SAMPLE CASE SCENARIO

Here is a fictitious case scenario utilizing all services provided in the home. Some patients may require one of the services listed below or any number of combinations of services to meet their healthcare needs. Medicare requires that skilled nursing and/or therapy services be provided before aide and/or social services can be given. If only aide services are required, community resources or registries offering aide services should be sought. Our agency can assist in identifying some of these resources for you.

The Case of Mrs. Smith
Mrs. Smith is 80 years old, lives alone and is very proud of her independence. Her osteoporosis and arthritis have progressed to the point that she can hardly get up out of the furniture that she has had in her home for fifty years. This makes it virtually impossible for her to walk a few blocks to the neighborhood market for groceries. Her children live over two hours away and are unable to help her with routine shopping or to take her to the doctor's office for her appointments. Her painful back and joints are interfering with her sleep, and she is becoming depressed about her situation. The family speaks to Mrs. Smith's physician about possibly having to place her in a nursing home.

The physician calls our agency ordering the following services with the goal of keeping Mrs. Smith independent in her home. The team moves into action as follows:

Nurse
The nurse checks Mrs. Smith's medications and finds she has not been using them properly to control her disease process and pain. Mrs. Smith said that the medications were too expensive, her arthritis interfered with her ability to open the bottles at times, and it was difficult for her to always remember to take the medications. The nurse establishes a method that makes it easier for Mrs. Smith to open the containers. Mrs. Smith learns effective ways to use her medicines for the best results. Side effects and adverse reactions are explained so Mrs. Smith can identify these and report them to the physician to avoid other health problems. The nurse seeks the help of the social worker to address the cost of Mrs. Smith's medications and will ask the speech therapist to help with memory aids.

Social Worker
The social worker, with the assistance of Mrs. Smith's physician, is able to contact programs offered through pharmaceutical companies that provide some of Mrs. Smith's medications to her free of charge. The savings found through this and in other community programs allow Mrs. Smith to hire help one day a week for household tasks she is no longer able to do. The social worker also makes arrangements for community programs to provide Mrs. Smith with hot meals during the week and transportation to appointments. A "Lifeline" system is installed. Via a button worn on the wrist or on a necklace, Lifelines will sends an emergency signal through the phone if Mrs. Smith falls or needs other emergency assistance. A portable telephone is obtained free of charge through the phone company. This reduces the risk of falls from tripping over telephone cords Mrs. Smith had running throughout her home.

Home Health Aide
The aide helps Mrs. Smith safely take a shower. Since Mrs. Smith has been able to only take spit baths since she almost slipped and fell in the tub a year ago, a shower is a welcome and appreciated change. The aide washes her hair, does her laundry, lightly cleans the bathroom, bedroom and kitchen and makes a quick snack before she leaves. The aide can also pick up a few items from the market for Mrs. Smith. Home Care provides this service two or three times a week, depending on Mrs. Smith's needs and until other help is obtained or she is able to assume her own care.

Physical Therapist
Mrs. Smith's legs had become very weak, making it hard for her to get up from the commode and/or furniture. The therapist finds a bedside commode to place over the toilet so Mrs. Smith can more easily change from a sitting to standing position. The therapist also raises some of the furniture onto wooden blocks so they will be at a more comfortable height. Mrs. Smith learns to pace her activities, and how to perform some exercises to increase her strength and range of motion and decrease her joint pain and stiffness. When Mrs. Smith gets strong enough, she may also join the water exercise program offered by St. Helena Hospital.

Occupational Therapist
The occupational therapist works with Mrs. Smith in finding ways to accomplish activities of daily living in a safe and energy-efficient way. Equipment identified as being needed in the bathroom are grab bars, a bath bench and a hand-held shower. Once these are installed, Mrs. Smith is able to take a shower independently. The warm water from the shower is therapeutic to her stiff joints in the morning. She also gains self-satisfaction from knowing she can still meet her personal care needs independently, which improves her mental outlook on life. Shelves in the kitchen are rearranged so necessary items are within reach. Different plates and utensils that are lighter and easier for Mrs. Smith to handle with her arthritic hands are obtained. The therapist suggests clothing such as sweat pants, slip-on shoes and pullover shirts to avoid difficult-to-manage buttons, zippers and other fasteners. The occupational therapist works closely with Mrs. Smith in each room of the home to identify other measures that simplify her life.

Speech Therapist
Mrs. Smith is found to have some memory problems. She frequently forgets the time and day of the week. This interferes with her keeping appointments and remembering her medications, some of which she must take up to four times a day. The speech therapist initiates a calendar and memory book system with Mrs. Smith. A medi-set is purchased to help organize her medications. Mrs. Smith learns multiple compensatory measures, which not only help her remember to take her medications, but keep her oriented to appointments and how to organize her life.

End Result
A month later the Home Care team discharges Mrs. Smith from services. Mrs. Smith's pain is controlled and her mobility is improved. She is taking her medications correctly and making all scheduled physician appointments. Mrs. Smith and her family feel she is safe to remain at home and her overall quality of life is improved.

The degree of success of each case depends on a multitude of factors. It is the goal of our Home Care team to work with the patient and the family to keep the patient at his or her highest level of functioning in a safe, optimal environment. The most optimal environment for most of us is in our own home.