Randy and I are often asked what do we do and who is Care partners? The simplest answer is that we are a solutions company! That answer typically results in the next question, “what does that mean?” It means we treat each client or patient uniquely. To truly provide patient or person-centered care we must distinctly identify each of their needs across the spectrum; medical, clinical, social, spiritual, and psychological. Next, we must determine what providers and resources we build around our client to address each of those needs. When identifying who those providers are, we believe the greatest impact to the patient will not be found through experience or skill set, but rather through love and connection.
I’m driven to highlight our case management team. We have so many beautiful patient stories centered around an initial care management assessment that appropriately identified our clients needs, mobilized the necessary providers, provided resources, established goals and guided the care team along the way. What drives these successes? Connection. While I would like to share an entire case study, I’ll elaborate with a high-level summary of a recent client experience. Our Care Manager brought a patient onto service following 11 straight months of transfers between hospital and skilled nursing facility stays. Our Care Manager coordinated his transition home following his second spinal fusion surgery. Aside from coming home in a halo and being bed-bound, he also had presented with many co-morbidities including COPD, CHF, bipolar disorder, seizure disorder, dementia and he was on 17 medications. Our Care Manager coordinated our Physician recognizing the critical aspect of medication reconciliation and the high risk for readmission. Our Care Manager coordinated Psychologist, Home Health, DME, pharmacy change/delivery and a team of CNA’s to wrap around our client with 24-hour care to serve as the eyes and ears for the clinical and medical team.
There was beauty in this story from both clinical and quality of life outcome perspectives. Without the skillset and expertise of each team member, this gentleman would not have gone from bedbound to ambulating without a walker; from hospice evaluation to graduation of home health services; from daily 24-hour care to 3 five hour shifts per week. While these are considered stellar clinical outcomes, the impact on quality of life was monumental from the spouse’s perspective. The deep connections created through continuity and providers uniquely matched to the family had a positive impact on the reduction of stress and anxiety for the spouse; thus contributing to a return to normalcy and purposeful activity.
We have the innate ability to connect with people. Our Nurse Practitioners, Clinicians, Social Workers, CNA’s and Caregivers all possess the magic. It’s heart, it’s purpose, it’s a calling. They step inside the homes of our clients and patients and connect deeply with them at the spiritual level. As we measure quality of life outcomes, this human connection component remains at the center of the reduction in stress, anxiety and depression for both the patients we serve, and their loved ones who were often baring the burden of care before Care Partners joined their family. When one lives the values of love, compassion and empathy, and harnesses those values to serve other purposefully; beautiful stories are made…….even when those stories involve end of life.
If you have a loved one, a friend, an acquaintance with care needs; please connect them with the Care partners team. We’d love the opportunity to serve them; even if it’s just navigating the fragmentation that is the health care space.