Return to Services

Client: Mr. E
Age: 59
Disability: Brain injury resulting in total dependence for all daily activities.

Introduction:

Rehab Assist, Inc. was contacted by Lakeside Trust and asked to complete a disability needs assessment and budget for Mr. E. On September 13, 2000 Buddy Brennan from Rehab Assist met with Mr. E and his wife, Esther in South Holland to begin the process.

Background History / Current Status:

Mr. E is a 59 year old black male. He was self-employed with 2 children. Mr. E became disabled as a result of an accident occurring on October 13, 1992. Apparently, Mr. E was installing lights at his local church when he fell from a ladder. Subsequently, he was taken to St Jude Hospital, placed in intensive care and intubated for 3 days. He improved and was placed in a regular bed, out of intensive care. Although initially much improved, he suffered a cardiac arrest shortly thereafter resulting in an anoxic injury to the brain.

This injury has left Mr. E severely brain injured. He is bedridden. He has no use of his arms or legs. His weight is 220 lbs. There is no expressive speech. There is no ability to follow commands. He has a tracheotomy and receives humidified air on a 24-hour per day basis. He is fed through a g-tube placed in his stomach. He requires diapers as well as catheterization for all bowel and bladder care. He requires suctioning 3-4 times per day as well as periodically during the night. He is able to sit in his wheelchair for brief periods of time. Mr. E has been cared for at home since January 7, 1993.

Current Medical Care:

Mr. E receives 2 visits per month from a home health RN nurse funded through Medcare. Visits are made for the purpose of changing Mr. E's foley catheter.

Therapy:

There has been minimal to no therapy visits over the last 7 years according to Mrs. E.

Daily Nursing Services:

These services are delivered by Mr. E's daughter-in-law, an LPN, Camille, his daughter Jennifer and Mrs. E, his wife. The duties they perform are the following: suctioning, bed baths, tube feedings throughout the day, changing of diapers (at least 6 times per day), emptying of urine bag, cleaning of trach tube, medication administration, and when necessary blood pressure monitoring.

There are no agencies or privately paid care givers at this time. Mr. E's oldest son also assists during the day with moving Mr. E to his wheelchair or bathtub.

Physicians:

Mr. E has only one physician, Dr. Mitchell at the University of Illinois, who he sees every three months.

Complications:

Mr. E has required hospitalizations on an emergent basis for respiratory issues, gastrointestinal problems and skin breakdown. He currently has a decubitis (bedsore) on the right buttock which his wife is treating actively.

Medical Equipment and Supplies:

Mr. E requires extensive medical equipment and supplies. The list includes:

-Modified van with lift (newly purchased)
-Wheelchair
-Suction machine / and tubing
-Feeding pump
-IV pole
-Nutritional supplement - Peritive - 6 cans / day
-Feeding bags (1 / day)
-Humidified air compressor (Healthlink - 708-594-2244 with Blue tubing (1 x / week) reservoir container 1 x / week)
-Electric bed
-Air Mattress for positioning
-Booties ($25) for prevention of decubitis
-Urine draining bag (2 x / month)
-Foley catheter (2 x / month)
-Trach change (1 x / month)
-Trach collars (change 2 x / week)
-Trach mask (1 x / month)
-Drain sponges (4x4 -130 / month)
-Gauze pads (4x4 - 80 / month) for bedsores
-Dressings (5x4) - 70 / month) for bedsores
-Syringes (60 cc - 4 / month)
-Carasyn (wound care) (2 bottles / month)-
-Wipes - Bowel/bladder care (2 boxes / month)
-Tape (3M - 2 rolls / month)
-Peroxide (1 bottle / month)
-Q-Tips (3 large boxes / year)
-Diapers (130 / month)
-Chux (60 / month)
-Saline (4 bottles / month)
-Rubber gloves (2 boxes / month)
-Cotton tipped applicators (6 boxes / year)
-Swab sticks (6 boxes / year)
-Paper towels (6 rolls / month)

Other items, which will need to be budgeted for, are: dietary needs which are cranberry juice, prune juice and distilled water. Also shaving cream, soap, deodorant and lotions, laundry costs, clothing costs, vehicle expenses, i.e. gas, oil change and maintenance and a back-up generator for all of Mr. E's medical equipment needs requiring electricity.

Home / Architectural Needs:

The E are in the process of building a home in the South Holland area. They report having reserved a lot for $20,000 with Timber Homes, Inc. Mrs. E is estimating the cost of the home to be between $300,000 - $350,000. She reports that Mr. E, Mrs. E and their daughter, Jennifer as well as her husband and 4 children will reside in the home.

Summary / Recommendations:

Mr. E is a 59 year old man who has suffered a devastating injury. He is completely dependent for all of his daily activities and needs at this time. He is cared for at home very capably by his wife and family members. They include Mr. E in community trips and events as much as possible. Mr. E's respiratory needs, positioning and feeding are well taken care of by Camille, Jennifer, Mrs. E and Amelia. Mrs. E does not feel agency or privately hired help is necessary at this time due to the excellent level of care provided by her family members. Her desire is that family members be compensated fairly for their time and efforts. The family has developed a caregiver schedule which they will follow on a routine basis.

Recommendations:

1. RN visits should occur on a weekly basis to insure more aggressive medical management and supervision for Mr. E. The family does a wonderful job, however more regular assessments will prevent a catastrophic event causing complications.
2. The addition of a Hoyer Lift, which will assist greatly with moving and transferring this very large man.
3. Establishment of a formalized nursing schedule including Mr. E's family's services as well as other supplemental nursing services provided to Mr. E by agencies or privately hired nursing staff
4. Mrs. E's ongoing hands-on care of Mr. E places her at risk for physical problems and burn-out. Her involvement will transition into overseeing all of her husband's care rather than providing a great deal of the hands-on care
5. Establishment of an ongoing budget outlining all annual costs for caregiver services, equipment, supplies and all other disability related expenses.
6. Outright purchasing of necessary equipment to decrease costs accrued from annual rental charges - (bed, wheelchair, suction machine, hoyer lift, etc.). Also a wheelchair evaluation provided by a seating specialist is recommended to assure proper positioning and stability for Mr. E.
7. Negotiation for discounts on regularly purchased items such as feeding supplies, diapers, etc. Establishing direct pay system with the trust account.
8. Establishment of emergency medical fund for unexpected expenses for medical care.
9. Ongoing case management to monitor status, coordinate and negotiate for all necessary services.
10. Physical therapy evaluation to determine Mr. E ability to benefit from a regularly scheduled therapy. If therapy is recommended, a regular schedule and budget for treatment should be developed.

It has been a pleasure to meet Mr. E and his devoted family. Please feel free to contact me with any questions.

Sincerely,

Buddy Brennan
Director
Rehab Assist, Inc.

BB/bmp
Encl.

Download a PDF version of this case study:
Disability Needs Assessment

You will need Adobe Acrobat reader to print this document.
Click here for a free download.