When Jackie Johnson, RN, took on the role of Director of Health Services at Boden Senior Living in Apple Valley, a Lifespark Senior Living Community, she had a singular mission for the residents: to make their final chapters good ones. “To do that, we had to ask ourselves questions like, how can we best support each person, what can our staff handle, and what extra services do we need to bring in to prevent any missteps,” Jackie said.
The increasingly complex health needs of one of their residents, Marion*, put that mission to the test. But thanks to a culture of collaboration and communication across teams, including the Boden staff, Lifespark COMPLETE providers, Lifespark Home Health, and Lifespark Hospice, it passed with flying colors.
Services, support, and social connections
Before Marion moved to Boden, she had been living with her daughter’s family since the death of her husband in 2018. But between the progression of her Parkinson’s disease, respiratory issues, and the side effects of her psychiatric medications, her health was deteriorating.
Marion’s daughter, Colleen, was concerned about how isolated her mother had become. “She’d always been such a social person, but now she was alone all day, struggling to climb the stairs and rarely leaving the house,” she said. “We couldn’t give her the support and social stimulation she needed.”
Colleen started researching senior living communities that would meet her criteria around cost and location. “We needed to find a place that would both accommodate my mom’s financial situation and bring her closer to her church community and family,” she said. She had heard good things about Lifespark, and Boden checked the other boxes, so in January 2022, Colleen moved her mother into assisted living at Boden.
Three times a week, she made the 45-minute drive to Apple Valley to visit Marion and take her to appointments with her psychiatrist, neurologist, and respiratory specialist. “When my mom’s health was good, she was very social and participated in just about everything—exercise classes, special events, grocery shopping, and outings to restaurants,” Colleen said. “But she also had a lot of hospitalizations due to falls, UTIs, COVID, and mental health episodes.”
Complex health profile
Jackie first met Marion during one of those hospitalizations. As Boden’s director of health services, she needed to review her client’s ability to return to assisted living. In spite of Marion’s chronic health issues, Jackie determined that with extra services and support, such as one-on-one care to keep her from falling out of bed, Marion could move back to her apartment.
Marion did well for a while, but a COPD exacerbation and pneumonia landed her back in the hospital. Her health quickly deteriorated, and by the time she was transferred to a transitional care facility, she was bedridden with an indwelling Foley catheter, on oxygen, and extremely disorientated.
Marion was also exhibiting cognitive and behavioral changes associated with Lewy body dementia. After several weeks with no improvement, she was discharged to Boden Memory Care and enrolled in Lifespark Hospice. “We really thought we would lose her, but it wasn’t the end for her,” Jackie said.
Unexpected recovery
When Kym Carrier, NP, Lifespark Nurse Practitioner on the Lifespark COMPLETE team, visited Marion in memory care, her client was still bed-bound and on hospice, but there were signs of improvement. “She was on a new nebulizer regimen which got her off the oxygen, and mentally, she was quite alert,” Kym said. “In fact, Marion could tell me the month, the date, the year, and the president—and that she didn’t like being bed bound.”
Kym kept Jackie up to date on Marion’s progress at their weekly care team meetings and through their Teams channel and had multiple conversations about what would be best for their client. “We couldn’t run assisted living or memory care without our internal Lifespark partners,” Jackie said. “We have a collaborative, cohesive team and they are a part of it.”
As the weeks passed, Marion was doing so well that she graduated from hospice, began physical and occupational therapy through Lifespark Home Health, and moved back to assisted living. Jackie was delighted to see Marion participate in the TRY-athalon Spark Games, a series of “meets” involving stationary biking, simulated swimming, and walking. “She was so proud to go from her wheelchair to literally running with her walker—she had a pretty miraculous recovery,” Jackie said.
Mental health concerns
Although Marion had been off her Bipolar medications since she was first on hospice, her mental health seemed stable for a while. Gradually, however, there were signs of mania, Kym said. “As a former nurse, Marion was hyper cognizant of her health and became vigilant about eating a good diet to lower her cholesterol naturally, without drugs,” she said. “Eventually, though, she refused to take any meds, even for her blood pressure, which was dangerously high.” Kym suggested they get her back on the psych meds, but the family was concerned that the side effects outweighed the benefits.
Marion’s medical paranoia escalated, and she started warning residents to check their med lists, believing they were being medicated without their knowledge. She was increasingly volatile and verbally and physically combative toward staff and residents. Marion was admitted to a geriatric psychiatric hospital but resisted treatment for several weeks. Out of options, the family filed a court order for forced medication which allowed Marion’s doctors to get her medically stabilized.
Jackie visited her at the psychiatric hospital a week later to do another assessment. “She definitely qualified for memory care, but we didn’t have any rooms at the time,” Jackie said. “We considered moving her to our Coon Rapids location which would be closer to Colleen, but ultimately, we felt it would be better for her mental and emotional health to be surrounded by the familiar faces of staff and friends.”
Marion was moved back into assisted living with additional services and reenrolled in Lifespark Hospice. This expanded her care team to include hospice nurses, caregivers, social workers, and chaplaincy who worked closely with Jackie and the senior living staff to support Marion as her health declined. As the weeks passed, she become increasingly delirious and never fully regained consciousness before her death at age 77.
Although the family grieved Marion’s passing, they had no regrets. “The care at Boden was excellent, and we really appreciated the way Jackie and Kym communicated with us and with my mother’s specialists,” Colleen said. “The staff and residents were like family to her and I know she loved being part of this community. ”
Learn more about Lifespark’s coordinated approach to complete senior health at Lifespark.com.
*Client’s name has been changed to protect family privacy.
