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Mrs Smith is 84 and had a stroke that caused left-sided weakness. She has hemianopia and an ileostomy, which she can no longer manage independently. She did not make much progress in hospital and was discharged into hospital-level residential care. But now, through five months of hard work and determination, she has regained mobility and is able to return home. She lives with her husband has a supportive family nearby and a new grandchild in Christchurch.
Allocation: Average of 46-units of complex care per week, four units of nursing for the period.
Goal: Mr and Mrs Smith want to be able to visit their new grandchild in Christchurch.
Assessment: A HealthCare NZ registered nurse coordinator completed a home visit, and set goals with Mrs Smith using our validated goal-setting tool. We then worked with Mrs Smith, her family/whanau and her informal carers, to come up with the best support plan possible.
Support plan: Together, it was decided that the support plan would focus on enabling Mrs Smith to achieve her goals. The Good to be Home team's visits would not be task-oriented; they would be focused towards restoring Mrs Smith's strength and confidence.
Mrs Smith is currently working with our community support workers to complete the mobility exercises prescribed by our physiotherapist. We are also supporting her to attend her exercise groups, which not only build her strength but also give her the chance to catch up with a close friend.
She is well on her way towards achieving her goal of visiting her granddaughter in Christchurch.
