Mrs. C Is a 77-Year-Old Hispanic Female

In 2013 she experienced a right CVA which resulted in left hemiparesis. Eight weeks ago, she experienced a minor foot injury and unknowingly developed gangrene. She was admitted to the hospital as a matter of urgency and underwent surgery for an above-the-knee amputation of her right extremity. Prior to the incident, she had a history of diabetes mellitus, hypertension, and hyperlipidemia. According to her medical chart, both of her upper extremities are within the functional range of motion(ROM). However, her left arm exhibits decreased muscle strength, endurance, and poor grasp. The left lower extremity presents no limitations and scored a 3+ in the manual muscle test. The client is now utilizing a power wheelchair to travel and navigate in her home and outside independently. She is in the process of finding a prosthetic limb that will fit perfectly.

The client lives in a 2-story home with her husband. They have two daughters, one of whom lives nearby and comes once daily to the client's home to assist with evening meals and other necessities. Mrs. C requires minimum to moderate assistance in her day-to-day activities. Her spouse and home health aide further support her as needed with her ADLs and IADLs such as bathing, meal preparation, dressing, mobility, and transfers. Mrs. C is retired from her career as a seamstress. Prior to her surgery, Mrs. C was more independent in self-care activities and socially very active as she was able to ambulate with a hemi walker. She wants to return to cooking and spending time with her family. And attends Catholic church on Sundays with her husband, daughter, and grandchildren.

In addition, Mrs. C voiced her desire of obtaining independence in the home such as making the bed in the master bedroom, eating her meals with her husband at the table, and sleeping in the same bedroom. Currently, she is sleeping on the first floor in the small bedroom and her spouse is sleeping on the couch. Her spouse and health home aide are using bathing cloths to cleanse her, as she is unable to access the upstairs shower/tub. Initially a portable shower was proposed but there was no space for it on the first floor. The client and her family hope to attain recommendations from occupational therapy practitioners for home modifications and adaptations to enhance her quality of life.

Order custom essay Mrs. C Is a 77-Year-Old Hispanic Female with free plagiarism report

450+ experts on 30 subjects Starting from 3 hours delivery

Get Essay Help

As an occupational therapy practitioner, it is crucial to ensure that Mrs. C's home environment is barrier-free, safe, and accessible so that she can live comfortably in her home. Upon entering Mrs. C's home, it was noted that the entry to the house was on the ground floor and no stairs were present. However, the doorway threshold was raised, and it made it difficult for her to navigate and enter the home independently. The client was advised to purchase a rubber threshold ramp from monsterscooterparts.com for $33.99. Resources regarding Medicaid waivers to pay for the cost of the ramp was provided, as it is considered a home modification or environmental adaptation. The width of the doorway was measured, and it was approximately 36 inches which allowed her to enter her home comfortably with a wheelchair.

The first floor has a large eat-in kitchen which contains a table and four chairs. Mrs. C prefers to sit at the dining table with her husband in her kitchen, as it is a family tradition. To save energy for both Mrs. C and her husband, it was suggested that they purchase solid lift risers to be put under the table legs to raise the table higher. Initially, Ms. C could not eat at the table while being seated in the wheelchair due to the table being low. Therefore, her husband had to frequently transfer her from wheelchair to chair which was becoming fatiguing for them both. The risers cost $9.66 and can be ordered as a package of 4 on Amazon. Unfortunately, this item is not covered by her insurance and the cost would come out of pocket. However, to eliminate the cost of purchasing the risers Mrs. C was given the alternative of utilizing a transfer board.

According to the New York State Medicaid Program: Durable Medical Equipment Manual the client will be covered by Medicaid under the code E0705F6. Conclusively it is up to Mrs. C and her family to determine which one is most suitable. If the client wishes to get the transfer board, the armrests of the dining chairs should be removed to clear any obstruction. Considering that the client appreciates cooking, it was recommended that the most frequently used dishes and cooking supplies be moved to the floor cabinets to make it more convenient for her to find products. The cabinet doors were omitted and replaced with curtains to provide additional range and comfort when searching for an object. For quick access, some items have been kept at counter-level.

She was also informed about Lazy Susan’s being placed in the fridge and cabinets to ensure all items are within easy reach. It was suggested that a mirror be installed over the stove for better viewing while she is cooking. Her sink, which was 29” height, 11” depth, and 30” width, has a pull-down faucet that makes it more manageable for her to the wash dishes. These improvements were cost-free, both her husband and daughter helped in rearranging the kitchen and installing the mirror above the stove. Her husband was able to build her lazy Susan’s from pieces of wood that were in the home.

The living room area is located on the first floor and has a large 9x12 area rug. This poses a safety hazard for Mrs. C as she is preparing to accept and master the skill of ambulating with the prosthesis. The carpet would be removed to allow her to maneuver in her wheelchair without friction, and to prevent the possibility of falling when wearing the prosthesis. The installation of automated lights would remove any technical obstacles such as being unable to reach the height of the light switches. Conversely, the Clapper is a sound-activated electrical switch that Mrs. C can utilize to turn and turn off the lights independently as well as an outlet with a wireless remote control. Such products are available for a low price on Amazon if the client is interested in purchasing and can be covered by the Medicaid waiver.

Because Mrs. C lives in a 2-story house that requires 13 steps to reach the second floor, I found this to be another architectural barrier of importance. Mrs. C should then look into renting a stairlift before she is ready to start walking with her prosthesis or looking into a more permanent arrangement in case, she does not feel comfortable going up the stair with her prosthesis. Resources such as how to rent a used stair-lift from a company or rehabilitation facility will be provided to help her understand and save money. The client was further familiarized with the company simple access mobility located in New York that offers short term and long term rentals for as low as $100 a month with the installation included. In addition, Mrs. C can also apply for grants, loans, or a Medicaid waiver. Medicaid is a federal and state insurance program that aids low income seniors.

