Diagnosis: Central Nervous System
Secondary: Alzheimer
Treatment: Home Health Care
The patient has a past medical history of cachexia, contractures, multiple falls, dementia, hyperlipidemia, hypothyroidism, decubitus ulcer of the heel and communication deficits who resides at home with the spouse. The patient had multiple falls and was hospitalized , subsequently transferred to rehab but returned to acute care after niece called 911 when visiting rehab and was hospitalized with severe hypernatremia. The patient had a request for 24 hour care in split shift/7 days a week to total 168 hours when leaving the hospital. There was a HELPS and Uniform Assessment System (UAS)-New York provided. The patient's physician wrote a letter requesting 24 hour care in split shift/7 days a week to total 168 hours per week. The provider noted the patient was home bound, required Hoyer lift for transfers, was mainly bed bound and required total care for activities of daily living (ADL's). The provider requested positioning every 2 hours to prevent skin breakdown in the setting of bilateral lower extremity contractures. The provider felt the patient was more at risk for skin breakdown and pressure ulcers due to poor nutrition. The current aide slept in the kitchen and awoke every 2 hours to reposition the patient. The health plan determination of medical necessity is overturned in whole. The patient has a complex medical history including dementia, cachexia, contractures and multiple falls, who has had a significant decline in physical health following hospitalization with prolonged rehabilitation stay and subsequent prolonged rehospitalization. There was a request for an increase in PCA services to 24 hours per day in split shifts/7 days per week by the treating provider as the patient required positioning every 2 hours to prevent skin breakdown and pressure ulcers. The patient was at higher risk for pressure ulcer given her contractures and poor nutritional status. The patient's husband was not able to provide the care noted in the assessments due to his own frailty and medical issues.