The issue of when to transfer nursing home residents to a hospital requires several considerations. In some nursing homes, physicians, nurse practitioners, or physician assistants are present for several hours every day, and a highly skilled nursing staff is available to manage IV lines, suctioning equipment, and sometimes ventilators. In other nursing homes, physician visits are sporadic, and few experienced nurses are on staff; therefore, a patient may need to be transferred to a hospital for technical or highly skilled care.
Nursing home staff often try to avoid hospitalizing patients, because all too often patients return from a hospitalization with urinary cathe¬ters and pressure sores. Patients are often confused, severely decondi-tioned, and receiving psychoactive medications. Many families and res¬idents also prefer to avoid hospitalization not only for these reasons but because treatment in hospitals can be dehumanizing and impersonal.
When transfer to a hospital does occur, medical records should ac¬company the patient. A phone call from a nursing home nurse to a hos¬pital nurse is useful to explain the patient’s diagnosis and reason for transfer, the patient’s baseline functional and mental status, the pa¬tient’s medications, and care directives as expressed in a living will

Seborrheic Dermatitis
A scaly, erythematous eruption affecting the central part of the face, eyebrows, eyelids, nasolabial folds, postauricular and beard areas, scalp, and body flexures. The central chest and interscapular areas can also be affected. Seborrheic dermatitis affecting the eyelids causes blepharitis and sometimes associated conjunctivitis. Despite its name, seborrheic dermatitis appears to have nothing to do with sebum.
Treatment: Seborrheic dermatitis of the scalp can be effectively treated with various shampoos. Active ingredients include sulfur, zinc pyri-thione, salicylic acid and sulfur, and tar. The scalp should be shampooed frequently, daily if necessary, and the product left in contact with the scalp for the recommended interval, usually 5 min. If shampooing is inconvenient or physically impossible, the patient can use topical corticosteroid lotions instead. Applied to the scalp bid, such lotions are helpful in severe cases. Hydrocortisone 1% lotion is often sufficient, but many fluorinated corticosteroid preparations are available as well.
Seborrheic dermatitis of the face and trunk is usually effectively treated with hydrocortisone 1% cream applied bid or tid. Preparations containing sulfur or salicylic acid are also helpful.
Seborrheic blepharitis can be treated with hydrocortisone 1% cream. If associated conjunctivitis requires intraocular administration of a corticosteroid ointment or suspension, an ophthalmologist may need to monitor intraocular pressure.
Irritant Contact Dermatitis
The most common form of contact dermatitis, this condition results from skin contact with strong chemicals or other irritants. Although the elderly have a less pronounced inflammatory response to most irritants than do younger patients, chronic irritant dermatitis occurs frequently in the elderly. The reason may be that their slower, muted cutaneous reactions make the contactant less obvious, so exposure continues.