Finding the Answer
Jerry is a 77 year-old man who was referred to PrimeCare by his Massachusetts General Hospital (MGH) primary care physician (doctor). At the time he was struggling with several medical conditions while living alone in an apartment in Boston. His close family members believed he was unsafe. However, as Jerry did not wish to leave his apartment, they had been unsuccessful in intervening and finding an alternative living situation for him. The doctor was frustrated because Jerry was not taking his medications as prescribed, and he often refused care from visiting nurses.

The PrimeCare care manager met with Jerry’s family and doctor to discuss his living situation and how to best manage his care. The family and doctor did not agree about where Jerry should live. His doctor believed a long-term nursing home scenario was inevitable, and therefore likely most appropriate for his current placement. The family wanted to see if Jerry would be happier and thrive in a “lower-intensity” assisted living facility.

After making a thorough assessment of Jerry’s situation, including his numerous medical and psychosocial issues, the care manager determined that Jerry was too medically unstable to transition to an assisted living environment. However, she also thought that much of his instability might have resulted from unidentified neurological issues. She convinced Jerry’s doctor that admission to the MGH for a comprehensive neurological examination might be helpful. As a result of this admission and subsequent examination/testing, Jerry was diagnosed with a new but mild stroke and treated at the MGH. He was then discharged for a short-term stay at a skilled nursing facility, with the ultimate goal of final discharge to an assisted living facility.

In Jerry’s case, the care manager’s medically focused perspective and expertise resulted in treatment and care that facilitated his ultimate transition to an assisted living facility. Her efforts not only met Jerry’s needs, but also satisfied the caregivers and medical providers that looked after him on a regular basis. Jerry was successfully transitioned to an assisted living facility where he receives meals on a regular basis, has help with taking his medications and perhaps, most importantly, he is not isolated and alone. In fact, the PrimeCare care manager introduced him to another of her clients who was living at the same facility. They are now in regular contact with each other, sharing meals and keeping an eye out for each other.

Medical conditions often underlie and drive the issues and problems that elders and their caregivers experience. PrimeCare, with its unique medical focus and expertise, will help to identify and resolve the medical conditions contributing to elder decline and frailty. Your care manager will work directly with the elder’s physicians and other care providers to ensure the best medical care possible. With the medical conditions under control, you and your elder can focus on making appropriate life decisions to ensure the elder’s safety, vitality and happiness.

Home Alone
Dan is a 74 year-old retired gentleman living with his wife in their split-level home in a community north of Boston. Recently he become increasingly frail and had experienced a number of falls at home; the last one resulting in his laying on the floor of his home alone for over 4 hours. His wife, who has a part-time job, is frequently away from the home for extended periods of time. After this last fall, she became fearful about leaving him home alone.

After speaking with a friend about PrimeCare, Dan’s wife contacted our care manager and discussed the situation. Following this conversation, a one-hour meeting was planned with Dan, his wife and the care manager in the PrimeCare office. With the guidance of the care manager, Dan and his wife were able to have an open and frank discussion about their situation.

After the meeting the care manager designed a report for Dan and his wife that offered specific recommendations and information about how to best support both Dan and his wife. These recommendations included:

	enrolling Dan in a formal physical therapy program to evaluate, assist and strengthen his mobility
	securing Lifeline emergency assistance service
	providing techniques to prevent falls and subsequent injuries

The care manager called Dan and his wife several days later to review and discuss the care report recommendations, and to answer any questions they might have, provide additional guidance, etc. Dan and his wife were extremely happy with the report recommendations and the concrete care plan provided by PrimeCare. They felt better about their situation and were now prepared to handle many of the daily living issues they had struggled with.

A frail elder living or left alone in a home can be of great concern to those who care for them. PrimeCare can assist you in evaluating your elder for safety in the home, and in devising a care plan that will allow your loved one to be safe and supported in their home. As evident above, such plans may include both medical and home environment strategies. Our primary concern is always the safety and well being of the elder, and the peace of mind of their primary caregiver.

The Ambulance Ride
Grace is a 72 year-old woman who lives in southern Massachusetts, but who receives her medical care in Boston at the Massachusetts General Hospital(MGH). She had always been able to drive to her doctor’s appointments, but she recently experienced an illness that left her unable to drive a car, or even sit up. As her daughter was unable to transport her to appointments, Grace would need to find some type of alternate transportation to continue her necessary medical care in Boston.

Initially, Grace’s daughter arranged for ambulance transportation and paid several thousand dollars for these rides (not covered by Medicare). As you might imagine, cost was becoming prohibitive, and Grace and her daughter turned to PrimeCare to determine whether less expensive transportation might be available. After researching the possible options, and following three separate discussions with one ambulance company’s director, PrimeCare was able to convince the company to accept a reduced fee of $1,200 per transport, this well below the average local rate of $2,000.

Grace has continued with her medical appointments at the MGH and she is saving $800 on each ambulance transport. In addition, the PrimeCare care manager coordinated a plan whereby Grace could have her day-to-day medical care (such as treatment of a cold, routine physicals, etc.) provided by a local physician, thereby minimizing the ambulance rides to Boston. In this fashion, Grace would receive cost effective care appropriate to her medical needs.

One of the many benefits of engaging PrimeCare is that we have the knowledge and resources to identify and secure effective, low cost care options for caregivers. This often includes negotiating pricing and other service agreements that most caregivers would not be aware of. As we are a medically focused service provider, we work closely with our clients to ensure they receive the highest quality medical care possible, and with the least interruption to their daily lives.