Case Studies at CRL Senior Living Communities

I reviewed one of my patients'  that started out in Bella Vista Manor not doing well and after choking he developed swallowing problems and weight loss as well. He was then admitted to the hospital. A swallow study in the hospital determined that there was numbness in his esophagus.

A PEB tube was put in and he began to rehab at Northpoint and soon after returned to Bella Vista Manor with a PEG tube.

He has improved so much that ne now resides at Bella Vista. His PEG tube was removed and still does not have any swallowing problems. He likes to cook and prepare most of his own meals. The staff at Bella Vista provides him with assistance with showering, TED hose, and medication management.

While attending Bella Vista, he likes to walk around using his walker to stay active as well as a variety of exercises he does in and out of his room.

The care givers at Bella Vista give him the attention and care he needs. He says he is “very satisfied living at Bella Vista.”

Professional yours,

Kevin Andrasko, M.D.,

During this resident’s tour he was non communicative and literally had to sit down due to an anxiety attack and was totally overwhelmed.

The tour ended and we thought there would not be a chance that he would move in. He was not taking his medications routinely, had high blood sugars, and was not on a consistent insulin administration routine. He was going out to eat regularly. There were multiple physicians’ involved and lacked coordination of care in meeting the multitude of issues.

Since his admission to Bellevue his blood sugars have stabilized, decreased a significant number (13) of medications he was taking, has more nutritious meals, therefore a more balanced diet to manage his diabetes. His physicians have better information being provided to unify his plan of care. He has embraced the community activities and plays piano for the residents in the Great Room. His verbal communication has improved significantly over time at Bellevue. He required the assistance of one and now is able to transfer and ambulate independently with his walker. At times he utilizes the pool for exercise.

The family is exceptionally pleased with the numerous positive changes that have improved his quality of life.

Dr. Fred Walbrun, M.D.,

Medical Director
Bellevue Independent and Assisted Living – Green Bay, WI
CRL Clinical Advisory Board Member

I became familiar with my patient during her hospitalization at the Aurora Sheboygan Medical Center. She had been in the acute behavioral unit for 60 days and was refused readmission from the skilled nursing facility where she had previously resided. She had also been denied admission to other skilled nursing and assisted living facilities due to behavioral concerns. Reported behaviors included physical aggression towards staff, refusing medication and throwing food/beverages at staff. She was also eating very poorly.

After thorough assessment by the Countryside Manor team, she was admitted to Countryside Manor with an order for a monthly IM injection of resperidol, due to the fact that she had refused scheduled behavior management medications at the skilled nursing facility and the hospital.

She initially was actively seeking to exit the community. This behavior subsided within one week. The Countryside Manor team utilized positive behaviors to reduce agitation. She responded well to daily hugs, music, and one to one contact. She has begun to take her oral medications and the IM injection has been replaced with oral resperidol. On review of her records, she presents as calm, eats well, and communicates with short answers to simple questions. Overall, she has done extremely well and has been followed very carefully by the staff at Countryside Manor. I have been involved with her medication management and will continue to monitor her progress. I have shared her success story with the skilled nursing facility refusing readmission and the hospital behavioral unit.

Thank you to all at Countryside Manor for the care given to my patient. Her family also appreciates all the care she has received at Countryside Manor, and is thankful that she can be in such a beautiful and caring environment.

Sincerely,

Dr. John Carpenter, M.D.,

I recently had a family come to Fox Point Manor looking for a Memory Care Community to provide care for their loved one who was diagnosed with early onset Alzheimer’s Disease and mild depression and was exhibiting some agitation while at home. She is a 56 year old, married, female who had lived independently with her husband and two children at their private home. She worked as a first grade teacher up until the time she started exhibiting major cognitive decline. Things became increasingly worse as the husband would go on business trips and the children were actively involved with college it became harder and harder to provide care. At this time, it seemed that there was no other option for the family after three years of trying to deal with the situation on their own.

This was an extremely difficult decision that was put on the family at this time, but with the support of the staff and reassurance that the staff would take care of their loved one made them feel so confident in Fox Point Manor. From the time of the assessment to the day she moved in was a week. When this resident moved in to Fox Point Manor she was extremely withdrawn and stayed in her room with limited communication to all staff and others. Within a couple of months time the resident became extremely involved in activities enjoying sing a longs, word games, exercise, walking club, arts and crafts, and much more. Although she has an incredibly difficult time communicating, she truly enjoys being a participant in all of these activities and it truly shows in her smile and laughter.

As the decision to place your loved one in a community like Fox Point Manor is a difficult choice and very overwhelming, the satisfaction of knowing your loved one is being taken care of and experiencing the wonderful environment Fox Point Manor has to offer, while promoting their independence and individual needs is very beneficial to families and residents.

Many times families are extremely reluctant to make this change in their lives but with the help and support from Fox Point Manor it will be one of the most rewarding, helpful decisions a family can make. The staff at Fox Point Manor is always willing to support you in anyway they can.

