Wellness Assessment Executive Summary

Martha Ann Grimm: Psychosocial Wellness Assessment Page 1 Generations Wellness, LLC

Generations Wellness, LLC

Psychosocial Wellness Assessment January 31, 2015

Martha Ann Grimm (a.k.a. Martha or Marty) is a 71 year old (birth date:

04/24/1943) Caucasian widowed female who was referred to Generations Wellness, LLC by her son, Eric Grimm, who is also her primary caregiver and legal guardian, for the purposes of a Psychosocial Wellness Assessment. Martha was also receptive to the services, and an initial visit was held 11/30/2014. Additional information was gained through various sources through 01/22/15 to create this assessment. Executive Summary Martha has a range of psychosocial factors that, at this time, seem have great impact on her present well-being as well as that of her potential future. It is difficult to separate each of these issues, most of which intrinsically tie to another need or issue presented: each issue presented seems to add onto the next or the prior. In all cases, however, a person-centered, individual approach is recommended, and an Aging In Place perspective must be adopted to promote the highest quality of care and quality of life possible. This perspective is not only well known in the medical field, but focuses heavily on in the care, treatment, and decision making rights and preferences of individuals affected by a dementia related disorder, regardless of status of competency. By focusing on the client in the here-and-now, rather than a simple diagnosis or need, quality of life is enhanced and a sense of personhood is maintained. Despite potential difficulty with decision making, it is always recommended that the person experiencing the illness be presented with options. Decisions for their future should consider the individuals needs as well as wants and goals. Including Martha in the decision making process is essential to her overall well-being. It is within her rights to attend hearings held on her behalf, and though she continues to express her desire to attend, she also shares that she has reservations and feelings that she is not allowed to attend. Conference with those who are appointed to act on her behalf, assist in upholding personal rights, or support autonomy in the highest possible form in addition to her physical and emotional well-being should be encouraged to ensure that Marthas desires are known and investigated appropriately for feasibility. Martha identified and reinforced each of the following goals independently and consistently to this worker:

To stay home throughout her life

To be included actively in the decisions and planning that is being made on her behalf

To continue to have Erics assistance in making major decisions and caring for financial matters

To continue sewing

To continue activities at Tanglewood Park on a routine basis

To reduce stress associated with familial conflict

To improve and/or maintain her physical health

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In assessing Marthas current situation, each of these goals seems not only achievable, but

reasonable. The following assessment further discusses each in depth, as well as the strengths and potential barriers identified. Overall, Martha has had a vast improvement in both her physical and mental health since her son began providing primary caregiver support, including moving Martha into the home she currently resides in as compared with her status for many years prior. Medical records from her psychiatrist and primary care practitioners support this immensely. She wants to participate in decisions related to her care, and has identified her preferences in regards to her living situation, caregivers of choice, and activities of daily living, none of which seem unreasonable or not feasible to this worker. There are no significant or immediate safety issues identified: her home environment appears clean and easy to navigate, and there are no signs or symptoms of emotional, physical, sexual, or any other abuse occurring. She has a full time caregiver as well as a variety of professional and social supports, all of which are able to meet her current existing needs as well as a number of anticipated needs. Martha is comfortable with her routine, and expresses in numerous ways that she is exceptionally happy with her life the way it is currently; evidence obtained during the course of this assessment seems to support each of these points without opposition. Above all, staying in the private home environment seems not only to meet Marthas personal goals, but also upholds her personal right to the least restrictive environment and enhances personal autonomy without jeopardizing safety, consistent with quality care and known best practice standards. Information for this assessment was obtained through the following sources:

Personal interaction/ interview with Martha at her residence (1330 W. Summit Ave, Roosevelt Park, MI) on the evening of 11/30/2014 and the early to midafternoon of 12/1/2014 as well as the evening of 01/14/ 2015

Discussion and interaction with Mr. Eric Grimm at the home on 11/30/2014 and during a portion of the 12/01/2014 visit, relatively briefly on 12/05/2014 during attendance at a probate court hearing for Martha as discussed in this report, as well as on 01/14/2015. In addition, telephone and email contacts were necessary numerous times throughout this assessment process for further information and clarification

Review of visitation notes by Dayspring Services dated 02/14/ 2014-11/28/2014

Review of medical records from Norton Family Practice (office of Dr. Jarrell, Marthas Primary Care Practitioner) from November 2012 through November 17, 2014

Review of various psychiatric medical records dating September 1, 2001-January 19, 2012 which included information and clinical notes from Pine Rest Christian Mental Health Services (Inpatient and outpatient care), Hackley Hospital, Northwood Behavioral Health, Dr. Katherine Jawor (Martha continues to see Dr. Jawor every 6 months and as needed for psychiatric services), and Dr. Zia Khan.

