Client Stories

The following stories represent a sampling of the clients I have worked with over the years. Names have been changed to honor client privacy.

A Challenging Wish List

Looking for the nice man with a great sense of humor

Pleasing a persnickety client


A Challenging Wish List

dresserFor seven years "Marie," now in her early 90’s, lived with her daughter in the daughter’s home. Being her mom’s caregiver was not a difficult task when her mother initially moved to Eugene from the East Coast, as Marie was independent and could stay by herself for hours at a time. But as time progressed, so did her dementia, and it became clear to her daughter that it was no longer safe for Marie to be left alone. What started as a pleasant and comfortable arrangement now was taking its toll on the daughter’s life.  Even a short trip to the grocery store required her to either take her mother with her or arrange for a friend or neighbor to keep an eye on her. After seven years Marie’s daughter realized that the stress of being a full-time caregiver, which included getting up four or five times a night to attend to her mother, and the fact that she had to put her own life on hold, was more then she could handle by herself.

I met Marie’s daughter two months after she had moved her mother into a memory care facility.  “I am very disappointed at the level of care my mother is receiving,” she said to me. “Yes, it is a beautiful place and the caregivers are nice, but the food is horrible--they don’t pay attention to her diet.  The caregivers always run around busily and have no time to stop and listen or pay attention to my mother.  My mom’s dementia is quickly progressing and since she is not demanding, she is mostly left on her own, isolated in her room.”

Marie’s daughter was very clear about what was important for her care and she gave me her list: a small place with a stable staff trained in caring for people with Alzheimer’s and dementia.  She wanted a facility that served healthy food and could accommodate her mother’s dietary needs, as well as offer social activities that would fit her mother’s ability.  “I am looking for a facility that feels like a home with staff that will show their love to my mother,” the daughter summarized. “And I don’t mind driving a little farther for the right place,” she added.

After I gathered all the information the daughter was able to provide me about her mother, I went to meet Marie.  I timed my visit to coincide with when Marie arose, (she was not an early-morning person, according to the daughter) as it gave me the opportunity to witness her ability to get dressed by herself and use the bathroom on her own.  I helped her tie her shoes and set her toiletry on the counter by the sink.  I watched her brush her teeth and her hair by herself. Marie was delighted to take a walk in the hallway with me, using her walker, and she enjoyed our conversation.  Marie couldn’t remember how many children she had or the name of her daughter, but she was pleasant and wanted to know if I would come back to visit her.

The detailed conversation with the daughter and the lengthy visit with Marie allowed me to gather information about Marie’s functional and cognitive abilities.  I was then ready to look for the appropriate placement for her.  An Adult Foster Home (AFH) could have been a good choice to meet the request for a small facility because of the personal attention given by the caregiver (no more than five residents per one, sometimes two, caregivers).  It is a care community that has a home-like atmosphere with home-cooked meals.  However, since Marie was up several times at night and had already experienced a number of falls while using a bedside commode, per the information I received from the memory care facility she was residing in, I couldn’t recommend an AFH, as they don’t provide night-time care.

I knew it would be challenging to meet all of the daughter’s ‘wish list’. However, what made it possible for me to help her find the right place was that she didn’t limit our search to a specific part of town and was willing to drive an extra 15-20 minutes for the right memory care facility.

A few weeks later, I help Marie’s daughter move her mother to a residential care facility on the outskirts of town.  It was a smaller memory care facility run by an RN with staff that clearly cared about their residents.  The home-like atmosphere, the delicious food, and the attention to her mother were all the qualities the daughter was seeking for her mother.

 “I am happy and sad at the same time,” the daughter told me a month after the move. “My mother doesn’t recognize me anymore, but I can tell she is loved and is getting the care she needs.  Now I have my life back and I can enjoy my visits with her, even if it takes me a little longer to drive to her new home.”


Looking for the nice man with a great sense of humor

porchWhen I met "Jim" he was in his mid 80’s and living in an independent retirement community. However, after his last two hospitalizations with pneumonia and the worsening of his chronic lung disease, it became clear to his devoted son that he needed more help than what he could receive from his current living environment. Jim was not happy when his son informed him that he was searching for a new home for his father.  “Why can’t I just go back to where I live now?” he growled. So much for the ‘sweet man with great sense of humor,’ I thought to myself, recalling how Jim’s daughter-in-law had described him.

Jim was weak from his recent pneumonia and given that he was using oxygen on a regular basis, his son wanted a smaller place without the long hallways. When I conducted Jim’s assessment, he couldn’t care less where he was placed. “My son is deciding for me, but as soon as I get better, I am moving back home. I am not even selling my truck,” he announced without making any effort to be nice to me.

What struck me most was that Jim was very hard of hearing. In a big assisted living facility, where 70-80 people gather for every meal in a big dining hall, he would have a hard time making conversation and hearing what was being said. If there is a friendly person under the surface, I thought, he would have a hard time making new friends there. Therefore, an assisted living facility was not my top recommendation.

