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An 86-year-old woman who lives alone and needs no assistance with activities of daily living has sick sinus syndrome and a pacemaker. She has history of abdominal surgeries mostly from hernia repairs and suffers from chronic neck and back pain. She has very mild heart failure (NYHA Class II) controlled with diuretics. Prior to Hosparus Health’s care, she hasn’t had a hospital admission in over a year. She has a daughter who has been involved in her care but lives out of state, and a son locally but he has many medical problems.

Her anxiety and depression has been long-standing with difficulty in managing multiple medications herself and obtaining medication from local pharmacy. In addition, she was unable to attend her local Synagogue because of her medical conditions. It was becoming an increasing hardship to continue living on her own.

Game Changer

Upon admission, Hosparus Health was able to provide consultation and recommendations for appropriate pain management and rotation from transdermal fentanyl to long-acting morphine with appropriate breakthrough dosing for opioids.

Countless hours of care coordination were provided by Hosparus Health RN who, with the local pharmacy, ensured appropriate delivery of the patient’s medications. We provided a medication planner and fills to make sure patient was able to take medication on time.

Patient had a large GI bleed that required hospital admission and work up. After being discharged home, it was clear she was having more difficulty in living on her own. Hosparus Health social worker and other members of her interdisciplinary team worked with the patient’s family to get her into a local, assisted living facility.

Our CNA was available to help with activities of daily living. The Social Worker and Chaplain helped in identifying local resources to so patient can stay at home for as long as possible.

All members of the Hosparus team stayed in communication with family members outside of state to ensure they had clear picture of patient’s medical issues and cognitive issues.
Hosparus Health will continue to provide this level of care for as long as is needed.

Contact us to learn more about our care programs and services.

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