ConciergeCare received a call from a trust officer about one of his fairly new clients, Mrs. Donaldson. One of his services as her trust officer was to send payments from her trust to the assisted living facility where she had an apartment.
The officer noticed that Mrs. Donaldson’s health and cognitive state seemed significantly different each time he saw her, and her son (who lived out of state) had mentioned by phone that Mrs. Donaldson had fallen several times in the recent past. Because of the trust officer’s fiduciary duty to Mrs. Donaldson, he wanted assistance and reassurance that her money was truly spent in her best interests.
With Mrs. Donaldson’s consent, we met with her and her son during his visit to Kansas City, and engaged them in ConciergeCare’s thorough assessment process. We found several areas for intervention, the most pressing of which were that Mrs. Donaldson was falling (consistently in the evening hours), and was having recurring urinary tract infections that were not being communicated quickly to her doctor. These two factors were causing frequent emergency room visits, not to mention bouts of confusion related to the infections that were uncharacteristic for this otherwise very clear-minded woman.
Because staying at the assisted living level of care was so important to Mrs. Donaldson—she loved her cozy apartment and did not want to move into a nursing home—ConciergeCare created a plan for her to do just that.
Examples of just a few of the resources ConciergeCare put in place to improve Mrs. Donaldson’s quality of life:
- A care companion for the evening hours—a young lady whom Mrs. Donaldson grew to think of as family,
- Easy “fixes” within Mrs. Donaldson’s apartment to help prevent falls,
- Weekly visits to Mrs. Donaldson at her assisted living apartment, to look for obvious problems and to keep good communication flowing from assisted living care staff → ConciergeCare → Mrs. Donaldson’s doctors → and back,
- Facilitation of an order from Mrs. Donaldson’s doctor for physical therapy to come to her apartment 3x/week for balance training,
- A visit to a local urologist to evaluate reasons for the frequent infections and make recommendations,
- Ongoing coaching for Mrs. Donaldson in methods of preventing urinary tract infection.
Over the past year, Mrs. Donaldson has had one mild urinary tract infection that was caught early, and zero falls in her comfortable apartment. She and her son both report satisfaction with her quality of life, and her trust officer is much less nervous!
Janice’s mother, Esther, is in a moderate stage of Alzheimer’s dementia. She had been relatively content at a local memory care facility over the past year, but this was unfortunately not to last. Janice called ConciergeCare for help after Esther had fallen, fractured her tailbone, and landed in the hospital closest to her facility. Janice felt like her mother was in too much pain and it wasn’t being addressed by the hospital staff. Janice couldn’t be at the hospital around the clock due to her own family and work obligations, and was exhausted from spending every spare hour she could at Esther’s bedside.
When the ConciergeCare RN arrived at the hospital to assess the situation, she found Esther’s room was on a general medical-surgical unit. Esther was lying flat on her back unattended and calling out “Help!” repetitively. Her covers were off, leaving her fairly exposed, and she had removed her ill-fitting incontinence brief. The charge nurse on duty said the unit did not have enough staff to provide a “1:1” sitter for Esther, but they were checking on her as often as they could. When the ConciergeCare RN assisted a nurse’s aide to put Esther’s incontinence brief back in place, she noted a pink area on Esther’s tailbone.
Despite Esther’s significant disorientation, the ConciergeCare RN could tell Esther was in a lot of pain and confused about why she couldn’t move without hurting. Esther’s nurse said night staff reported Esther didn’t seem to be hurting “as long as they didn’t move her or raise the head of her bed,” so he was continuing that plan. He mentioned not wanting to give pain medication other than ibuprofen to such an elderly person.
The nurse also reported that Esther wasn’t eating anything from her meal trays, so the physician was talking about a feeding tube for nutrition. (Indeed, a full meal tray was delivered to Esther’s room while ConciergeCare was present, but no staff arrived to help her eat.) Finally, while physical therapy had been consulted, Esther had refused to participate in therapy because it hurt. So far, she had been flat in bed for three days.
ConciergeCare Services Provided:
It was clear there were multiple problems with the care Esther was receiving. ConciergeCare developed a Plan of Care for Esther that was implemented during her hospital stay after requesting a family conference with the attending physician, case manager, physical therapy manager, and charge nurse. The Plan included the following interventions:
- Esther was transferred to the hospital’s orthopedic unit, where nursing staff was more current in best practices for fracture management.
