Case Studies
Family Mediation
enABLE had a family in conflict resulting with some outbursts from the Client toward one of her children.
The Client had named her son as Medical Power of Attorney (POA) and her daughter as Financial Power of Attorney. The siblings did not get along and one of them had felt the other was taking advantage of their mother.
As a neutral party, enABLE was able to investigate the situation from all angles and assess the allegations of one child, which revealed information that debunked the initial accusations. enABLE’s determination was that there was nothing inappropriate occurring–just a lack of information being shared between the children. After conducting a few mediation sessions between the Client, the daughter, and the son, enABLE was able to reach a resolution–Designate a separate POA who was a more neutral party as the son and daughter were unable to see eye-to-eye. All parties were in agreement, as was the new designated POA.
By designating a neutral POA, enABLE was able to help remove the stressors of the decision makers working together. They provided insight and understanding for what was causing destructive behaviors, and alleviated the stressors for the kids. They were able to embrace their roles as children and focus on loving their parent. The family relationships began to repair and now the family is able to enjoy the holidays together and focus on what matters most.
End of Life with a Doula
An enABLE client was recently given a terminal diagnosis and moved into hospice care in his home.
The Client’s wife was feeling overwhelmed by the situation. She was concerned about being with her husband when he passed and had anxiety about leaving his side to make food or take care of other necessary things. Additionally, she did not have a complete understanding of how hospice worked and found many people coming in and out of her house.
enABLE’s End of Life Doula was brought in to work with the wife. She was coached through the process of hospice care, informing her what everyone was doing and why they were there. She was able to explain to the wife what happens as our Client transitions, meaning his body moving into a dying state. These transitions can come anywhere up to a week before someone passes. One can misinterpret what is happening in someone’s body, which is a natural part of the dying process. She was able to be there with the wife, explaining to her the process that the body goes through when making this transition, what to expect, and how to know that they are getting close to passing.
By explaining the process and understanding the signs and timing, enABLE was able to help her to stop worrying about being there, which allowed her to be in the moment with him. This information was invaluable to her in her hour of need.
Resourceful Care Management
enABLE had a client who lived alone in her home for 50 years and her sisters needed assistance from enABLE to help make sure the Client was being taken care of. They were concerned that it was no longer safe for her to drive, but the Client would not give up the keys to her car. By getting to know her, enABLE knew she did not use the car often. It was just the idea of giving up the keys that was presenting a problem.
The Client’s sister decided to take the car keys away from the Client. The Client was furious and upset.
enABLE worked with the family to arrive at a solution. With permission from her POA, we asked the neighbor to unplug the battery in her car. Her sister returned her keys and enABLE waited to see if she tried to drive the car.
enABLE felt that if she was not trying to drive the car, why fight her for the keys? If she did try to drive, she would call and they’d know about it. By doing this, she was able to maintain her dignity and safety at the same time. The situation was about control, which it often is. The client never even tried to drive the car.
Resourceful Care Management
enABLE had a Client who lived alone and was falsely stuck on the idea that her neighbors were dumping their trash into her trash cans. enABLE had spoken with the neighbors and knew this was not happening.
The Client was convinced that she was going to get a fine for the trash cans being too heavy, which caused her great distress.
After talking with her POA, enABLE received permission to install non-operational security cameras on the outside of her house facing her trash cans. The client was told she could call anytime to check the footage to see if people were putting trash in her cans.
Upon installing the cameras, it only took two times of her calling to check on the trash with enABLE assuring her that no one was putting items in her trash cans before she was able to relax and let go of this as a major concern. She eventually stopped calling about it altogether.
How We Help
An enABLE client was suddenly struck with a physical condition that happened quickly last year and had changed her ability to move. She struggles with memory impairment, which results in some hoarding behaviors–not remembering she had purchased things already.
She became constipated, contracted sepsis, and had to be admitted to the hospital. She was discharged accidentally without a hospital bed or wheelchair to go home in (she is unable to walk). Insurance claimed that because they had inaccurate records from the Skilled Nursing Facility, they thought she was independent.
The family brought enABLE in to help navigate this challenging situation. Her sister is the POA, but she is older and has needs of her own that need tending to. She puts a lot of trust in enABLE to take care of things. An enABLE Care Manager helped everyone understand what the client would need, how to follow the doctor orders, and identify any medical challenges. She got her a hospital bed, brought home health services in so a nurse regularly visits her in her home. She coordinated caregivers to come in while simultaneously navigating family infighting.
The Care Manager organized all of her client’s care, physical therapy and massage therapy to help with muscle rigidity. She had a meal service scheduled, a nutrition program in place, and also brought in enABLE’s internal specialists to provide medication management and nutrition services. She has also coordinated several home improvement projects–having ramps installed in the house, screen doors installed to help with flies and allow ventilation. The Care Manager also helps with cat flea treatment and general maintenance. She is looking into a wheelchair accessible van and continues to shop for all of her care supplies, toiletries, linens, etc.
Companionship and Reassurance
enABLE had a client who lived alone with pretty advanced dementia. As work with her began, they realized that she should no longer be living alone. She experienced an unforeseen hospitalization and moved into a skilled facility directly from the hospital.
The Client’s family and POA do not live near her so enABLE is the only support she has in her new location. As a result, her POA relies heavily on enABLE’s services to ensure Client’s needs are met.
enAble schedules and take her to her various appointments as well, but mostly offers her stability and support. Because her memory is slipping, enAble often reassures her, reminding her of where she is so that she is not constantly anxious.
