Concierge: Ashley Valentin
Patient‘s Age: 64 years old
Admission Date: 4/13/2021
Discharge Date: 6/10/2022
Discharged to: Home
Length of Stay: 389 days
Reasons for Stay: Sepsis and COVID Recovered
How did this patient hear about St. James? Mather Hospital recommended the patient.

Details of Experience:

Denise is a lovely woman who enjoys spending time with family and attending church. In 2020 she was diagnosed with Breast cancer, received surgical interventions, and became a Breast Cancer survivor. After recovering from cancer, she fell and needed multiple spinal surgeries. After the surgeries, she was not able to move her legs and lower body along with minimal movement in her arms. Denise had extensive physical and occupational therapy until January of 2021. However, she was sent home due to insurance coverage and was sent home with home care services for four hours a day, four days a week. She went back to the hospital a few months later with increased back pain that was worsening over three days. Where the hospital set her up to go to St. James to become stronger and manage her pain.

Denise was admitted to the St. James community on April 13, 2021. Within the first few hours of arrival, Denise was welcomed and evaluated by the nursing staff. For the next few days, she met with different members from each department who were going to be a part of her care team. When Denise was evaluated by physical and occupational therapy, she presented with weakness, impaired postural balance, decreased activity tolerance causing difficulty with transfers, full dependence in activities of daily living, and functional mobility. Denise’s goals were to be able to dress herself and walk 25-50 ft. Denise was motivated to participate in physical and occupational therapy to meet her goals.

Denise knew the next steps to meeting her goals would be challenging, but she was looking forward to working with her care team. She met with her case manager, who knew that when Denise went home, she would no longer have the 4 hours a day, 4 days a week. The service stopped once Denise went into the hospital, and Denise’s case manager worked on getting Denise a managed long-term care plan.

Managed long-term care is a system that delivers long-term services to chronically ill or disabled people who wish to stay in their homes and communities. These services include home care or adult day care and are provided through managed long-term care plans that are approved by the New York State Department of Health. Denise’s case manager assisted Denise on evaluations with Maximus and then other different Manage Long-Term Care Insurances. Her case manager provided packets of different Managed Long-Term Care insurances. Ashley and Jill were able to assist Denise in receiving nine hours a day, seven days a week of care.

Denise and Ashley spend many hours together during her time at St. James. The more Ashley heard everything Denise went through, the more Ashley was able to assist her and advocate for Denise. Ashley gave Denise a necklace from one of Denise’s favorite verses from the bible, and Denise wore it almost every day to inspire her to work towards her goals.

While working with Ashley and Jill on her discharge plan, Lisa and Hailey were working on assisting Denise on her goals to stand, walk, eat, dress, etc. Lisa and Hailey encourage Denise through each milestone, from standing from one minute to five minutes to not being able to walk ten feet to walking 125 feet. Denise stated, “Finish the task…they don’t give you a task you cannot finish. They want you to succeed in everything you do.”

Ms. Woodard spent 389 days at St. James, working hard every day to meet her goals. Reflecting on her time with St. James, she stated, “I’ve been to other facilities, and the difference with St. James is all the employees work with their heart. St. James has heart.”