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Out of Hospital Care Case Studies

ComPack Client Case Study

ComPacks client Phuong is 63 years old. He was recently discharged from hospital after suffering from a severe fracture of his right tibia and fibula after falling in the street. He has been told by his surgeon that he cannot bear weight on his right leg for up to 6 weeks. He is using crutches or a frame indoors and a wheelchair for outings. Phuong lives alone in his own home and is normally independent with daily living and domestic tasks. Phuong can manage all transfers independently in/out of his wheelchair and in/out of a chair, bed and toilet but requires assistance with showering using a shower chair. He is independent using an over toilet aid and urinal bottle for night-time. Phuong cannot manage vacuuming, changing bed linen and his laundry.

The ComPacks Case Manager was able to arrange a male care worker to provide personal care services to assist Phuong 3 times per week. This involves assistance with showering and dressing. ComPacks is also assisting with vacuuming, mopping, laundry and shopping on a weekly basis. Phuong’s sons are assisting with evening meals and are helping their father on the weekend. The Case Manager reviewed Phuong’s progress at the 4-week mark, and found that Phuong had developed more confidence and was managing well with his showering. It was agreed that Phuong would not need services after the end of the ComPacks package as his sons would manage the domestic duties from that time onwards.

Download OHC Patient Brochure for ComPacks HERE

SASH Client Case Study

Joanne is 61 years old and lives alone. She resides in a small property some 20km from the nearest health centre. She was referred to the SASH packages by the Social Worker for support with tasks such as cleaning, laundry, shopping, and preparing meals. Joanne has multiple health conditions including Chronic Fatigue Syndrome and Heart Failure. She has associated impairments such as: breathlessness, insomnia, and impaired mobility. Joanne has applied to the NDIS on 2 occasions, but her latest Access Request was declined because there was insufficient evidence to support her case.

The SASH Case Manager met with Joanne at her home to assess her needs and establish a Care Plan. Joanne’s plan included assistance with shopping and meal preparation weekly and domestic tasks such as cleaning and washing fortnightly. To reapply for the NDIS was Joanne’s long-term goal. The OHC Case Manager linked Joanne to a Disability Advocate to appeal the latest NDIA decision.

Joanne was assessed by an Occupational Therapist who documented in her report Joanne’s lifelong impairments. Joanne and her Disability Advocate commenced the appeals process through the NDIA. Joanne’s appeal was successful and her NDIS support plan, now allows her to access home support and therapy services. Joanne continued with the SASH package until her NDIS support plan was implemented.

Download OHC Patient Brochure for SASH HERE

Palliative Care Client Case Study

Selma is 55 years old and has terminal ovarian cancer. She lives with her husband Rami and their daughter Christina. Rami has given up work to care for Selma. Selma was referred to the Palliative Care package by the Oncology Social Worker following a stay in hospital. Selma was still able to mobilise, shower and dress herself however is finding that the process is now exhausting and leaving her with little energy for activities that she might enjoy. The Case Manager was able to arrange a Care Worker to provide bi-weekly domestic services to support the family.

After 3 weeks Rami contacted the Case Manager to report that Selma’s condition had deteriorated, and he had been told she may die within the next week. The Case Manager attended the home the next day where Selma was now bed bound. The LHD Palliative Care team was managing the clinical aspect of Selma’s care and Rami was still wanting to attend to her personal care. He wanted the Care Workers to prepare meals for him and his daughter and to sit with Selma while he showered.

The Case Manager was able to adjust Selma’s Care Plan and daily support was organised from the next day onwards. Selma died in her home 4 days later. Rami contacted the Case Manager the day after Selma’s death. He thanked her for the great support provided by the Care Workers which allowed him to spend quality time with his wife in her last days.

Download OHC Patient Brochure for Palliative Care HERE

For more information about Your Side’s OHC Program contact:

Tracey Compton – Intake Coordinator, Out of Hospital Care Program

  (02) 8405 4425

  intake.ohc@yourside.org.au

Fax: (02) 8415 8939

DOWNLOAD OHC ELECTRONIC REFERRAL FORM HERE

Information can be typed directly into this form, saved and emailed to: intake.ohc@yourside.org.au

DOWNLOAD OHC FAX REFERRAL FORM HERE

To be printed, manually filled out and faxed to (02) 8415 8939

PLEASE NOTE: Referrals for the Out of Hospital Care Program can only come via Health Professionals.

Your Side is delivering Out of Hospital Care in the Murrumbidgee district. Our delivery partners include Community Services #1 (delivering Case Management and service co-ordination) and Violet (Violet Guides support people at end of life).