- Undertreating pain in the elderly can lead to states of delirium. Ibuprofen was discontinued, as that class of medication may disrupt bone healing. A set schedule was ordered for IV pain relief to be given, with extra-strength Tylenol given between the IV doses.
- With Janice’s consent, ConciergeCare arranged for a companion-level caregiver to stay at Esther’s bedside during the hours Janice was unavailable. The caregiver was directed to provide frequent mouth care, assist Esther to eat, engage her in conversation to help with her disorientation, and ensure staff was repositioning Esther in bed, to avoid bed sores.
- Early mobilization is crucial to elderly fracture patients, to avoid other life-threatening complications. The physical therapy manager agreed to coordinate with nursing staff so that Esther’s therapies would take place ~30 minutes after receiving IV pain medication.
- Once Esther was receiving adequate pain relief, she could stand to have the head of the bed high enough to eat. Nutritional shakes were also ordered to supplement her low meal intake.
ConciergeCare assisted Esther and Janice throughout Esther’s hospitalization and rehabilitation. Esther is back to her memory care facility, using a walker well, and participating in a daily exercise program run by the facility’s staff.
Ruth is employed full time and has two children at home, one who is high school-aged and one who has just started college. She lives several states away from her mother, Betty, and has spent the last few months flying back and forth to stay on top of her mother’s increasing needs. Betty has had several minor falls in her home as well as some ongoing medical issues requiring frequent doctors’ visits.
Since her father died last year, Ruth has worried for Betty’s safety at home—her dad had always doted on and helped her mother around the house. Ruth also worries about balancing care for her mother with meeting her job requirements and being available to her daughters. She has already missed several days of work due to Betty’s needs.
ConciergeCare met with Ruth and Betty at Betty’s home. We found that Betty was also recognizing that her medical situation was worsening and was fearful that one more fall could be the “bad one” that changed everything for her.
ConciergeCare Services Provided:
Assessing the whole picture for this family revealed a number of ways in which ConciergeCare could help Ruth and Betty manage the changes in Betty’s life. We put in place the following, with Ruth’s and Betty’s approval:
- Our RN created an Integrated Health Record for Betty that is kept updated with all changes in medications or treatment; Ruth also has electronic access to it so that she can refer to it when talking long-distance with Betty’s care providers. The IHR process gave Ruth and Betty clarity about Betty’s health problems and how they could be better managed. ConciergeCare faxes updates from the IHR to Betty’s doctors before each of her appointments, so the doctor has accurate information about what has transpired since Betty was last seen at his or her office.
- After discovering deficits in appropriate legal documents and financial planning, we connected Betty and Ruth to an elder law attorney and a financial planner, who assisted them with power of attorney documents and gave them a true picture of Betty’s assets—an area that was always handled by Ruth’s father.
- The ConciergeCare Plan we presented to Ruth and Betty included the option of Betty staying in her own home with renovations for safety, private home care, meal delivery, and outside transportation. But after visiting several assisted living communities we recommended based on Betty’s needs and the financial plan established for her, Betty decided she would feel safer and less isolated socially by moving into her favorite of those.
- ConciergeCare then connected Betty and Ruth to an excellent realtor, an estate sale company, and a senior move manager so that her transition to assisted living was smooth and didn’t require Ruth to take a leave of absence from her job. The senior move specialist ensured that Betty’s favorite belongings were saved and well-organized in her new space, which was of great importance to Betty as she “down-sized.”
- The ConciergeCare RN continues to visit Betty monthly to check on any needs and changes. She attends certain of Betty’s doctor appointments with her when problems arise and extra communication is needed. She interfaces with the assisted living nursing staff to make sure Betty’s medication changes are always correct and that other medical needs are consistently met.
Ruth is now able to visit when she has vacation time from work—not having to leave abruptly for emergencies. She keeps in close communication with ConciergeCare using a secure on-line platform, where she is able to receive updates. Betty is thriving socially in her new community—successfully beginning a phase of life that seemed overwhelming initially with the loss of her husband.
Mary is the director of human resources at a mid-sized employer. Many of the company’s employees come to Mary seeking solutions for problems that affect their job performance and attendance.
Frequently, the problems involve employee’s aging parents—and the need to take time off to provide care, arrange care, physically move a parent to a new living situation, or attend doctor’s appointments with a parent because of a new medical situation. Mary knows from experience that employees with these challenges can also fall prey to “presenteeism”—they may physically be at work, but end up spending time on multiple phone calls of a personal nature or web research to find resources.
