Bshs 437 Care Management Plans
Bshs 437 Care Management Plans
Chronic care management, encompasses the oversight and education activities conducted by health care professionals to help patients with chronic diseases and health conditions such as diabetes, high blood pressure, lupus, multiple sclerosis and sleep apnea learn to understand their condition and live successfully with it. This term is equivalent to disease management for chronic conditions. The work involves motivating patients to persist in necessary therapies and interventions and helping them to achieve an ongoing, reasonable quality of life
Read the case study and complete the following assessment tool.
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Case Study
Bshs 437 Week 4 Care Management Plan
Mrs. S is receiving medical treatment for arthritis and diabetes and is overweight. She has problems with her breathing and has difficulty walking, getting into and out of bed, and bathing. You are a care manager for ABC Elderly Care Management. You must review this information, in addition to her existing medical records, so you can make an immediate referral to a new primary care physician. ABC Elderly Care Management also was alerted that Mrs. S may need long-term care.
The new primary care physician met with Mrs. S a few days after receiving her records and performed a comprehensive physical. The physician found that the patient has severe emphysema (for which he orders respiratory therapy) and osteoarthritis. In addition, Mrs. S is taking multiple medications, several of which are unnecessary and will be discontinued. Mrs. S also shows early signs of Alzheimer’s disease.
About a week later, you visited Mrs. S at her home to complete a comprehensive assessment form (CAF). Mrs. S is severely dependent in three activities of daily living and unable to shop or cook for herself. You also are concerned about her eating habits and the fact that she is prone to falling.
You must proofread your paper.
Assessment Tool
Research area agencies on aging in your state by using the Internet.
Complete the following assessment tool by identifying a problem and by determining what resources and services you would refer Mrs. S to based on your research. Next, describe how your recommended referral can help her manage or overcome the stated problem. Include a total of 8 problems with related referrals and explanations.
Include references to websites and other sources in the “References” section following the table. Format your assessment tool consistent with APA guidelines.
References
Kodner, D. L., & Kyriacou, C. K. (2000, October–December). Fully integrated care for frail elderly: Two American models. International Journal of Integrated Care, 1(1), 1–19.