She had several chronic conditions, took lots of meds, moderately confused, incontinent, needed help with all ADLs, but had a sparkle in her eyes, loved her meals and chocolates. Everyone thought she was doing well until a flu outbreak hit the facility.
Rosie became feverish, delirious, weak, short of breath, and bedbound. She soon developed pneumonia and became dehydrated. Her documented wishes were honored and she received aggressive treatment in the nursing home, but never fully recovered and died 3 weeks later, not before developing a pressure ulcer.
Everyone was surprised because she seemed to be so well.
But Rosie was physiologically frail and at risk of these bad outcomes. Her frailty was the result of the natural aging process, the accumulation of chronic illnesses, and the losses of function and cognition. Most LTC residents are frail and some PAC residents as well. Every effort should be made to prevent the poor outcomes but understand that even with a proactive approach and high-qualitycare some bad outcomes will occur. Recognition of frailty and documenting a risk-based plan of care will mitigate survey assessments of avoidable outcomes and poor care.