Martino had moved into an apartment in the same neighborhood as her family home a few years after her husband died. There were many reasons for the move. The location of the family home was wrong: it was too difficult to get help up the hill, and the grocery stores were miles away. In the winter, she was snowed in for days at a time and she felt isolated because she couldn’t drive in the snow and ice. The bus system was infrequent, and the bus stopped a few blocks away. By moving into an apartment in the same neighborhood, Mrs. Martino aged in place within her community but not in her dwelling.
Mrs. Martino had two children. Like her, her son and his family lived in Victoria, British Columbia, while her daughter and her family lived in Edmonton, Alberta. Socially, Mrs. Martino had a wide circle of friends. She had many interests and kept her mind and body occupied. She was a member of the nearby seniors’ center and joined in exercise classes, crafts, and other activities. She loved playing Scrabble and bridge and kept her mind active through a study group. She also swam every day.
She was fiercely independent although, like so many other elders, she had a combination of chronic medical problems that had developed over the years and had been diagnosed and treated by the family physician.
Family physician and pharmacist
Mrs. Martino was a diabetic with a thyroid problem and congestive heart failure. She was also losing her sight because of macrimal degeneration and glaucoma, and had some hearing loss that was caused by a decrease in the size of her hearing canals. Under her family physician’s direction, she was able to control these chronic conditions through medication and diet. She bought her medication from a pharmacist who always carefully explained what each medication was for and how and when to take it. Fortunately, these conditions were not a bother to her. She had no disability and could do everything she wanted.
Mrs. Martino’s medical conditions are common to many elders and can be controlled through visits to the family physician, with occasional visits to specialists to confirm the management and treatment of the chronic conditions. Most elders visit a pharmacist to obtain their medication.
Activities of daily living
In medical terms, at this point, Mrs. Martino managed well with the activities of daily living (ADL). This means that she was able to cope with the actions essential to maintaining independence, such as walking on flat surfaces and stairs, being able to sit and get out of a chair or in and out of bed, being able to dress and bathe herself, and being able to do her teeth and hair and eat her meals. Medical professionals evaluate an elder’s ability to perform these activities, and then use the results to assess how much care the person needs. (See more about assessment in Chapter 3.)
However, Mrs. Martino did need some help to accomplish some instrumental activities of daily living (iadl). iadls are defined as actions that help elders do the essentials to remain independent, including shopping for food, house cleaning, banking, gardening, driving, or being able to walk longer distances or take public transit. Her son helped with her income taxes and some banking and drove her to the grocery store on occasion. She also had a cleaning person who helped clean her apartment.
An encounter with the regional health services
For her 80th birthday, Mrs. Martino took a cruise to Alaska. Unfortunately, she fell, badly breaking her ankle. There was no doctor aboard, so the freighter diverted and deposited her in an acute care hospital at the nearest port, where they operated on her ankle. Within three weeks, she was able to return home. She was fortunate to have purchased medical insurance; otherwise, the bill could have been thousands of dollars.
She was in a wheelchair when she was discharged from hospital with her leg in a cast. Although the physiotherapist had taught her how to walk on flat surfaces and up and down stairs with crutches, she was still weak.
On her return home, Mrs. Martino contacted her family physician, who instructed her to call the local health unit so she could receive some in-home help. The intake nurse arranged for an assessment by the continuing care division of her regional health board. Most regional health boards have a continuing care division of some kind. It may also be called the long-term, extended, or chronic care division. This division usually provides a comprehensive range of community-based, supportive health care services to assist people whose ability to function independently is affected by long-term (i.e., more than three months) health-related problems.
Mrs. Martino explained that she was living alone and that she had a number of chronic illnesses, besides the fact she was in a wheelchair with a broken ankle. Because she could not currently do many of the activities of daily living without assistance, she needed immediate help or she was at risk of being hospitalized again. She was assessed and was assigned a case manager, who worked closely with her family physician. The case manager is usually a registered nurse who can coordinate health care services, teach family members how to care for their elders, plan further client care based on a health assessment, and communicate with physicians regarding medical progress. Mrs. Martino’s case manager decided that she needed the following homecare support:
• A resident care aide/nurse aid/homemaker who would help her bathe, dress, make her bed, prepare her meals and buy the food, and clean the apartment.
• A physiotherapist to give her exercises to help her regain her muscle tone and provide therapy to regain mobility. The physiotherapist also showed her son how to assist with these exercises. (Note: Many states and provinces charge a fee for physiotherapy services. Check with your state/province medical plan to see if these services are covered.)
• A nutritionist to provide instructions on how to prepare meals that accommodated her diet restrictions (i.e., foods low in sugar for her diabetes and low in salt for her heart condition).
• An occupational therapist to suggest ways she could make bathing, cooking, and cleaning easier as she became more mobile. (Occupational therapists also assess your physical and mental limitations and home facilities. They will recommend changes, assistive devices, or adaptations in the environment to increase your independence.)
In a few short weeks after arriving back in her apartment, Mrs. Martino was able to maneuver the wheelchair; then graduated to a walker, crutches, and finally a cane. Six weeks later, she was able to do everything for herself, and she resumed her activities and social lifestyle.
Supportive Health Care Services
Through the supportive health care services offered in her community, Mrs. Martino was able to recuperate with relatively little difficulty. Supportive health care services is a generic term that includes many programs, not all of which may be available in your area. Some services may be government sponsored and others may be private. Your family doctor, hospital, hmo, Eldercare Locator, local health board, or senior services organization will be able to help you determine what services are available and how to contact them. Also see the section “How to Get in Touch with Health Care Services” at the end of this chapter. Following are some of the services they may provide:
Case management services
Professionally trained staff are usually available to help clients connect with the appropriate services needed. Case managers assess, consult, teach, and link clients to the most appropriate care providers. Case management is a good idea on paper, but in fact, case managers often have up to 350 clients. Often, only clients who are in crisis are managed because there is just no time to do a good job for everyone. Case managers in hmos may have less of a caseload.
In-home support homemaker services
