Integrating Care for Older People: New Care for Old, a Systems Approach

By Christopher Foote; Christine Stanners | Go to book overview

Epilogue
Remember Emily? Meet Winifred

One Monday morning in early February during a meeting in the co-ordinator’s office, the telephone rang. We could only hear half the conversation and could not fully see the computer screen that the co-ordinator was updating as she talked. Intrigued, we waited to hear the full story. Winifred was 85, living on her own and with a son 60 miles away. Over that weekend her arthritis had become much worse and she said she could barely move around her house. Monday was the day she usually shopped and her concern was that she had no food in the house. She wondered if anybody could help with her shopping, not being able to do it herself. Two telephone calls later the co-ordinator returned to the meeting, having asked a volunteer to go round and do the shopping and see if there was anything else that she could do at the time to help. The co-ordinator had also advised Winifred that she would call in just over an hour to do a new assessment. Additionally, she had also confirmed the availability of an EPICS day hospital place for the next day.

Following the assessment, the co-ordinator organized for the rapid response team to call to put in some early morning and bedtime care for four or five days. She rang the GP and briefly discussed the situation. He advised about some short-term painkillers and agreed that he did not need to see Winifred that day but that he would see her at the day hospital the following day with the team present.

With her pain under better control and some physiotherapy to improve her mobility, Winifred quickly returned to being independent. The day hospital organized a routine review for a month later to confirm that she had not deteriorated and didn’t need more therapy. The volunteer agreed to call weekly for six weeks. The social services were able to do their assessments and organized twice-weekly home care and ‘meals-on-wheels’.

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