Michelle Get your social worker, and Medical Director involved. This is a little beyond skilled nursing in a LTC setting. This resident should be on an inpatient hospice unit. I take it he is using his skilled benefit. A lot of times families don't want residents sent out d/t the additional cost that incurs. The resident have the right of using their hospice benefits, if he waves his/her Medicare A benefits Hospice is the better route at this time for this residnt.They will work at controlling any pain, end stage issues that he may have at this point. Have your social worker call a family meeting with all the interdisciplinary team and present this option to them. Good Luck!