Similarly, other employees may have chronic illnesses that are difficult to oversee—requiring frequent doctor’s appointments, telephone calls about the condition or medication side effects, and necessary actions to “pick up the slack” in communication flow between medical specialists. Still others deal with more sudden healthcare crises—their own or other family members.
One of the company’s internal missions is to be the mid-sized employer of choice in the area. Mary plans to develop programs of tangible assistance to employees, but is not sure what will best serve them.
ConciergeCare Services Provided:
ConciergeCare worked with Mary and her company to build a benefit package to offer employees. Following are the particular services that Mary’s company chose to best serve their employee population. Employees are able to choose any or all of the offerings, and the quarterly education piece is available to all employees:
- One professional assessment and Plan of Care by ConciergeCare’s social worker and registered nurse (per employee or immediate family member per year);
- Integrated Health Record creation and maintenance for employee or immediate family member;
- Healthcare and/or aging navigation for employee or immediate family member, up to 30 hours per fiscal year at a reduced rate;
- Quarterly educational offerings at Mary’s company about topics in healthcare, caregiving, and planning for aging (topics chosen by company after surveying employees);
- Hospital or healthcare billing navigation, up to 15 hours per fiscal year at a reduced rate.
After the first year, an internal assessment of the new offering revealed employees who had taken advantage of the ConciergeCare benefit were eager for the assistance to continue. Employees with chronic ailments who had taken advantage of the benefit had reduced their own absenteeism by a small but significant percentage, and across the board, managers reported a decrease in their perceptions of “presenteeism” within their departments.
Elizabeth is the 56-year-old CFO of a large local company. She thrives on her work and is also involved in the community as a board member and fundraiser for a civic organization. Two years ago, Elizabeth had a heart attack, and her hospital stay revealed she had developed diabetes and sleep apnea. Simultaneously, a bothersome hip issue seemed to be intensifying, and she felt like chronic pain was her new future.
This cascade of problems left Elizabeth depressed, and she was overwhelmed by the new specialists she was supposed to visit, and the new medications she was supposed to try. She genuinely wanted to do everything that was recommended to feel better … But the number of phone calls it took to make and change appointments, the time she spent at the appointments and the pharmacy, the energy it took to research her health problems and who might best help her, the days she needed to be home early to meet the medical equipment company to straighten out CPAP problems—it all made her feel like her career was in jeopardy.
So what did Elizabeth do? She stopped looking for answers, started missing appointments, stopped wearing her CPAP, and felt worse and worse.
Her daughter Jane called ConciergeCare because she truly worried that Elizabeth couldn’t go on this way. Elizabeth wouldn’t let Jane take the reins–she is very private and didn’t want Jane to become the “parent” in the relationship by taking control.
ConciergeCare Services Provided:
The Registered Nurse for ConciergeCare met with Elizabeth at a time outside of business hours, and during the assessment explained ConciergeCare’s policy of complete privacy in all client matters. As a business person, Elizabeth felt a comfort level that she could entrust her health management to professionals who work within set codes of ethical standards. Together, they mapped out a way forward, which included the following interventions to allow Elizabeth to devote herself to her career:
- ConciergeCare’s RN became the first contact person for all of Elizabeth’s physicians, therapists, pharmacy, and medical equipment company. The RN scheduled all appointments, took all calls from medical personnel, notified medical offices of any necessary changes or cancellations, kept an Integrated Health Record up to date with results of each appointment or diagnostic test, arranged for CPAP and oxygen equipment when Elizabeth traveled, and calendared all follow-up care that was recommended.
- ConciergeCare picked up and delivered Elizabeth’s prescriptions and supplements.
- ConciergeCare’s RN met Elizabeth weekly to assess pain levels and pain relief interventions, review blood sugar readings, check on sleep quality with CPAP therapy, and offer support for recommended regimens. Based on this assessment, the RN could recommend different approaches or contact Elizabeth’s specialists for her if necessary.
- Over time, Elizabeth decided to have ConciergeCare’s RN attend appointments with her to be her “eyes and ears”—she liked that the RN could offer the physician information that she might have forgotten or overlooked as important.
Elizabeth now focuses on her company’s finances and her favorite civic activities, without worrying about the job of being administrative assistant of her “medical life.” She has lost weight and managed her diabetes so well that she now controls it with diet alone. Managing her diabetes and sleep apnea has decreased her cardiac risks. A course of physical therapy has given her a simple routine that she does at home to prevent hip muscle strain. Elizabeth and Jane have preserved their mother-daughter relationship without Jane taking on a caregiving role that made Elizabeth uncomfortable.