Before Mary was diagnosed with primary progressive multiple sclerosis (PPMS), she loved being outdoors, whether taking a six-mile hike or digging in her garden. As her condition progressed, however, walking became increasingly difficult. Finally, after a serious fall landed her in the hospital, and then to transitional care (TCU), Mary realized she couldn’t return home. “Multiple Sclerosis (MS) only gets more severe, so you constantly have to reassess your situation,” she said. “My house just wasn’t a safe fit for me anymore.”
While still in the TCU, she planned and coordinated the process of packing up and selling her home and moving into an Independent/Assisted Living community, with the help of her brother. To continue her recovery, the TCU occupational and physical therapists recommended home care, so before being discharged, Mary researched potential providers.
“I’d had home care in the past, so I knew what I was looking for,” she said. “Lifespark seemed like the best option.”
Integrated team approach
Just days after Mary moved into her new digs in December 2021, a Lifespark RN met with her to do a thorough assessment. To address Mary’s immediate needs and longer-term goals, the RN Case Manager put together an integrated team of specialists from occupational therapy (OT), physical therapy (PT), nursing, and social work. Together they developed a care plan.
“Lifespark made all the arrangements and the specialists then contacted me, something I’d never experienced with any other home care program,” Mary said. “The providers were always very fragmented with no communication between the OT, PT, or nurse. With Lifespark, I never have to repeat myself.”
Although her primary care physician is not part of Lifespark, Mary’s RN Case Manager bridges the gap through ongoing communication and advocating for her client.
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For Hallie Lucero, MS, OTR/L, Lifespark Occupational Therapist, being in constant communication with her fellow team members allows her to provide the best care possible. “Every morning, we have a team call to review each client and discuss any issues,” she said. “These daily touchpoints give us time to address client concerns and come up with solutions, so I never feel alone in my job.”
One of Mary’s concerns was not knowing how she would get her prescriptions from the pharmacy since her Assisted Living community didn’t provide this service. Hallie brought this to the social worker who tapped into Lifespark’s resources to solve the problem.
Mary described Lifespark as a close-knit team where each member has a piece of the puzzle, and they work together to make it all fit. “They’re all amazing,” she said. “I tell them they’re angels that have been sent to me.”
Guided by the client’s goals
Currently, Mary meets with at least one Lifespark specialist every day to focus on specific goals based on her priorities. The PT team has been working with her to improve balance and gain strength so she can open heavier doors. Hallie and her fellow OTs have been focusing on daily life skills, such as using the fasteners on her clothing, getting in and out of the shower safely, and making a simple meal using the stove. They’ve also been applying compression wraps to manage the lymphedema in Mary’s legs, which has helped reduce swelling by 10-15 cm.
One of Mary’s goals has been to prepare her own meals. “She loves to cook and eat healthy food,” Hallie said. “But with the loss of fine motor skills in one of her hands, that’s been hard for her.” To build Mary’s kitchen confidence, Hallie introduced her to several one-handed kitchen gadgets, including a cutting board that clamps down on the veggies so she can safely slice, dice, and chop with one hand.
“Lifespark looks at me as a whole person—not just helping me get around with my walker, but also helping me look at fears that might get in the way of living the life I want,” Mary said. “I have a lot more confidence now, so I’m able to make even more progress.”
According to Hallie, Mary has been using her newfound confidence to advocate for her fellow residents. “Her neighbors have been coming to her with their concerns about accessibility in the building and lack of services, like housekeeping and transportation,” Hallie said. “Mary’s taken on a leadership role in voicing their collective needs,” adding that the Lifespark team has also been working with management to make changes.
Recently, Mary was approached by management to ask if she would be willing to serve as a peer advocate for other residents. They also asked if she’d consider bringing her love of gardening to the care of the building’s container garden. “Both are wonderful opportunities for Mary,” Hallie said, adding that her willingness to take on these new responsibilities speak to her increased strength and confidence, physically, socially, and emotionally.
As Mary’s rehabilitation draws to a close, the Lifespark team has been looking into resources to support her continued progress. “I’m proud to work for a company that thinks about the future and helps clients plan ahead,” Hallie said. “We talk about what services they’ll need and help them find resources and support.”
The social workers work with clients to explore options, such as private-pay home care or county assistance, if needed. The OT and PT team train in new caregivers to ensure the safety and well-being of the client. “Handing off the baton has to be a carefully thought-out process,” Hallie said.
As for Mary, she feels that her prayers have been answered. “The Lifespark people have enhanced and enriched my life in so many ways, including teaching me how to stay strong and positive,” she said. “What I’ve learned from them, I’ll take with me for the rest of my life.”
To learn how Lifespark can help you or a loved one age magnificently, schedule a free consultation or call us at 952-345-8770.