Louis' Story: Maintaining Independence
Independence has always been very important to Louis. Even though the 88-year-old resident of Guelph is widowed and lives alone, he takes great pride in being able to care for himself. His two sons help out as much as they can but live outside the area.
After having to stop driving because of memory concerns, Louis was referred to the Guelph Health Link for an assessment.
“During my initial assessment of Louis, I met a very pleasant man who was accustomed to caring for himself and proudly shared the fact that he walked to church every Sunday morning,” said Heather, a Registered Nurse with the Guelph Family Health Team. “He was really happy living at home but I had a few concerns with his ability to safely care for himself. His legs were swollen, his blood pressure was high, and his memory impairment meant that he wasn’t always the most careful when cooking, bathing, etc.”
Health Links were launched with the mission to create wrap around care and services for residents like Louis who have multiple medical conditions and complex medical needs. These residents benefit from a comprehensive care plan that is unique to their particular situation. They also don’t need to worry about navigating the many services they might need – all of the right providers are brought to them.
Louis began receiving a number of community supports but it wasn’t quite enough to meet his needs. “Louis’s sons were increasingly worried about him. He was refusing to go to a day program, he had begun wandering in the neighbourhood, and one day when he set off the fire alarm, he was unable to communicate what he should do if there were a fire,” said Heather. “Knowing how important staying at home was for Louis, I suggested to him and his family that a Health Link round table discussion occur to ensure he was receiving the best support possible to enable his continued independence.”
Key community partners including Louis, his family, a neighbour, his family doctor, the Primary Care at Home nurse, his Waterloo Wellington Community Care Access Centre care coordinator, the occupational therapist, Meals on Wheels, a St. Joseph’s outreach worker, a Community Responses Behaviour Team member, a Primary Care at Home social worker and a facilitator met to discuss how to better support Louis.
“Louis is now receiving care from personal support workers five days per week. He has supervision while cooking breakfast and is receiving proper personal care. Throughout the week his neighbours help him with orientation and safety. He also continues to see the foot care nurse through the Family Health Team and is receiving regular checkups by the Primary Care at Home nurse and his family physician,” said Heather. “The Health Link process to date has allowed a man, living alone at high risk, to stay in the comfort of his own home where he can be happy, healthy, and safe.”