An elderly man lives with his daughter and her family. Up until recently, he has been able to get out of his bed or a chair independently. Because of a chronic lung condition and worsening arthritis, he must now ask for assistance from his family to rise to his feet. Right now he is able walk with his walker, but his daughter is fearful that he will continue to deteriorate. Because he is reluctant to ask for help, he stays in his chair most of the day. She can see that he seems weaker and slower these days. He is also complaining of increased pain in his joints.

Since he can no longer rise without assistance, the family must ensure that someone is home with him at all times. The daughter and her husband both work, so managing this dynamic is proving to be problematic. She is able to obtain some assistance from extended family and her church members for now, but she is afraid those resources may soon disappear.

While the daughter wants her father to remain in her home, she is struggling to provide him with all the care he now requires.

Typical home health response:

Skilled nursing could be implemented. This would allow a nurse the opportunity to perform such interventions as:

• Identify any possible underlying causes for the increased weakness, such as a worsening of a previously stable lung condition, and report those findings to the physician.
• Assess the client’s pain management regimen, establish effectiveness and facilitate improved pain management
• Instruct family on risks associated with impaired mobility and methods to prevent complications

Physical Therapy/Occupational Therapy could be implemented to address the clients decreased mobility and functional status, with the goal of returning him to independence with bed/chair transfers and ability to safely walk with his walker throughout his daughter’s home.

Home Health Aide could be implemented, if indicated, to assist caregivers with personal care to ensure that client does not develop skin complications related to his immobility.

Result: With home health assistance, it is determined that the client’s deterioration is related to low blood oxygen levels and increased joint pain. A physician’s order is obtained for pain medication and home oxygen. With the help of therapy and nursing services, the client shows drastic improvement. His pain is controlled, his strength improves and he is once again able to rise to his feet independently and walk throughout the house. Because the client is now able to be left alone safely, the daughter is confident that she will be able to keep her dad with her in her home…where she feels he belongs.