By Morgan Jenkins, Transition Director

Maintain Me just recently had the pleasure of presenting our services to some of the case managers at Saint Joseph. We are thrilled any time we have an opportunity to educate our community partners on what Maintain Me can do for their patients for improved continuity of care and lessen the risk of re-hospitalization. 
Jessica, in the Emergency Department recently gave us an opportunity to demonstrate, here is our story: 
Debbie's daughter brought her to the hospital because of a recent remarkable decline. She had behaviors that were new, she had stopped eating or drinking, and her family was worried. Turns out, Debbie had a UTI, but to make matters worse, she had moderate to late stage dementia. Debbie did not have enough going on to be admitted after appropriate treatment, but returning to her home to be cared for by her elderly husband was not a safe option. So we got the referral, Jessica knew we were a good place to start! 

After Debbie's daughter called me frantic, I got to work! Not eating or drinking for an extended period of time, and the UTI that would require ORAL intake to treat, combined with her dementia, told me Debbie was very likely hospice appropriate. I got the family's choice for a hospice referral, spoke with the hospice to get the process started, and Jessica helped me get the order sent right away.

Lutheran Hospice assessed the next day! (Team work!) And found that Debbie met criteria for an inpatient acute stay. Mean while, I was already on the phone exploring options. I had a place that was able to assess Debbie the same day she came home, and I had another one ready to do the same. After a short while under the care of Lutheran Hospice, Debbie began to eat, and they were able to prescribe some medications to help her with her anxiety, as well as treat her UTI.
While her treatment continued, Debbie's family and I started touring. We found an awesome place for her, one that even her dear husband was comfortable with, because this was terribly hard for him. Debbie was moved in and getting settled 10 days after the referral to Maintain Me. She is doing well, and her family is resting easy knowing she is safe, and happier by the day! 

This would not have been possible with the quick action of Jessica, Lutheran Hospice, and Maintain Me. Community Partners are the key to success. 

***Names have been changed for privacy.