by Caroline Wellbery, MD, associate deputy editor.

A collection of Curbside Consultation published in AFP is available at

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