Following the son’s request that was compatible with the findings from Jim’s assessment, we decided to look for a suitable Adult Foster Home (AFH). Location was not an issue as the son lived in Seattle and Jim’s sister could drive anywhere to visit.

Since Jim’s son lived out of state, I was looking for an AFH where the owner was experienced and knowledgeable in the medical field so she could give attention to Jim’s medical needs, address them quickly, and keep the son informed of any change in his father’s health. Luckily for Jim, a beautiful AFH owned by a nurse had an opening. The son, who was impressed with the owner’s skills and knowledge, signed the agreement on behalf of his father.

A case for care management

For some time prior to his move, Jim had been displeased with his primary care physician. His first appointment with his new doctor was scheduled for a few weeks after his move to the Adult Foster Home (AFH). When I visited Jim in his new home, he still seemed very anxious and unhappy. In addition to having to move against his will, Jim’s main complaint was of a burning sensation in his face that had been going on for over five years. He had been prescribed anti-anxiety medications as the treatment. However, neither the pain nor the anxiety had subsided in all this time.

Jim’s son realized that if he went to see his new doctor by himself, there was a good chance that many of his medical issues would not be addressed or communicated well because of his poor hearing, “and”, he added, “his stubbornness.” As a result of this conclusion, he hired me to be his father’s case manager. Before Jim’s upcoming appointment, I spent more time with him, reviewing his medical concerns. The burning sensation in his face and his anxiety were at the top of his list. I asked many questions about these symptoms, which gave me a greater understanding of this health issue. Having worked as a home health PT, I knew that most doctors had a very short amount of time to spend with their patients. The more information I would bring to his new doctor on his condition, the better she could address it. As a result of my intervention and thanks to his new doctor, who appreciated the team approach, Jim was referred to a neurologist who diagnosed and then treated the cause of his facial burning sensation.

It takes about three months for a person to get used to his new home in a care community, even for those who move willingly, I tell my clients. Within three months of Jim’s move to the AFH, his facial burning was gone as well as his anxiety. So “the nice man with a great sense of humor” re-emerged and became a scintillating conversationalist with the other residents at the ‘family’ dining table.


Pleasing a persnickety client

doorI met "Gina" many years before I ever heard about senior referral services. Gina lived at home by herself with no close family. Her primary care physician ordered the services of home health physical therapy because she was having too many falls. I was Gina’s home health PT. If I had to describe Gina, I would say she was a character.

She wanted things exactly her way and was almost impossible to please. She wouldn’t consider any of my suggestions to reduce her fall risk. She refused to use a walker even though her legs were weak and in pain. She was no longer able to cook, clean, or even leave home. Yet she would not consider making any changes in her life. The longer I worked with Gina, the clearer it became that for her to decrease the fall risk, improve her diet, and break her isolation (Gina was very talkative and craved the company of other people), she needed to move to a care community that would provide the care she needed and the social environment she was missing. Even so, she didn’t want to move and she didn’t see the value of spending the money needed to move into an assisted living facility (ALF).

The challenge was to help Gina realize that living her life as she was would eventually send her to the hospital with a broken hip or from malnutrition. At the same time, I respected her wishes and was determined to work with her within those given difficult parameters.

A breakthrough came in the unexpected form of a power wheelchair. Because of the weakness and pain in Gina’s legs, she was qualified to receive a power wheelchair. However, in order to receive insurance reimbursement, I had to prove that she could use it in her home. Gina’s home was so cluttered with furniture and other items that it was not possible for her to use it there. “Gina,” I said during one of my visits, “can I tell you about assisted living?” “Well, I don’t know,” she responded. “How much would it cost me?”

After I described the long wide hallways, the big dining room and the social activities, Gina agreed to visit one of the ALFs nearby, so her friends could still easily visit. She didn’t even ask about the cost. Since Gina had no family, I contacted the administrator at the ALF and asked if they would be able to arrange for their bus to bring Gina over for a visit. At the same time, I arranged for the medical supply provider to deliver a power wheelchair for Gina to try during her tour at the ALF.

Although my responsibility as Gina’s PT was to treat her at her home and possibly recommend an alternative living environment that was safer, arranging a visit in a care facility is the responsibility of the patient or her family. Orchestrating and coordinating the visit with the care facility for transportation and with the medical supplier for the wheelchair is beyond the scope of what is expected of any home health PT.

 “You know” Gina said to me at the end of her visit, “I think it’s expensive, but I do like this place. When do you think they will let me move in?”

I continued to see Gina as my home health patient until she moved into the ALF and helped her and the nurse at the facility design her care plan. Using her power wheelchair to cruise up and down the long hallways and outside in the beautiful outdoor space and going to Bingo twice a week was all Gina needed to feel this was money well spent.

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