How we think through care
Clinical judgment and conversations that guide the plan.
Our approach connects a resident’s baseline, changes in condition, facility capabilities, and personal goals. The details below explain the principles behind the work; each facility’s responsibilities and coverage are defined before services begin.
Our clinical approach
A critical care perspective.
Grounded in post-acute care.
Dr. Rishi Gulati combines his experience in post-acute and long-term care with fellowship training in critical care medicine.
That perspective connects changes in breathing, circulation, alertness, and function with a practical plan for the resident and care team.
- 01Recognize a change
- 02Assess in context
- 03Communicate the plan
- 04Reassess and escalate
Respiratory support in context
Conventional oxygen, high-flow nasal cannula, CPAP, and BiPAP serve different purposes. Understanding their capabilities and limitations helps inform the review of respiratory needs, treatment response, and the appropriate care setting.
Oxygen saturation is considered alongside breathing effort, respiratory rate, changing oxygen requirements, and alertness. A pulse oximeter does not measure carbon dioxide.
Changes that matter over time
A resident’s usual baseline and recent trajectory give meaning to individual readings. Increasing oxygen needs, new confusion, reduced intake, or declining activity tolerance may warrant reassessment even when another measurement appears reassuring.
Circulation assessed at the bedside
Capillary refill, skin temperature, blood pressure, heart rate, alertness, and available urine-output information can contribute to the assessment of circulation. Each finding is interpreted in context; capillary refill is one part of the examination.
The connections between medical problems
Breathing difficulty can involve the lungs, heart, fluid balance, kidney function, medications, or several factors together. A connected assessment considers how these problems interact and how the resident responds to the care plan.
A clear next step for the care team
A useful clinical plan identifies what to observe, when reassessment is needed, whom to contact, and which changes require urgent evaluation. Clear communication with nursing and respiratory therapy, where available, supports a shared understanding of the plan.
Continuity through recovery
Hospital transitions require an understanding of the illness course, current respiratory support, medication changes, pending results, and follow-up needs. Recovery planning also considers cognition, nutrition, mobility, and the resident’s goals of care.
Care decisions reflect the resident’s goals and the facility’s staffing, equipment, monitoring capabilities, and ability to escalate care. Advanced respiratory support requires an appropriately equipped and staffed setting; acute deterioration may require emergency evaluation.
Goals of care & family conversations
Clear conversations.
Care that reflects what matters.
When illness changes the plan, residents and families deserve a clear conversation. Dr. Gulati’s critical care experience informs how he listens, explains complex medical situations, and supports people through uncertainty.
Our aim is for residents and families to feel heard, informed, and supported—with space for questions, emotions, and honest discussion about what lies ahead.
Listen carefully
Begin with the resident’s values, priorities, and understanding of their illness. Include loved ones as the resident wishes and an authorized decision-maker when needed. Make room for fears, hopes, and cultural or spiritual concerns.
Explain clearly
Discuss the medical picture, likely course, and treatment options in plain language—including potential benefits, burdens, and uncertainty. Offer compassionate support through difficult news and decisions.
Plan together
Connect the resident’s priorities to a documented care plan and revisit it as their condition or wishes change. Goals may include recovery, maintaining function, life-prolonging treatment, comfort, or a combination.
A shared understanding for the care team
Working with facility staff, these conversations help clarify the resident’s preferences, the plan for changes in condition, and what should be communicated across shifts and care transitions.
Facility partnerships
Define a plan that fits your setting.
Tell us your facility location and broad physician needs. Please do not send patient information through this website.