1. Settings of Care Board Game Vignettes

2. Case #1 90 y/o, lives alone in home; fell, couldn’t get up No family in area; has close neighbor who checks on her daily and found patient on floor Sent to ED; no fractures, rhabdomyolysis, infection Dehydrated, soft tissue musculoskeletal injuries, pain, and unsteady gait Admitted to you because unsafe to go home In hospital; working with PT; pain & gait better What is the ideal discharge setting for her?

3. Case #2 84 y/o widower Cognitive deficits (MMSE 22/30) Lives in senior independent living building One daughter lives nearby and checks him regularly (but not daily) Patient diabetic, treated with OHGA Admitted: Hyperglycemia and worse CRI Insulin added with accuchecks (at least daily) Daughter can give insulin and assist with accuchecks, but can not do this every day Patient has some financial resources What is the ideal discharge setting for him?

4. Case #3 69 y/o female Lives alone in low income housing; no family Hospitalized with recurrent MRSA in 2 nd Total Knee Replacement Knee joint removed; needs antibiotics Allergic to vancomycin ID suggests daptomycin daily IV X 6 weeks Currently ambulating by pushing herself around in a wheelchair What is the ideal discharge setting for her?

5. Case #4 78 y/o male living at home with family Severe Parkinson’s disease and some dementia Admitted for 3rd episode of aspiration pneumonia in 3 months Responding to therapy, but hospitalization is traumatic for him Family feels that, after this episode, patient should not be re-hospitalized if he gets pneumonia again Family says they couldn’t handle having patient at home if he aspirated and got short of breath. Patient’s health insurance is Medicare / Medicaid What is the ideal discharge setting for him?

6. Case #5 87 y/o female with baseline cognitive deficits (MMSE 22/30) Lives in house with multiple extended family Falls and sustains pelvic fracture In hospital, is able to work with PT Improvement in endurance and gait is slow Family and patient have a long standing agreement that patient will never go to a “nursing home” What is the ideal discharge setting for her?

7. Case #6 85 y/o female living alone in apartment No family in area Slowly progressive cognitive decline; now with paranoia Eats and drinks little because she fears people are trying to poison her Admitted with dehydration Now hydrated and stabilized on psych meds She has no significant financial resources What is the ideal discharge setting for her?

8. Case #7 75 y/o lived in own home caring for frail spouse Long hospitalization due to complications after CABG, including respiratory failure Off ventilator, has PEG tube Beginning to eat Slowly works with PT (sits on edge of bed) Has a large sacral pressure ulcer requiring wound vac therapy What is the ideal discharge setting for her?

9. Case #8 80 y/o female lives alone in own home Admitted with first episode of CHF Cognitively intact and only other medical problem is poor vision One daughter who lives in the area, but frequently out of town on business What is the ideal discharge setting for her?

10. Case #9 82 y/o widower Lives in senior independent housing Admitted; 3 rd episode of CHF, felt secondary to poor medication compliance Patient admits he often forgets to take some of his medications or he gets them confused; MMSE 21/30 Has 2 children, but both live more than 30 miles away Patient has some financial resources What is the ideal discharge setting for him?