Post a description of a case from your personal or clinical experiences in the last 5 years that involves an elderly patient who has been in at least two different sites of care. Explain the impact of differences in the settings themselves, inherent culture of the settings, and ethical practices of these sites on the patient. Then, explain whether the patient had an advanced directive in place at the time of the change in sites of care, and if so, whether any difficult treatment decisions had to be made as a result. Finally, explain the impact of financial issues on site placement and treatment decisions.