Bob: When a Fall is More Than a Fall
Bob had recently become an Aging Wisely client and his care manager would be working with his family to set up some services and start to look at the possibility of moving to assisted living locally or near his long-distance caregiver daughter. Shortly after their first visit, the care manager received a call from Bob’s daughter. He had fallen the previous night and had failed to push his emergency response button. A neighbor had finally discovered the situation that morning and called his daughter and 911.
The care manager met Bob at the hospital. Though they had only worked together briefly, she had his updated medical history and medication list to help him provide to the E.R. staff. (Bob had a crumpled list of medications in his pocket which was a bit outdated and stumbled over a few questions, turning to the care manager to fill in some blanks.) She was also able to gently give a little background to the emergency room physician so that he understood Bob was living alone and experiencing some self-care challenges as recently evidenced by the fall situation. The care manager contacted Bob’s daughter to keep her apprised. She had been scheduled to leave in the next couple days for a major overseas trip and was contemplating cancelling.
As the care manager worked with the emergency room team, Bob and his daughter, they were able to come up with a plan. The doctor determined there was sufficient reason to admit Bob for some further testing even though it did not appear he had any broken bones. Meanwhile, the care manager would begin working on a temporary solution for after-care involving either rehabilitation or a respite stay in assisted living. Since they had been contemplating a transition anyway and in light of the fall, this plan seemed most logical and safe. The care manager could handle the details and make sure the process went smoothly for Bob, while reevaluating to determine a longer-term plan.
Mary: Communication Confusion in the E.R.
Mary lived in a Largo nursing home and her care was overseen by one of Aging Wisely’s care managers. All but distant, elderly relatives had died and her primary local contact besides her care manager was her long-time C.P.A. who managed her affairs and had agreed to serve as her power of attorney and healthcare surrogate. Mary had mid-stage dementia and a long history of agitation and depression. In the past, she had several “incidents” due to these issues but had been managing well lately due to consistent care coordination. She was fairly settled in to her life at the nursing home. When big changes might disrupt her routine, her care manager was a calming presence to her. The care manager also helped others to understand how to best approach Mary.
Her nurses noticed some concerning symptoms when checking on Mary and contacted her care manager to let her know they would be calling for an ambulance. The care manager was able to arrive just moments after Mary…which was a very good thing due to the potential for “communication confusion”. For one thing, this type of change was likely to cause Mary to become agitated and act out. For another, emergency room staff would have been able to get very little information from Mary. She had some difficulty hearing in addition to her dementia. The care manager was able to give the staff a full background, as well as bring Mary’s “communication board”, a small white board which could assist when staff wanted to ask some basic questions to Mary. The care manager helped to reassure Mary and prepare her as the doctors ran some tests. She also communicated to Mary’s C.P.A. about what was going on and discussed next steps.
It turned out Mary could be released directly from the E.R. as her tests revealed she was stable. The care manager made a specialist follow-up appointment and communicated about her return to the nursing home. She made sure the nursing home would get Mary a meal upon her return since she had missed lunch. She arranged transportation and double-checked the medication and treatment information was properly communicated to her nursing home staff.
Lucille: Why Am I Here?
Lucille lived in a Palm Harbor Assisted Living Facility. The facility contacted Lucille’s local daughter after noticing some changes to her vital signs and contacting an ambulance to take her to be evaluated. Her daughter called her Aging Wisely care manager, who had been assisting with coordinating Lucille’s medical and care needs. Her daughter was planning to leave work to meet Mom, but after discussing the situation decided to have her care manager meet her there initially since she had the best handle on Mom’s medical needs.
Lucille had Alzheimer’s disease and usually recognized familiar people such as the care manager and her daughter, but generally was not oriented to place or time. She seemed happy to see the care manager, but kept asking where she was and what was happening. The care manager was able to reassure her and also ensure she was comfortable, getting her a drink of water and a couple extra blankets when she was cold. She helped to give the necessary background information to the emergency department staff and coordinated with the client’s daughter, who came over to the E.R. when she finished at work.
As the medical team was evaluating the patient, the care manager helped to clarify some information and answer some of the daughter’s concerns. In the end, the client returned to the assisted living with some new medications and support services. The care manager set up a care plan meeting to ensure consistent care for the client in accordance with her wishes and minimize potentially unnecessary hospital trips.
Need help with patient advocacy in Florida? Worried about an aging parent who lives in the Tampa Bay area or want help dealing with (and preventing) emergencies? Call us at 727-447-5845.