Martha’s Comeback
Martha is 76 years young. Last year Martha was hospitalized on several occasions because of aspiration pneumonia. Her provider at that time was having a very hard time assisting her during meals. During her second hospitalization she was also diagnosed with malnutrition. The doctors initially wanted to insert a feeding tube however there was no one to sign for one. We talked with doctors and requested a barium swallow to determine if there might be other reasons why she was aspirating, such as being fed too fast, food not be consistent and appropriate texture, etc.
As she remained in the hospital she was placed in restraints because she was taking out her NG tube and taking off her oxygen. Doctors were insisting that someone sign a DNR order and also determined that she was not a candidate for a g-tube due to her “picking” behaviors. Martha’s provider refused to continue to support her.
Creative Consulting Services has developed many provider relationships over the years and her Support Coordination team determined that Martha would not go to a nursing home. We found a provider who has very specific skill sets in supporting folks who have medical complexities with respect, compassion and dignity. This provider came and visited with Martha in the hospital, reviewed her documentation and spoke at length with hospital staff and physicians. They had an opening and determined that Martha was a match with the other individual in the home. Support Coordination met with the provider and Martha at the hospital throughout this transition.
We did hit a roadblock when we were trying to find support for her to sign discharge and other documentation, as doctors believed she did not have capacity to sign for herself. We were able to introduce a community member that knew the Area Coordinator to Martha and that was all it took.
Martha moved into her new home on March 2, 2016. She is thriving. She is an avid collector of hats and loves parties. You can see the change in her yourself by the before and after pictures below. Martha is an example of a life well lived no matter what your age or medical complexity. It just takes a circle of support who cares.
As she remained in the hospital she was placed in restraints because she was taking out her NG tube and taking off her oxygen. Doctors were insisting that someone sign a DNR order and also determined that she was not a candidate for a g-tube due to her “picking” behaviors. Martha’s provider refused to continue to support her.
Creative Consulting Services has developed many provider relationships over the years and her Support Coordination team determined that Martha would not go to a nursing home. We found a provider who has very specific skill sets in supporting folks who have medical complexities with respect, compassion and dignity. This provider came and visited with Martha in the hospital, reviewed her documentation and spoke at length with hospital staff and physicians. They had an opening and determined that Martha was a match with the other individual in the home. Support Coordination met with the provider and Martha at the hospital throughout this transition.
We did hit a roadblock when we were trying to find support for her to sign discharge and other documentation, as doctors believed she did not have capacity to sign for herself. We were able to introduce a community member that knew the Area Coordinator to Martha and that was all it took.
Martha moved into her new home on March 2, 2016. She is thriving. She is an avid collector of hats and loves parties. You can see the change in her yourself by the before and after pictures below. Martha is an example of a life well lived no matter what your age or medical complexity. It just takes a circle of support who cares.
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