Problems from Discharge and New Medications

5 bottles of medication

Many Medications

The Care Coordinator received a call from a member’s daughter/caregiver on 5/11/2016. It was a return call, as the Care Coordinator had called to follow up with the member because they had just been discharged from the hospital on 5/10/2016.

The member was in the hospital for 3 days and new medications had been started to assist with the management of the members advancing dementia and UTI.  The daughter stated she had been able to care for her mother and work her own full time job prior to the medication changes.

The daughter had spoken with the PCP regarding the increased confusion and the PCP told her to give the medication two weeks to work. The daughter was very worried about keeping her mother at home, in familiar surroundings, as long as possible and stated she would quit her job if she had to. The daughter stated that she had no one else to help her supervise and care for her mother.

The Care Coordinator asked if everything was manageable for today and the daughter replied yes. Care Coordinator then reached out to the LTSS worker, and made a referral for a new assessment due to a change in condition. The LTSS Care Coordinator completed the assessment the next morning. As a result of the assessment, a Waiver Application was submitted the same day. We called the State of Michigan and were able to get the member approved for Waiver Services within 24 hours of the distress call.