Discussion with Barb, DaySpring Services companion, during her usual visit to Marthas home on 12/01/14

Attendance at probate court (Muskegon County Probate Court) hearing 12/5/14

Telephone interview on 01/22/2015 with Ms. Melissa Klos, Marthas Stylist and Nail Technician (Provence Salon) for the past year







Telephone interview with Chris Mallory, Marthas sister in law (Mr. Fred Grimm was Chriss brother), on 01/05/2015

Telephone interview with Valerie Alcorn on 01/11/2015 (Valerie has known Martha for approximately 20 years and was Mr. Fred Grimms assistant for many years)

Discussion with Kelly Kann, RN, Generations Wellness LLC, who accompanied this worker on 01/14/2015 to the home for further input in this assessment process

Telephone interview of JoAnna Lasser on 12/18/2014; Mrs. Lasser grew up near the Grimm family at the home in North Muskegon, and was very close friends with Marthas daughter for many years. She reports she has known Martha as long as I can remember.

Review of Annual Report of Guardian as submitted to Muskegon County probate Court by Mr. Eric Grimm for reporting periods 08/29/2011-07/18/2012, 07/18/2012-08/29/2013, and 08/30/2013-08/29/2014.

General Information Physical Description Per her most recent primary care appointment on 11/17/14, Marty is approximately 53 tall and weighs 171 lbs. During our interaction on January 14, 2015, Martha said she may have lost a couple of pounds since then but feels that is fairly accurate. She is Caucasian, and appears her stated age to this worker. She has gray hair that reaches approximately to her shoulders (she prefers to wear it down), and she wears bifocals at times, as well as a dental apparatus (partial). She does not wear any heavy cosmetic items.

Medical Diagnoses (per medical records of primary care practitioner, Dr. Erin Jarrell):

Current diagnoses: Alzheimers Disease, Type II Diabetes-controlled, Bi-Polar Disorder, Allergies, Restless Legs, COPD, Asthma, Venous Stasis, Shoulder Pain, Hyperlipidemia, Insomnia, Vitamin D Deficiency, Gait Disturbance.

History of: Degenerative Disc Disease, Urinary Tract Infection(s), Iron Deficiency, uncontrolled Type II Diabetes, Psychosis.

Surgical History

Tonsillectomy

Cervical Fusion (Dr. Marquart) related to degenerative disc disease

Open Reduction and Internal Fixation of left radial shaft fracture (fall) (Dr. Recknagel: 2011)

Knee cyst removal

Surgery related to shoulder fracture (Dr. Hamati: 2012)

Figure 1: Martha Ann Grimm, January 14, 2015


Vision Martha has bifocals which she wears per her preference; though this is not necessarily every moment of each day, she seems to wear them most of the time, particularly if she is involved in any type of activity such as reading or sewing. She has diabetes, and takes her vision seriously and maintains appointments for screenings and evaluations as is warranted and recommended. She gets her prescription for glasses filled at the local Sams Club, however all screenings and vision evaluation needs are completed with Shoreline Vision in Muskegon, per her preference.

Dental Martha has a lower dental partial which she wears most of the time. She is able to place it and remove it independently without difficulty, and reports she is able to clean it herself as well. She is able to brush her teeth independently and uses and electric toothbrush that was recommended by her dentist. She visits the dentist around 3 times per year now for cleaning and routine maintenance and general oral health needs, but said to this worker: I didnt always do that. She reported to this worker that she has no dental issues right now which cause her concern or impede upon her in any way. Dr. Thomas Smith of Norton Shores is her routine dentist of preference.

