Social work Report:

Patient is a 58-year old female, who lives alone with her husband in their home in Trout Creek. Her husband is 72 years old, and has been on disability for 12 years due to advanced COPD. He is on home oxygen, and fatigues easily. Patient provides assistance to her husband with ADL’s, and completes all necessary housework. She has a son, who is divorced and lives in Plains. She also has a daughter in Florida who is estranged from the family. She has one sibling, a brother, who is terminally ill with lung cancer. Both her parents and in-laws are deceased. Patient is self-employed as a seamstress. She works in a small shop located on the home property. She has no medical insurance, and is not yet eligible for Medicare.

Regarding assets, she and her husband own their own home. Her husband receives a pension and Social Security totaling $2200 per month. He has Medicare for his health costs, but pays approximately $250 per month out-of-pocket for prescription medications. Patient was contributing approximately $1000 per month of income. She and her husband have approximately $2000 in savings at this time. The patient and her husband are adamant about not leaving their home in Trout Creek, insisting that this home is where they plan to spend the rest of their lives. Their current assets will more than likely prevent patient from receiving services through Medicaid.

Patient has been denied inpatient rehabilitation services. She and her husband are eager to have her return home. Home health services are available from Plains, however, the services will need to be paid out-of-pocket. Mr. Keene may be able to receive some home assistance through Medicare, but will need to be evaluated for need.

After discussion with the family, their desire is to have the patient return home and receive “a few therapy sessions” to reinforce what has been started in the hospital. The son states he is willing to help out a few days a week at home, but he works the swing shift and is unable to stay for more than a couple of hours at a time. The family is interested in obtaining personal care assistance personnel. I reminded the family that such assistance would have to be hired privately.

The family is very concerned about the mounting costs of hospitalization, and are requesting a discharge as soon as possible.

Recommedations:

1. Schedule discharge planning meeting with team.
2. Obtain Home Health consult.
3. Review options with family after input from team.

Occupational therapy report:

This 58-year old female was admitted with a right middle cerebral artery stroke on July 12, 2007. At this time, she is alert and oriented to person and place only. She is able to follow simple commands. Speech is slurred, but understandable. She has a left visual field cut. Sensation is grossly intact, though extinction noted on the left. Left arm is weaker than the right at 4/5, with hand and wrist strength most affected. She has mild ataxia with the left hand. She is right-handed.

Patient is able to adequately wash face and comb hair with minimal cues. However, oral hygiene is impaired, with patient neglecting left side of her mouth and poor control with oral rinsing. With dressing, patient needs moderate assistance with pulling on underclothes and socks. She is unable to button her bathrobe. General impulsivity is noted with activities, and she requires many clues to stop, and proceed through tasks sequentially.

At this time, I am unable to obtain information about the home setting due to possible fatigue/ confusion from the patient. Family members not present at this time.

Recommendations:

4. Left hand strengthening and coordination exercises.
5. Pacing of activities and instruction due to impulsivity.
6. Consult with speech regarding oral safety.
7. Obtain assistive dressing equipment and provide training.
8. Evaluate toileting activities after consulting with physical therapy regarding capabilities/ equipment needs.
9. Obtain information regarding the home environment from family.
10. Occupational therapy BID for now.

Goals:

1. Able to complete toileting and basic hygiene activities with minimal supervision (