Long term care was a rotation completely unique from others I have completed thus far. While the general mood of the rotation was more calm and controlled, this setting posed its own challenges for me as a student. Prior to this rotation, the main focus has mostly been acute treatment of a presenting problem. While future prognosis and care was always involved and considered in a patients treatment, it was a tremendous part of my work in this rotation. In long term care, a patients future is the entire purpose of their stay, as rehabilitation, medical treatment, and all care provided is geared toward improvements that will ensure a healthy and successful future. Goals of care were not focused on just pain control, interventions, or antibiotics for a current infection, but also on activities of daily living and physical therapy that have an impact on the patients daily life for years to come.

Physical and occupational therapy were areas of medicine I was familiar with but never got to experience so closely before. During this rotation I got to witness how specific physical exercises can impact healing and function of fracture sites, muscle atrophy, and regular movement. Occupational and speech therapy were especially interesting, as they focused on detailed tasks and exercises aimed at improving the simplest yet most important of daily functions. I was excited to learn about these areas and how they can help a patient recover, as well as how and when I can refer patients for such therapy.

Managing medical problems in a geriatric population was also more challenging than previously. Older patients have many variables contributing to their health, not just diagnosed diseases and disorders. With dozens of medications on board, it’s a much tougher task to add on a new medication without it affecting others, and deciding which medication is most appropriate while considering dosing and side effects. Side effects were a large problem, as polypharmacy leads to compounding adverse effects and patients can suffer greatly due to the necessary medications they are taking. I learned how to diligently look at all medications and examine their interactions and adverse effects, and when to discontinue a medication when the risk to the patient was outweighing the benefit of the medication. This rotation has really allowed me to dive deeper into pharmacology and improve my skill in this area.

A rewarding part of this rotation was the time spent with patients that did not involve medicine or rehab. Visiting patients to ask how they are doing and learn about their lives was something I looked forward to each day. With so many medical and physical issues that are taken care of in geriatric patients in a long-term care facility, it is easy to overlook the patient themselves. Taking the time to check in with patients, ask about their day, and do something to help them out is just as important as taking care of them medically. Many patients are left alone in a facility, not visited by family or friends, or only rarely seeing their loved ones. Having someone to speak to everyday can be a tremendous relief when feeling lonely and recovering from illness or injury. This rotation taught me not only about how we can help a patient medically, but how compassionate care weaved into everyday tasks can truly affect a patients recovery.