The program Home and Community Based Services (HCBS) waives or offers at-home services through managed Medicaid programs or Medicaid State Plans. These programs provide assistance to help qualified individuals avoid nursing home placement and remain living at home ('Help Paying for Stair Lifts: Medicare's Benefits and other Financial Assistance'). The client was educated about the two programs in New York, Community First Choice State Plan Option (CFCO) and Medicaid's Managed Long Term Care (MLTC). The first floor has half a bathroom that Mrs. C often uses, and it was suggested to remove the cabinets from under the sink to allow her to fit easily with the wheelchair as she performs her personal hygiene. The second floor has a complete bathroom with a shower/tub.

In the same way, the sink cabinets from this bathroom will be removed to create extra space. It was suggested that grab bars be installed by the bath to assist with transfers. Unfortunately, Medicaid will not cover the grab bars though many non-Medicaid programs will cover DME. Mrs. C was advised to purchase a transfer bench and a handheld shower nozzle to facilitate independence. Other resources with buying these items may be by purchasing the equipment used, such as the transfer bench. This bench can be found on Ebay.com for $19.99 in good condition. To eliminate barriers such as not being able to access her bathing supplies, a bucket found in her house was placed by her shower chair so supplies are close by. An elevated toilet seat, as well as bathroom guard rails, were advised to be installed to enable comfort, safety, and transition from the wheelchair. We were able to get most of the bathroom equipment without charge from a website called the DME list.

The master bedroom has wall to wall carpeting and a large king-size bed, a chest of drawers, and a dresser inside. The bedroom carpeting poses a disadvantage for Mrs. C because the carpet has a high pile and it does not allow her wheelchair wheels to roll smoothly. Applying a plastic mat over the carpet may be an option for the client, rather than replacing the flooring as it can be quite expensive. It was found that the positioning of the client's furniture was in a manner that obstructed her ability to make the bed and access her clothes. She was then instructed to rearrange her bedroom furnishings to make it more accessible to her needs. It was proposed that the client move her clothing to the lower drawers or to a closet so that she may have access to her clothing.

Adding lower rails to the closet will make it easier to navigate. The rearrangement of the furniture in the bedroom enabled space to accommodate a commode chair. This will be important for Mrs. C and her husband because he is the one who gets up to take her to the bathroom at night. As per Medicare Part B, a commode chair is considered durable medical equipment and will be covered when ordered by the client's doctor.

The rationalization proposed for the durable medical equipment(DME) and home modifications for Mrs. C and her family is to encourage independence around her home and remove architectural barriers. If those changes are final, Mrs. C should be able to operate independently. Adopting the above mentioned DME and modifications would grant her the necessary assistance to carry out her everyday tasks with less stress and less energy. Adapting her living room, bedroom, kitchen, and bathroom would give her a sense of self-confidence, self-esteem, and freedom. Mrs. C would then be able to concentrate on other activities that are important to her such as spending time with her family.

Although in the case of Mrs. C the need for home improvements is extremely important, Medicaid regrettably does not cover all the costs of the requirements. The client has other opportunities to receive funding such as applying for Medicaid waiver programs that cover home modifications to enable elderly and/or disabled individuals to remain living at home. Some waivers pay for assistive technologies such as special equipment for the bathroom and adaptive lighting. Other waivers pay for physical modifications to the home, such as the addition of wheelchair ramps, stair-lifts, and walk-in or wheelchair accessible bathtubs and showers. These modifications are more formally referred to as Environmental Accessibility Adaptations. Further examples include the widening of internal spaces, such as landings or doorways, to accommodate for wheelchair access. Some waivers include resources for both technologies and modifications ('Medicaid Programs that Pay for Home Modifications for Aging & Disabilities ').

If the client is not eligible or accepted to these programs she can also look into the Department of Housing and Urban Development which offers HUD Home Improvement Loans, and the U.S. Department of Agriculture has Rural Repair and Rehabilitation Grants. There are also other alternatives such as purchasing used equipment to reduce the cost, asking family members to help with modifying things in the home such as removing doors or do it yourself projects with items found in the home. There are also helpful nonprofit websites such as the DME List, where people donate durable medical equipment that is either new or has been slightly used.

The website offers equipment free of charge for those in need and it is easy to administer. One simply inserts their zip code, the miles within the zip code, and the equipment of interest, and a list of items within your range will appear. Craiglist.com is another website that sells used low-cost equipment and people sometimes donate items. Nevertheless, Mrs. C is fortunate to have a loving family like her daughters who are open to financing certain items required for their mother such as switching the lights around the home to be automatic and purchasing the hand-held shower head for $12.99 from Walgreens. The threshold ramp which cost $33.99 and the leg raisers for $9.66 was personal expense. She was approved for the Community-Based Services (HCBS) Waiver by the Community First Choice State Plan Option which covered the cost of the stairlift.

We were able to use the DME list to acquire about the bathtub bench and the toilet riser free of charge. The grab bars in the bathroom and plastic mat for the bedroom were free of charge from an organization called Project Senior Repair, which is sponsored by the Metropolitan Council on Jewish Poverty. The requirement to be qualified for this program is to be over 65 years of age or to have an annual salary not exceeding $20,500. The bars, plastic mat, and services were free, but there was a $10 donation suggestion which Mrs. C paid for. The commode chair for the bedroom was covered by her health insurance. Other modifications around the house were done by the husband such as removing the doors from the cabinets etc.

Don't let plagiarism ruin your grade

Run a free check or have your essay done for you

Check my essay Hire Writer