Shirley – Transitioning to 24/7 Care at Home
Windward’s team quickly coordinated a full continuum of care after a fiduciary’s client learned she could no longer safely live at home without support. We implemented home safety modifications, set up 24/7 care, and managed the client’s medication and medical appointments, enabling the fiduciary to focus on the client’s financial health.
A client’s fiduciary reached out to us after their client, Shirley, was taken to the hospital. The doctors’ initial exam couldn’t determine what was wrong with her, but they knew she would be unable to return home without an in-home care arrangement. An Aging Life Care Manager® from Windward immediately went to the hospital to learn more about Shirley’s situation and to discuss with the fiduciary how we could support them at this critical moment. It turned out that Shirley had Parkinson’s and was a fall risk, in need of 24/7 care in order to live safely at home.
Our Role
- Our Aging Life Care Manager visited Shirley’s home and worked with her roommate to remove any tripping hazards and to implement other modifications to ensure safety throughout their shared living spaces.
- We set up 24/7 care within two days of her confirmed discharge date from the skilled nursing facility and coordinated all aspects of her discharge plan.
- Windward Home Health was added to the team to coordinate Shirley’s complex medical needs going forward, including scheduling and attending medical appointments and getting her medications organized, which had been found all over the home.
- Our team helped the fiduciary get Shirley approved for payments from her long-term care insurance for her daily in-home care. This included having our RN meet with the insurance company for the assessment and our Aging Life Care Manager handle all the required paperwork.
- Our 24/7 team care support resulted in significant improvement in Shirley’s overall health and well-being, as she now regularly takes her meds, eats healthy meals, attends physical therapy classes for her Parkinson’s, and sleeps well.
Outcome
The fiduciary was very pleased with what Windward accomplished in just a few months. Our quick response and continuum of care services meant Shirley had everything she needed, and they could focus on their fiduciary responsibilities knowing she was in good hands.
Need Support Coordinating Care After a Hospitalization?
Windward helps fiduciaries and families manage hospital discharges, 24/7 home care arrangements, and complex care transitions with confidence. Contact us today.