General Update #94

Rachael Kimble followed up with Dusty's previous emailed request for communication.
Joyce has a telehealth appointment tomorrow at 10:45 a.m. Aspen Park's RCM (Maggie) will check in with Dr. Collins prior to the appointment to help with the appointment. Progress, discharge and overall health of Joyce will be discussed. 

Abby noticed that Joyce is self-limiting herself with therapy (not doing all that she is being asked). Dusty asked for clarification on if Joyce is refusing to do the work (attitude), cannot comprehend mentally what is being asked of her (mental faculties issue), or other issue occurring. 

Abby would like Joyce to do the UI program to help with incontinence and skin issues, which is something that Dusty might be able to talk to her about doing therapy. Dusty was confused at this as he thought this was already underway from previous communications with Aspen Park staff and so asked for clarification. 

Currently Joyce's goal for discharge is slated for next week. 
PT/OT are looking at max potential next week - Dusty asked for clarification on this.

Joyce still needs help in the bathroom and overall help in the home with caregivers, according to Rachael. Rachael asked if this is something that Joyce's family would be willing to have in the home. The therapy team suggests having someone with Joyce 1-2 hours per day and having someone to help with meals. Dusty confirmed that the family is going to be determining a plan to meet those suggestions for support of Joyce. 

Rachael provided these options for in home care if the family wanted to pursue pricing:

Seubert’s Quality Home Care 
208.883.1114 Moscow Office 

Alternative Nursing Services
208.882.0616 Moscow Office  

Family Home Care 
208.874.2329 Moscow Office  

Care Connections  Home Care LLC 
208.892.3774 Moscow Office  

Adult Day Health  
208.883.6483 Moscow 

Disability Action Center 
208.883.0523 Moscow Idaho  

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Dusty called and spoke with Rachael to discuss Joyce's discharge plan and other items listed above where he noted requests for clarification. 

Rachael stated that Joyce tires easily and cannot complete all the work that therapy attempts to get her to complete at each session. Her attitude is good, her energy levels do not permit her to make it through full course of work. Aspen Park OT/PT believe that Joyce has reached the upper limit of gains they can achieve with her in her current state and that prolonging her stay at Aspen Park for additional therapy work would not be productive at this point. 

Rachael stated that Joyce declined to do the urinary incontinence therapy work with the Aspen Park staff. Dusty asked why that was the case and Rachel responded that Joyce was given the option and declined, possibly out of embarrassment or other reasoning. Urinary incontinence therapy work can be undertaken via home health if desired. Currently, with Joyce's discharge date approaching, would be too late in starting the program work now. Rachael confirmed in the notes taken by Aspen Park staff that Joyce is able to toilet by herself a majority of the time (as Joyce self-reported to Dusty via phone in previous conversations) but sometimes uses the staff for "stand by assistance" at times. The staff have been attempting to discourage this to promote full independence but Joyce requests it potentially when she is feeling insecure or possibly afraid, Rachael suggested. Joyce occasionally needs assistance in cleaning herself up or adjusting her clothing following toileting events but for the most part is able to be independent. 

Joyce will have her appointment with Dr. Collins and all should be cleared for Joyce to obtain doctor's approval to return to farmhouse via home health order. Rachael oversees the home health order processing work and will follow up with Dusty once it all comes through to identify date and time for him to help transition Joyce to her home. Dusty confirmed he can be available for whatever timeline is set. Dusty asked to confirm if there will still be twice per week therapy scheduled for Joyce at her home and Rachael said that would still occur, scheduled at a future date. The therapists will schedule time to inspect the farmhouse and make recommendations on any equipment or changes needed for Joyce's safety.

Rachael asked to confirm the home oxygen supplier for Joyce and Dusty stated it should be Lincare. Rachael will follow up with Lincare to determine if any resupplies or servicing of equipment need to be undertaken prior to Joyce's return home.

The therapist recommendations for a home health caregiver (1-2 hours per day, assistance with meals) were based on their observations of Joyce in the Aspen Park facility. Joyce may perform better when at home environment. 1-2 hours/day of someone being with Joyce is recommended for overall checks on her health, medication assistance, etc. and Dusty confirmed that the family should be able to meet those needs. Joyce usually needs the most help when she is tired, which occurs randomly throughout the day (no set pattern). A pattern may develop that the family can work around when Joyce returns to the farmhouse. 

If the family decides they want a home care provider to assist Joyce, the rates are usually $25-27/hr and is an out of pocket expense unless Joyce has long term care insurance that covers such services. Rachael recommends Alternative Nursing Services or Family Home Care from the options listed above.

 

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