This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in JAMA

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: The Grand Rounds by Dr Carrese¹ about the difficulties of planning hospital discharge of an older patient who demands to go home raises important questions. The recommendations made in the article are sound and may lead to workable solutions in most cases. But we think it would be helpful to delve deeper into the approach suggested.

It is noted early in the article that the multidisciplinary team felt that "her current arrangement [of living at home] was unsafe and that it placed her at higher risk of developing various medical problems and eventually clinically deteriorating." However, this may not have been a higher risk than living in an assisted-living facility or a nursing home. While clinicians may view as lower-risk such sites in which they have greater control over the care provided, relocation to these places is associated with serious risks.²

In this case, the patient experienced . . . [Full Text of this Article]

Kenneth Brummel-Smith, MD
ken.brummel-smith@med.fsu.edu
Department of Geriatrics

Jeffrey Spike, PhD
Department of Medical Humanities and Social Sciences
Florida State University College of Medicine
Tallahassee

RELATED LETTERS

Refusal of Care by Patients
Susannah M. Bernheim, Joseph S. Ross, and Elizabeth H. Bradley
JAMA. 2006;296(24):2921.
EXTRACT | FULL TEXT  

Refusal of Care by Patients
Catherine Quigley, Janet Atherton, and Alison Rylands
JAMA. 2006;296(24):2921-2922.
EXTRACT | FULL TEXT  

Refusal of Care by Patients
Jeffrey L. Spiess and Lisa Tomm
JAMA. 2006;296(24):2922.
EXTRACT | FULL TEXT  

Refusal of Care by Patients—Reply
Joseph Carrese
JAMA. 2006;296(24):2923.
EXTRACT | FULL TEXT