Case Study: The Willows at Ramapo Rehabilitation and Nursing Center (June 2020)

Patient’s Name: Edith Williams
Patient’s Age: 91-years-old
Admission Date: 05/13/20
Admitted From: Good Samaritan Hospital
Discharge Date: 06/18/20
Discharged To: Home
Length of Stay: 37 days
Reason for Stay: UTI

Details of Experience:
Edith W. is a 91-year-old female who came to our community from Good Samaritan Hospital due to a recent Urinary Tract Infection. She has a history of Hypertension, Depression, Chronic Kidney Disease, and Diabetes. Her son was very involved in her care and often called for medical updates and to see how she was doing. He was very eager to see her return home, safely.

Upon entering the building, Edith was greeted by our Concierge, Yehuda, and was welcomed to our Community. She was immediately brought to her room, where she was introduced to the nurse on her floor and the nurse supervisor. After reviewing all of her hospital paperwork, the nurse reviewed her current medications with Edith, making sure she was comfortable with the medications she was taking. Her physical examination was completed including vitals and physical state. Edith was also introduced to other members of our team, including the Social Worker, Dietician, and Respiratory Therapist. They all asked her questions and reviewed their role here at the Willows, and how they were going to assist her in returning to home successfully.

After reviewing all of their current hospital notes, the Physical and Occupational Therapists came to her bedside and did a thorough assessment of her current physical and functional status. Through all of this, they were able to form a plan and a set of goals to help get her discharged back home to her family. With Physical Therapy the focus was ambulation. In the early sessions, she needed physical assistance from the therapist to help her ambulate safely for the initial 10 feet with a rolling walker. Part of her issue with ambulation was exercise tolerance. She would get very fatigued and have to take frequent breaks. The Physical Therapist used seated leg exercises with weights and resistance bands to help build up leg strength and increased exercise tolerance. She was able to slowly build her way up to being able to walk a little over 30 feet with just supervision with a rolling walker. With Occupational Therapy their focus was improving her independence with her morning routine and dressing. Just like her issue with ambulation, she had a very low tolerance for activity and would get fatigued quickly. The therapist worked bedside with her with hand weights, weighted bars, and resistance bands to help build up her strength and exercise tolerance. In the end, she was able to do most of her morning routine and dressing with little to no assistance. She made great progress and was ready to return home back to her prior levels.

Edith was visited daily by the concierge to check in on how she was doing and, to see if there was anything he could do to make her stay better. She always had a kind and friendly word for everyone. Her son regularly came for window visits. His familiar face and friendly conversation were a comforting factor in her successful speedy recovery.

Despite everything going on for the past four months with the Covid-19 and the limitations that she faced with visitations and movement around the building, Edith handled her time here productively and with strength. She worked her way through her time here with the one goal in her mind to get back home and she was successful. She was discharged home with the tools set to make it a smooth transition home.