Case Study: The Willows at Ramapo Rehabilitation and Nursing Center (October 2019)

Patient’s Name: Alfonso Dipietro
Patient’s Age: 87-years-old
Admission Date: 06/26/2019
Admitted From: Good Samaritan Hospital
Discharge Date: 10/07/19
Discharged To: Skilled Nursing Facility
Length of Stay: 114 days
Reason for Stay: Respiratory failure due to CHF 

Details of Experience:
Alfonso Dipietro is an 87-year-old male who came to our community from Good Samaritan Hospital with an admitting diagnosis of Respiratory Failure due to Congestive heart failure. Alfonso also had a history of Hypertension, Hernia, and Dementia. Due to his Congestive Heart failure, he came to us on supplemental oxygen. Alfonso came from a long term nursing facility and his goal was to return there upon discharge.

Upon entering our community Alfonso was greeted by our concierge and shown to his room where he was welcomed and introduced to our nursing staff. After settling in he was introduced to our Therapy Team. He was evaluated by our Occupational and Physical Therapist, Respiratory Therapist, and Speech Therapist. Throughout speech therapy, his diet consistency tolerance progressed from puree solids and honey-thick liquids to mechanically altered chopped solids and thin liquids as he demonstrated improvements in mastication and bolus manipulation and control through the use of swallowing exercises. He learned the importance of utilizing compensatory strategies (i.e. reduced pacing, bolus size modifications, and alternating solids and liquids), general swallowing techniques (i.e. second dry swallow), and sitting upright during and for at least 30 min after meals. By the end of the intervention, he demonstrated his understanding and awareness of safe swallowing strategies to reduce the risk for aspiration and appeared to be safely tolerating his least restrictive diet to meet his primary nutrition and hydration needs. For Physical Therapy Alfonso worked on transfers and ambulation. He exercised that improved strength in his legs exercises tolerance and endurance. He worked his way up to being able to capably walk with a rolling walker with some supervision. As the days and sessions past he was able to walker greater distances with fewer breaks.

For Occupational Therapy, Alfonso worked on his daily living skills. He did exercises that worked on building strength and endurance on his upper body and arms. He worked on the skills necessary to make it through his day functionally and as independent as possible. An important focus was put on dressing and hygiene. The morning routine is a difficult part of the day for people who have any type of respiratory challenges. The Therapists worked on energy conservation tips to help deal with the stress of the routine. As mentioned, Alfonso came to us on supplemental oxygen to help maintain safe oxygen levels. The Respiratory Therapist worked side by side with the other Therapists to help focus on exercises to help improve his Respiratory status. Eventually, Alfonso was moved for being able to do all exercises and activities on room air safely.

Alfonso was constantly visited by the concierge who inquired after him. Alfonso was always friendly and loved eating his meals with his friends in the dining room. Alfonso’s friendly face and attitude will be missed. He always had a good word for every staff member and fellow residents.

Alfonso worked very hard and patiently to reach his goal to return back to his facility to be with his wife again. His success came from working hard and being highly motivated during his stay here at The Willows.