Professionally yours,

Dr. Paul Grindstaff

I am very pleased with the progress one of the patients has made since she was admitted to Lakeshore Manor, Oshkosh.

I saw her in late June of 2009 when she was hospitalized at St. Agnes Hospital Behavioral Department. At that time, she was doing poorly. She was drowsy and followed only minimal commands. Her speech was very hard to understand. She would cry when she was approached and she could not walk.

Following that hospitalization, she was admitted to Lakeshore Manor Alzheimer’s/Memory Care and Assisted Living. I saw her for follow-up in my office on September 8, 2009. She was able to ambulate with a walker and some assistance. She has not had any seizure activity and her behavior was much improved with no agitation. She was cooperative and her mood was good. Her speech was only mildly dysarthric.

It is hard to believe how much better she has become! I believe that the care and environment at Lakeshore Manor provided a very positive and healing effect on her condition.

I want to praise the wonderful job the team at Lakeshore Manor has done for her.

Sincerely,

Dr. Xian F. Gu, M.D.,

I reviewed one of patient’s records from his hospitalization prior to his placement at Merrill Hills Manor. This patient was new to Merrill Hills Manor in August of 2010.

This was a 70 Year old gentleman that had a diagnosis of Dementia. He was admitted to the hospital after his family reported new impulsive and erratic behaviors in the past week. The patient was put on Depakote, Risperdal and Lorazepam as needed. The patient was then discharged to a skilled nursing facility. After a short stay at the nursing home, the patient was sent back to the hospital for behavioral issues. He had become agitated and combative with other residents at the nursing home and it was decided that the nursing home could not meet his needs. Haldol was then added to his list of as needed medications.

He was then transferred to Merrill Hills Manor. Upon his admission to Merrill Hills, he did not want to stay and did not understand why he was not allowed to go home. The first morning after his admission, he got up and began to clean the floors in the community and weed the potted plants. This continued on the next day and the next. He verbalized understanding of his placement for a short term stay. During his stay at Merrill Hills Manor, he did not display any inappropriate, agitated, or combative behaviors. He became an active part of the community. He attended all activities, assisted other residents, helped in the maintenance department, walked the visiting dog, attended outings, all without any issues.

During my first visit with him in August, I discontinued his Haldol and added a scheduled dose of Lorazepam. In September I made some adjustments to his Depakote and discontinued his scheduled Lorazepam. In October during my visit with him, I decided to start decreasing his Risperdal dose because the staff reported no behavioral issues. In November the good reports continued and I decided to discontinue the as needed Lorazepam and continue to decrease the Risperdal. In December I was able to discontinue the Risperdal all together. Since he had done so well over the past four months, his wife decided she was able to care for him from home. He moved home on December 23, just in time for Christmas.

Thank you to all the staff at Merrill Hills Manor that cared for him. He had marked improvement in his behaviors. He went from being very agitated, impulsive and combative, back to the kind, gentle man he truly is. His family is very appreciative of the care he received while at Merrill Hills Manor.

Sincerely

Cary J. Kohlenberg, MD

One of my patients' moved in at Parkside Independent and Assisted Living in October of 2010. At time of admission she used a wheelchair and had recently spent time in the hospital because of weakness and hypotension. They were uncertain of why she had become so weak at that time. She has Cohn’s disease and struggles with diarrhea. While at the hospital her blood pressure was only 80/60. Upon arrival to Parkside she was weak and dehydrated and had just encountered an upper gastrointestinal bleed. Her Coumadin and aspirin were on hold due to her last INR. She was status post recent myocardial infarction so that took great monitoring on Parkside’s staff since her aspirin was on hold. She has a history of occipital stroke and pernicious anemia, atrial fibrillation and history of hypertension.

In the last couple of months she has done very well at Parkside. She is well hydrated due to the hydration stations and she loves the fruit smoothes that are provided daily. Her blood pressure is under control through staff monitoring and administering her medications. In the past she was not willing to do activities due to her Cohn’s disease but now is participating in activities on a daily basis. She is on a specialized diet that seems to be helping with the Cohn’s disease. She gets her labs done on a regular basis and has not had any trouble recently. She now walks with a walker and she is so proud that she can put her wheelchair in the closet. She started off walking with the staff. They would push a wheelchair behind her and walk her with a gait belt. At first she complained of pain in her legs and wanted to give up, but now she is thrilled that she doesn’t have to use the wheelchair and she is even happier that she can walk all by herself without a gait belt and someone pushing a wheelchair behind her.

Upon asking her how she likes her new home she states “I wish I would have moved here sooner; I just didn’t know that I would like it so much”.

Overall, she has done extremely well in a short period of time due to all the great staff at Parkside. Thank you to the Parkside team for all the great care that you provide her.

Sincerely,

Dr. David Ringdahl, M.D.,