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Neville was referred to Grand Pacific Health’s Connecting Care program following a hospital admission with Cellulitis. He was visited by Care Coordinator Sue, in his home for an assessment and a discussion about his health goals. Sue learned that Neville was 62 years old, medically retired and struggling with obesity – weighing in at over 200 kilograms. His wife and adult children were assisting him as much as they could, but Neville had a complex health history suffering from numerous co-morbidities including; Hypertension, Ischaemic Heart disease, Heart failure, Diabetes and Osteoarthritis – requiring additional support. Neville was a keen football player in his younger years, it meant later in life he had to undergo surgery for a right knee replacement, and the left knee now also requires attention said Sue:
“Neville’s mobility has been restricted to about 20 metres due to pain from his knee and shortness of breath.”
“He tried to use a stick when mobilising but didn’t feel safe with that approach,” Sue added.
Neville’s financial situation was also impacting on his ability to access healthcare services and he didn’t have a Chronic Disease Management Plan. He slept in a chair at night due to his shortness of breath, which didn’t help things either. An Occupational Therapist from the hospital was in the process of organising a hospital style bariatric bed, which would enable him to elevate his legs to aid wound healing. Other issues Sue identified included; ongoing Cellulitis, Oedematous legs and fluid retention, along with poor diabetic control. Initial care coordination involved a referral to the Physiotherapy department at Port Kembla hospital for a mobility assessment and possible exercise/falls prevention program, referral to the Illawarra Heart Failure Program for exercise and education, GP referral to an Endocrinologist and an Educator at Illawarra Diabetes Centre, as well as putting a Chronic Disease Care plan in place to see a podiatrist for foot care.
Mobility assessments were undertaken by a Physiotherapist in Neville’s home, leading to a four wheel walking frame suitable for his weight and a home exercise program being prescribed.
“Neville felt much safer using a frame,” said Sue.
“He now regularly attends all of his appointments for self management, has improved control of his heart health and diabetes. His leg wounds are now healed, and he is awaiting assessment for a knee replacement by an orthopaedic surgeon.”
“Neville’s weight has decreased from 215kgs to 179.5kgs and I am so proud of his progress,” added Sue.