Hearing Martha has no hearing deficits identified in the medical records reviewed by this worker, and denies such when asked. She does not wear hearing aids, and was able to hold conversation with this worker and with others in the presence of this worker without any need for increased volume or decreased background noise. Martha has not had a recent hearing evaluation, however no barriers have been identified which would constitute the need for such at this point. Communication is further discussed in that section of this report. Ambulation: Martha has some history of falls resulting in injury, and this is not a new issue. She had fallen in her past environment as well as in her present environment. At least two falls in 2011 resulted in broken bones followed by skilled nursing placement for rehabilitation. In the twelve months preceding this assessment, Martha has fallen twice: in June of 2014, a face first fall prompted an Emergency Room visit complete with facial and head CT Scans which came back negative for acute findings. A fall resulting in swelling and bruising over her left eye on approximately 10/26/14 also occurred, for which she also saw her primary care provider with no significant or permanent injury. Marthas ability to ambulate safely has, per medical records and statements of Martha and support parties, greatly improved in the past 2-3 years. Martha walks independently in familiar environments such as her home. The private home she resides in is equipped with handrails throughout the main floor (including hallway), entryway, and even outside of the main front door (see also the Environment section of this report for discussion of safety precautions within the home). She participates in a variety of exercise programs routinely at Tanglewood Park, including Tai chi and Sit and Be Fit, as Martha calls it. She feels these programs have helped to make her stronger and more confident in her balance, and reported that she will continue to enroll in these opportunities when available. She also routinely goes for walks when the weather is nice to a nearby park or to take the pet dog, Buddy, out. She has a 4-prong cane which she reports she uses often when outside only (in 2011, a wheelchair was necessary at times, and later, a walker); upon further discussion Martha may use the cane in uneven or unfamiliar situations rather than her initial statement of only outside. The cane was easily located near the sofa in the living room, and Martha was quickly able to point out its location to this worker and others when asked on multiple occasions. At times she





uses furniture within the home for a bit of additional balance, (for instance, a hand on the counter as she is walking by) but not excessively so in this workers presence or per observation of K. Kann, RN. Martha should be encouraged and reminded to use her cane whenever she is going outside, as well as to be aware of blood pressure issues which have affected her balance in the past and apparently contributed to at least one fall. Occasional verbal reminders by care partners who are present (including son, Senior Companion, etc.) seem to be effective in this regard. In addition, it may be of benefit for Martha to investigate enrollment in group programs such as A Matter of Balance which is made available through Senior Resources, the local Area Agency on Aging. Amy Florea, Community Service Director (phone 231-733-3519) will not only likely be able to provide information on upcoming offerings of this program, but provide details of other educational sessions which may be of benefit to Marthas health goals. There is an enabler bar on Marthas bed which allows her a grip to pull herself up when necessary. Side rails are not recommended for confused individuals as a result of high risk of physical harm resulting from misuse. However, Martha understands for what use the rail is intended, can explain and exhibit its use, and has no significant periods of confusion which might increase her risk factors at this point, in this workers assessment. Martha also has an emergency alert pendant/watchband which she should be strongly encouraged to wear every day. This device is equipped with a motion sensor that will place an immediate call for emergency assistance as well as notifies her emergency contact (her son, Eric) when triggered with sudden motion such as in a fall.

Nutrition Martha has a number of medical diagnoses which impact her diet, including Type II Diabetes. Though her diabetes is currently considered controlled, she has a history of uncontrolled diabetes, and therefore watches her diet carefully in an attempt to regulate her blood sugar levels. Additionally, she has a history of and/or current vitamin deficiencies including vitamin B and D, Iron deficiency, and hyperlipidemia.

Martha admits that she might like to eat too much, and confessed: I have a sweet tooth. She has struggled at times to adhere to dietary recommendations of her physician related to not only diabetic concerns, but general weight stability which impacts other areas of function, such as balance and

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Martha Grimm: Weight in Pounds Per Medical Record Review

Martha Grimm:

