By Paula Erwin-Toth MSN, RN, CWOCN, CNS

Part 4 in a series discussing the challenges and opportunities in patient/family education
For Part 1, Click Here
For Part 2, Click Here
For Part 3, Click Here

We are still seeing Mr. Gillan in his home. As you may recall Mr. Gillan is a 72 year old man with venous insufficiency. He presents with a venous ulcer on his left lower leg. He has several co-morbid conditions including hypertension, cataracts, and osteoarthritis which includes his hands. His primary caregiver is his 74 year old wife who suffers from diabetes and mild dementia.

Mr. Gillan’s wound has been progressing well; his therapy and adjunct services have helped stabilize both Mr. Gillan and his wife into a steady and safe home situation. Due to the lack of family Mr. Gillan was encouraged to appoint a Medical Power of Attorney and made/him her aware of the Gillan’s Advance Directives; in the worst case scenario Mr. Gillan asked his attorney to act as Power of Attorney should he become incapacitated. The social worker was instrumental in encouraging Mr. Gillan take this step to ensure his wishes will be honored should the need arise.

Sadly Mr. Gillan suffered a CVA and was rushed to the hospital. He has significant paralysis and dysphasia and is going to require extensive rehabilitation. Mrs. Gillan is unable to remain in their home by herself — after his stroke she wandered away and was found cold, frightened and dehydrated but otherwise unharmed several hours later. This may sound like a melodrama but these things happen every day. Now what do we do? Not only is Mr. Gillan at risk for developing pressure ulcers and deterioration of his leg ulcer, his whole way of life and identity are threatened.

This is where the hospital Case Manager can help coordinate available services based on the Gillan’s needs and eligibility. The goal is to try to place both the Gillan’s in the same facility. Due to Mrs. Gillan’s confusion and tendency to wander she needs to be in a secure setting specialized in caring for people with Alzheimer’s Disease. Fortunately, they have space for her and Mr. Gillan in their rehabilitation unit. Like the OASIS in Home Health Care, the MDS (Minimum Data Set) in long-term care and rehabilitation facilities provides the basis for care, risk factors, outcome measurement, performance improvement and of course reimbursement.

Our colleagues in LTACs (long-term acute care) and LTC (long-term care) deserve our praise and appreciation. They admit incredibly complex patients and address their needs in a comprehensive and systematic manner to improve outcomes and prevent deterioration of their condition. This has to be compatible with the person’s right of self determination and informed consent. Not an easy task!

No matter what setting you work in we all have unique challenges, needs and rewards as we care for our very special patients with wounds.

About The Author
Paula Erwin-Toth has over 30 years of experience in wound, ostomy and continence care. She is a well-known author, lecturer and patient advocate who is dedicated to improving the care of people with wounds, ostomies and incontinence in the US and abroad.