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Am Fam Physician. 2022;106(6):714-717

This is part 2 of a two-part Curbside Consultation on care transition for older adults. See part 1, Care Transition and Long-term Care Options for Older Adults.

Author disclosure: No relevant financial relationships.

Case Scenario

My 85-year-old patient, E.P., with a history of Alzheimer disease, hypertension, hypothyroidism, and mild chronic obstructive pulmonary disease, has been receiving adult day center support and family care for their Alzheimer disease. E.P. is now wheelchair walking, experiencing delusions and hallucinations, has bowel and bladder incontinence, and is dependent in all activities of daily living. E.P. has not been able to direct their medical and executive affairs for a few years. The adult care center cannot continue to provide services for E.P., and the family is unable to provide further assistance. A family member (E.P.’s guardian) is asking for help with placing E.P. in a long-term care facility. E.P. currently receives Medicaid support. What critical steps do I need to understand and take to assist the patient and their family in transitioning E.P. into a long-term care facility? What information and documentation does the facility need from me to effectively manage this transition?


Part 1 of this Curbside Consultation, published in the November 2022 issue of American Family Physician, discussed the importance of planning for long-term care support and services, including strategies for aging in place, alternatives to long-term care facilities, long-term care insurance, and Medicaid requirements.1 In the case stated here, these alternatives have been exhausted, and the patient now requires care in a long-term facility.

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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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