Maintaining Independence � Tom and Judy
Situation: A long-married couple in their 80’s, having moved from their house to a senior apartment, is facing a crisis. Tom has been hospitalized twice in 30 days because he’s suddenly having trouble managing his diabetes. He and Judy want to continue living together in their apartment. Their grown children, who live in other states, are very concerned about the health and well-being of their parents, and if they really can continue to live safely on their own.
Our Role: Tom and Judy’s daughter asked My Health Care Manager to conduct its Initial Support service – a situational assessment and report with findings and recommendations – after being referred by a social worker concerned about her parents' health and safety.
Tom and Judy’s Health Care Manager collected information from the family, the case worker, physician and neuropsychologist to clearly understand the situation. The research showed Tom was losing some of his cognitive skills and that a physician had diagnosed him with early-stage Alzheimer’s and dementia. My Health Care Manager summarized options and presented them to Tom, Judy and their children. Judy could assume daily responsibility for helping Tom manage his diabetes –a role she has never learned – or, the family could consider moving to an assisted living facility where Tom could hire skilled nursing care.
- Through My Health Care Manager’s hourly services, a one-month plan was created to determine Judy’s abilities in this new role.
- The Health Care Manager coordinated in-home nursing care 1 hour per day, established diabetes education support, designed hourly medication and blood sugar testing schedule for each week for Tom and Judy and visited periodically to monitor and support Judy’s progress and effectiveness.
- Scheduled weekly phone updates with the daughter to keep her informed and increase her peace of mind.
Outcome: Today, Tom and Judy are living well together in their own home. Judy has done an excellent job supporting her husband and assisting in the management of his diabetes. Tom’s blood sugar has been under control and the family has avoided unnecessary or recurrent hospitalizations.
My Health Care Manager continues to partner with Tom, Judy and their children through monthly services.
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