Alzheimer's Dementia

Referral Circumstances:

Oxford Healthcare received an on-line inquiry about services for a mother. The daughter who lives out of state reported that her mother seems to be forgetful, argumentative, and has isolated herself from friends. Last week law enforcement had stopped her for driving improperly and suspended her driver’s license. A trip the emergency room had no significant findings.

Demographics:

72 year old female who lives alone. Has been very independent and active. Is very private and desires to continue living in the home that she and her late husband had custom built. Patient is demanding to drive.

Diagnosis

Dementia Suspected and later confirmed

Care Plan:

Oxford HealthCare RN visited the home within 2 hours of Saturday inquiry. RN completed health assessment and developed a private duty care plan that included: safety-supervision, bathing assist, dressing assist, cooking, eating reminders, medication reminders, grocery shopping, transportation, light house cleaning, and socialization. RN reviewed findings of patient’s assessment with family. Medical Evaluation set for Monday morning. Claim initiated with patient’s long term care insurance company. Private Duty aide services scheduled for 24-7 care.

Care:

A team of Certified Home Health Aides was formed for 24-7 care. 8 hour shifts scheduled Monday through Friday. 12 hour shifts scheduled on the Weekends. The Certified Home Health Aides ensured that this patient was safe, properly groomed and dressed, eating, not driving, all medical appointments kept, taking medications on time, and maintaining social outings. The Oxford RN provided frequent aide supervision and ongoing care coordination with her physicians and family. The patient was diagnosed with Alzheimer’s Dementia. In the final stages, private duty certified home health aides worked in conjunction with hospice. The RN modified the patient’s care plan to take care of her increasing needs such as feeding, incontinence care, and ambulation assist. The patient was able to live out her days at home. The daughter was able to have peace of mind about her mother’s care.

Payor Source:

The patient’s long term care insurance covered 50% of her care. The other 50% of her care was paid by a reverse mortgage loan.

Congestive Heart Failure

Referral Circumstances:
Concerned granddaughter requested 24/7 care for her grandfather who was living with her and her family. Granddaughter was partial owner of a local business requiring her to work long and sometimes evening hours.

Demographics:
88 yr. old widowed male

Diagnosis:
Congestive Heart Failure
Complicating Factor: Multiple sensory deficits

Care Plan:
Oxford HealthCare’s Certified Home Health Aide’s provided 24/7 care in the home. CHHA’s assisted with activities of daily living, including, bathing, dressing, incontinence care, repositioning, safety supervision, transfers, laundry, meal preparation, feeding assistance and light housekeeping. In addition, vital signs monitoring, oxygen monitoring, and coordination of care with hospice regarding use of “as needed” medications were provided. RN supervisory visits are provided every 60 days and more often as needed.

Payor Source:
Out of town family was able to pool resources together to allow for extended care in the home.

End of Life Care

Referral Circumstances:
Oxford HealthCare was contacted by a hospice agency requesting immediate support caring for a terminal patient whose spouse needed rest.

Demographics:
85 year old terminal male with 82 year old spouse

Diagnosis:
End stage Cancer. Patient up all night. Bed Bound. Risk of Bed Sores.

Care Plan:
Oxford HealthCare RN visited the home within 4 hours of call. RN developed a private duty care plan that included: vital sign monitoring, bed baths, incontinent care, turning, skin monitoring, feeding, companionship, and safety-supervision. RN met with first aide on shift and reviewed care plan. RN completed care management with hospice and family to plan private duty shifts in coordination with hospice visits and ensure supplies and equipment needed on site.

Care:
Oxford HealthCare’s Certified Home Health Aides cared for patient 7p-7a for 4 nights. The patient was kept clean and dry, turned for comfort and reduced risk of pressure sores, hydrated with water, monitored throughout the night for safety, and enjoyed conversation with the aide on duty. The aide received on-going direction from the Oxford HealthCare RN. The wife slept during the night shifts and spent meaningful time with her husband during the day. On the 4th night, the aide noted rapid changes in his vital signs. She woke up the spouse and notified hospice of impending death. The wife was by her husband’s side and able to share last words as he passed away. The aide comforted the wife and assisted as needed until hospice and family arrived.

Payor Source:
The wife paid out of pocket for immediate, end of life care. She was very grateful to spend quality time with her husband before his death. The aide provided much relief in doing the hands on tasks and comfort care at night

Care of the Client with Diabetes

Referral Circumstances:
A concerned neighbor and friend contacted Oxford HealthCare requesting information on personal care assistance available through the agency. The friend reported that her neighbor frequently needed emergency transportation to the hospital for shortness of breath and problems related to her diabetes.

Demographics:
72 yr. old widowed woman living alone in her own home

Diagnosis:
Unstable Type II insulin dependent diabetes
Complicating factor: mental health diagnosis

Care Plan:
A Certified Home Health Aide provides assistance with activities of daily living 4 hours a day, 6 days a week. Increased hours will be provided as needed, including assistance with bathing, dressing, meal preparation, medication reminders, safety supervision, light housekeeping, errands and laundry. In addition, Certified Home Health Aide provides assistance with vital signs and blood sugar monitoring. RN supervisory support is available 24/7.

Payor Source:
Client did a reverse mortgage in order to receive care for an extended amount of time in her home.