Explain the impact of differences in the settings themselves

My experience-A 67 years old male African American who moved to the states from Africa 3 years ago. He had history of CHF, ESRD, HTN and DB type 2. He was admitted to medsurg unit with SOB secondary to fluid overload and CHF exacerbation. He was getting hemodialysis. Per physical and occupational therapy, the plan was to send him to LTC that provide hemodialysis. However, he didn’t have an insurance. While he was waiting for placement, one day he became unconscious in the bathroom and pulseless. he was intubated at the bedside. Then he was transferred to ICU for higher care. At that time, he was full code and he didn’t have advanced directive. 5 days later we learned that he died.

Please answer these question using above personal experience. Thank you so much.

1. a description of a case from personal or clinical experiences in the last 5 years that involves an elderly patient who has been in at least two different sites of care.

2. Explain the impact of differences in the settings themselves, inherent culture of the settings, and ethical practices of these sites on the patient.

3. Then, explain whether the patient had an advanced directive in place at the time of the change in sites of care, and if so, whether any difficult treatment decisions had to be made as a result.

4. Finally, explain the impact of financial issues on site placement and treatment decisions.