After each visit, her comment is, “I am so grateful and thankful that you came to visit me because I feel more at ease.” She may not always remember who enABLE is, but she does remember that she has a good feeling about the team. Bringing more joy into the lives of everyone enABLE’s team works with is at the heart of everything they do.
Exercise
enABLE has a client who is both deaf and mostly legally blind. enABLE was hired for a nutrition consult as he had gained between 30-50lbs. after moving into the facility where he lives. The enABLE program lead for exercise and nutrition came for a visit one day and began to discuss exercise with him. She knew some sign language and was able to figure out how to communicate with him.
People often discount others with disabilities and don’t offer them the same services as fully-abled people. He expressed interest in exercise and revealed that he used to run and play soccer.
They decided to exercise together. She stands on his left side so he can see her as best he can. They stay on the property where he lives and run together, perform squats, push ups, crunches, lunges, and high knee exercises. She would give him goals for each week, and leave them open-ended to see what he would come up with.
He was inspired by the goal setting and increased the number of laps he was doing each day around the property, resulting in him losing weight and bringing him into a healthier state of being. They do a little victory dance after each weigh-in. He has even changed the way he snacks–rather than choosing chips all the time, he mostly selects fruits.
Nutrition
A fiduciary referred a bed bound client to enABLE. She had a family friend who was doing her grocery shopping and picking up her carry-out meals.
When enABLE came in to evaluate the situation, she was having some issues with her chewing. The textures she was eating were not appropriate for her.
enABLE had a speech therapist come in to assess the situation. As a result, her diet was modified to ensure she could sustain her nutrition. The enABLE nutrition lead arranges meals for her on a weekly basis. They also managed her nutrition so that she became stable and experienced bowel regularity.
Being bed bound, the risk for pressure ulcers and skin breakdown is very high. If she had continued on her previous food track, she would have likely experienced more skin breakdown and constipation.
Advocacy
enABLE has a client whose POA lived outside of the area and had recently moved into a facility. Soon after moving into the facility, the administrator told her they were going to kick her out because she was too much work, her needs were too great, and beyond their scope of care. They started working with a new placement agency who brought enABLE in to help manage the situation. The enABLE Care Manager worked with them to tour facilities and find the most appropriate options for the care needs.
This client had several strokes and severe aphasia, which made communication very difficult. She could make sounds, but understanding what she was saying took a lot of effort and you would really have to get to know her to have a sense of what she is saying. enABLE’s first priority in working with this Client was to get her into a new environment. enABLE organized the move, got her settled in, and coordinated a medical team in place for her. During the move the enABLE Care Manager worked closely with the administrators in her new home. The relationship enABLE developed with them was very helpful and the benefits to the client were clear. She was now in a care home, had home health services, and was receiving speech therapy. enABLE assisted her with her communication, which was a priority. Any way enABLE could improve her communication abilities, they were going to try. A speech therapist came out and made the assessment that her speech and comprehension were unreliable and determined that treatment would not be effective.
After she was stable, moved into a great facility, and maintaining good communication around changes in her condition with the administrator, enABLE knew she could still be engaged. She was capable of doing things, and enABLE did not want to ignore that. She had a medical episode, which landed her in the hospital and she was discharged with home health services in place. As a result of this, enABLE had another speech therapy session. While not everyone was in agreement that this was going to produce any change, enABLE advocated for the speech therapy. This was not so much to improve her speech or treat it, but mainly to keep her engaged and still finding happiness in life.
Through working with a speech therapist, enABLE made her environment language rich, putting labels on everyday items, and playing simple card games with her. The goal was not so much to complete anything, but to engage her and ensure she was having fun in the process. enABLE used a white board for active conversation with her and learned how to use pictures to engage her in conversations about the holidays. Advocating on behalf of the client during these sessions was really important, even though it was no longer about treating her anymore. By working with an enrichment therapy group, enABLE created a schedule that all her caregivers could follow, involving more engagement and enriching activities the caretakers could do with her. enABLE worked with the caregivers to get these activities to happen, even if enABLE was not physically present.
Placement
enABLE had a Client who was living in a big assisted living facility. Her son approached enABLE looking for help to assess the situation. The assisted living facility was pretty independent and he began to receive regular calls from the facility because his mother’s capacity was diminishing and the place was becoming less appropriate for her. The son worked and had a busy life but wanted the best for his mom so he hired caregivers to come in for extra support. While she was in this larger facility, enABLE made monitoring visits, took her to doctors appointments, and did wellness checks. enABLE helped to educate the son about what kind of resources were available and did an assessment of his mom to determine what would best suit her.
Her Living situation no longer fit her needs. It was determined that the appropriate location for her was in a board and care home in a smaller community. Having enABLE there to validate that the larger facility was not the right place for mom was helpful.
enABLE helped set up tours of communities, assisted with paperwork, and helped move her into her new home. They coordinated her downsizing, and assisted with packing. After moving her to the smaller community, enABLE continued to work together. They identified next steps, continued to have monitoring visits where they were able to report on any changes in condition. enABLE operated as the eyes and ears for this client.
enABLE developed a great working relationship with the administrator at the care home who kept enABLE abreast of any changes. When her condition started to decline and saw lack of mobility, loss of interest, loss of appetite, enABLE was able to put her in hospice care. At every step of the way enABLE was able to be in touch with her doctors and to be informed about what was happening with her medically. The family appreciated the support through the transition of care which happened beautifully and she was well supported to the very end. She was in a familiar place where she was safe, which gave peace of mind to her son.