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Creating A Path Forward for Delia and Carl, With Help From Ridgeview and Lifespark

  • Sep 7, 2023
  • Cathy Gasiorowicz
  • 6-min Read

It was a postcard that arrived in September 2021 that prompted Delia* to pick up the phone and call Lifespark.  As Ridgeview patients, she and her husband, Carl*, had access to additional services, thanks to a joint partnership between the two organizations. After learning more about Lifespark COMPLETETM, she agreed to meet with Jen Wiley, RN, Lifespark Life Manager.

Dangerous and vulnerable situation

When Jen arrived at the couple’s horse farm, Delia welcomed her into their home, but Carl kept his distance. The couple’s situation was visibly troubling, Jen said, though not all that unusual. “They were living in a hoarded, three-story house with three small poodles,” she said. “Between the clutter, the dogs, the narrow pathways, and the tubing from Delia’s oxygen tank, both of them had fallen multiple times and often called the fire department for lift assists.”

In addition to needing oxygen, Delia, now 81, had heart failure, arthritis, diabetes, depression, and anxiety. Carl, now 74, struggled with lymphedema, hypertension, chronic pain, cellulitis, and vascular leg wounds. According to Jen, Lifespark Home Health provided home care services whenever his wounds reopened, but once they were healed, Delia would take over. “She tried keeping his legs clean and bandaged, but with all of her own health complications, she couldn’t keep up,” Jen said. “His wounds would open up again, Home Health would return to help heal them, and then the cycle would repeat.”

Both Delia and Carl wanted to stay with their Ridgeview clinic, especially Dr. Runkle, whom they liked and trusted. So, when Delia learned that she wouldn’t have to switch doctors, she decided to sign up for Lifespark COMPLETE but wasn’t able to convince her husband to join her. As Jen said, “We meet each member where they are and try to build rapport and earn their trust.”

Small steps forwards

During their monthly visits, Jen was struck by Delia’s warmth and spirit, in spite of all her health issues and responsibilities. “She’s the sweetest, kindest, loveliest person and sharp as a tack,” Jen said.

Through the life planning process, Delia identified several goals, which included spending time with her daughter’s horses, getting involved in her church community, and displaying her copper pots on the bay windowsill. However, with four rows of boxes and furniture blocking the window, that goal was currently out of reach. With Jen’s encouragement, Delia hired a service to help with the cleaning and decluttering. “She still can’t quite get to the bay window, but the pathways are wider and there’s less dust in the house,” Jen said.

Suggestions, support, and encouragement

Delia knows there’s plenty of work to do, but she feels more optimistic. “Jen gives me so much encouragement and support, and very good suggestions, like filling out my Advanced Care Directive and POLST [Physician Orders for Life Sustaining Treatment] form,” she said, adding that Carl wanted to fill his out with Dr. Runkle. 

“Jen also watches my health,” Delia said. “When she sees too much swelling, she’ll say, ‘I think you ought to talk to your cardiologist, or do you want me to talk to him?’ And when she was worried about my lungs, she arranged two home visits with my doctor [a Lifespark pulmonologist and geriatric care expert], and now my breathing is much better.”

Tipping point

When Jen first met the couple, Carl was still driving, but as health deteriorated, he became less and less mobile. Unable to climb stairs or walk on his own, he relied on Delia to bring him food and drive him to his doctor appointments and the lymphedema clinic. As taxing as this was for Delia, Jen didn’t have authorization to get involved with his care, communicate with his doctors, or connect him with outside resources.

A few months later, Delia fell again, this time breaking her hip. After a short hospitalization, she was discharged with Lifespark Home Health for physical and occupational therapy. “That’s when Delia realized she wasn’t able to take care of Carl in any way,” Jen said. “Fortunately, his doctors identified that he needed home care, so I was able to facilitate the details of bringing in Lifespark Community Home Care, private-pay in-home service.”

In February 2023, Carl finally agreed to have Jen as his Life Manager. That’s allowed her to collaborate with his doctors and talk with the outpatient lymphedema clinic on how to keep his legs properly wrapped, healed, and free of infection. She’s also been able to build a rapport with Carl who has opened up to her.

Another positive change is the relationship Jen has developed with Delia’s daughter, Abby. “As Delia and I got to know each other, she would talk about me with Abby, and for the past several months, her daughter has been present at my visits and has reached out to me independently,” Jen said.

“At our last visit, she was super gracious, saying how much she appreciates that I have a good pulse on her mom’s medical conditions and what’s important to her, and also that it relieves some of the burden on her now that she doesn’t have to manage it all,” Jen said.

Progress on all fronts

Both she and Abby had floated the idea of the couple moving out of their home. “Because of the clutter and their comorbidities, I had planted the seed about them moving into a senior community, but neither of them wanted to talk about it,” Jen said. “After Delia broke her hip, she warmed up to the idea and now they have a solid plan in place.”

The couple found a senior living community where Carl can get skilled nursing care. He moved in early May and Delia will join him after she puts the house on the market in June. “My husband didn’t want to move, but I was tired of doing it all, “Delia said. “After living in this farmhouse for 35 years, I’m ready to move on and retire!”

Jen is delighted by the progress the couple has made in the past year-and-a-half, the most significant being their willingness to sell the house and move. “Carl’s lymphedema is better controlled, and Delia has been checking her blood sugar regularly,” she said. “Delia found a Monday night Bible study group, she got help with the decluttering, and with her daughter, Abby, did something called ‘horse yoga’ which she absolutely loved.”

The couple was happy to learn that their senior community is closer to where Jen lives and to Abby and her horses. “Delia kept asking me, ‘Will you still be able to visit us?’ I promised her and Carl that I would,” Jen said. “It’s been lovely getting to know Delia and Carl and I’m super excited for what’s in store for them.”

To learn how Lifespark can support you and your loved one, visit Lifespark.com.

*Names have been changed to protect client privacy.

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