59-Year Old Male with Cardiac and Respiratory Issues
While living in a poorly ventilated rooming house in Feeding Hills surrounded by cats, a 59-year old male was discharged from the hospital in July 2018 diagnosed with chronic cardiac and respiratory diseases. Suffering through recurrent bouts of emphysema, the individual was living with inadequate personal care and poor nutrition although he qualifies for PCA (Personal Care Assistant) Services.
Instead of contacting primary care professionals, he usually presents himself at the local Emergency Room when he feels medical treatment is needed.
Working closely with the subject, the Care Alliance Comprehensive Care Coordinator identified core areas necessary to improve the individual’s quality of life and minimize the suffering brought on by his medical condition. Their priority objectives included:
- Locating a better housing environment with enhanced ventilation and reducing the presence of allergens
- Improving diet and nutrition
- Developing a plan for better personal care
- Reducing reliance on emergency room visits
- Developing ongoing care coordination and monitoring
Impact of Care Alliance’s Comprehensive Care Coordination
With these established objectives, the Care Coordinator:
- Contacted Agawam Housing Authority to re-submit the subject’s application for better housing
- Established a daily meals-on-wheels program to improve nutrition
- Re-established the PCA program to help with personal care needs
- Facilitated contacting a primary health professional to reduce ER visits
With these actions, the Care Coordinator now reports:
- Improvements in housing, nutrition, and personal care
- Reduction in ER visits for non-emergency situations
The Care Alliance of Western Massachusetts is happy to answer all your care coordination questions. Please call us at 413-538-9020 for more information or fill out the Contact Us form below.
Care Alliance of Western Massachusetts works with residents of Hampden, Hampshire, Berkshire, and Franklin Counties. We also provide services to residents of Athol, Petersham, Phillipston, and Royalston in Worcester County.