Weight in

MMC: Mercy Memory

Clinic

HK: Heartland

Knollview

NFP: Norton Family

Practice


strength. For instance, she gained a significant amount of weight in 2012, but had also suffered weight loss after a series of illnesses including urinary tract infections in late 2011 and early 2012. Periods of overeating were identified in 2012, including episodes of binging and/or nighttime snacking. Over time, Martha has made lifestyle changes which have helped her achieve a weight that she, and her medical team, are more comfortable with. She occasionally struggles with nighttime snacking, however, now makes healthier choices. Martha identified that Eric helps me a lot with what I eat and staying active. Eric (Marthas son and primary caregiver) encouraged participation in an exercise group at Tanglewood Park, and though initially somewhat resistant to the new activity, Martha is now enrolled in numerous classes and reports she thoroughly enjoys them. This increase in activity has, undoubtedly, been beneficial to her nutritional intake, and is also discussed throughout this assessment. By ensuring that healthy snacks and meal options are available, as well as by preparing the majority of evening meals and supervising choices Martha makes, Eric has helped Martha to change some of her eating habits over a period of years. Participation in diabetic education programs through the local hospital have also been of benefit, per discussion with Eric and Martha. Additional diabetes management classes, such as Diabetes PATH (Personal Action Toward Health) or Healthy Eating, were also discussed with Eric and Martha by this worker. These courses, as well as similar classes which may be of benefit in this area, are available locally through Senior Resources, and further information related to scheduled events can be obtained by contacting Amy Florea, Community Service Director (phone 231-733-3519). No chewing or swallowing issues are currently presented. As stated earlier, Martha has a lower dental partial; this, as well as extensive dental work in the past 1-3 years to repair cavities, etc., has greatly improved Marthas ability to eat a variety of foods comfortably. Food preferences are further discussed in the Preferences and Routine section of this report. Self Care and Activities of Daily Living Martha is able to participate in nearly all routine activities of daily living, however at times needs supervision or assistance to complete the task. Currently, assistance is readily available to her for every task that a need thus far identified. Martha prepares small, easy meals independently. For instance, she makes coffee or uses the toaster, is able to functionally use the sink and stove, as well as locate and identify items appropriately for cooking. When she is home alone, she reports that she does not use the stovetop, and will utilize the microwave for soup, etc. She typically participates in preparing larger or more complex meals with Eric for dinner as well. This worker observed Martha using such items as the microwave, coffee maker, and toaster and Martha appeared at ease and fluid in her movements from one step to the next. She is able to wash dishes and put them away appropriately. Eric typically completes the majority of shopping, and this helps to ensure that healthy and appropriate food and snacking items are available. Martha does participate, however, by picking up smaller or individual items on her own at times, accompanying Eric to the store, and/or assisting in the completion of item lists. Martha does not drive. Following numerous evaluations which indicated that her reaction time may be delayed, she gave up her drivers license at the recommendation of her primary care physician, Secretary of State, and her son, Eric. She stated that initially this was a difficult choice for her, however in a very short time she became acclimated to the use of public transportation; in her area,



this is the Go Bus (Muskegon Area Transit System). She is very comfortable with this now, and uses the Go Bus System on a very regular basis. Her primary care practitioner is aware and has documented that Martha independently rides the Go Bus, attending a number of her appointments without the need for supervision or accompaniment, and has not expressed any concerns in records related to this issue. Martha uses the Go Bus system to attend many of her appointments including health, salon, shopping, or to Tanglewood Park. There have been no reported incidents in which she has been lost or otherwise confused, and she is able to independently call to set up additional appointments; Eric also assists in this regard as needed. Martha is able to choose her own clothing routinely and appropriately; she requires no assistance in this regard. She is able to dress herself, but at times minor assistance is necessary. She has a history of fractures in her wrist/shoulder, as well as degenerative disc disease which can potentially limit her abilities at times. She uses some clothing that is easier to dress in or which aid in comfort, such as elastic banded pants. She wears compression socks every day. She receives assistance in bathing at minimum twice per week through DaySpring Services. Her attendant sets up the bath for Martha and helps her to enter and exit the tub safely. Personal hygiene, self-maintenance and grooming has been a significant issue for Martha in the past, as well as a clear indicator of potential decline in mood, cognitive status, or general mental health status. At this point, Martha is taking exceptional care of herself as compared with the past; individuals this worker spoke with indicated that even as far as 20 or more years ago, hygiene issues were not abnormal. During her memory evaluation in 2011, practitioners mentioned that Martha appeared unkempt, had a personal body odor, etc. Prior to that, a number of psychiatric and emergency room records indicate that Martha appeared disheveled, or had poor personal hygiene. Marthas attention to her personal needs over the past couple of years is a significant improvement. A friend of Marthas informed this worker that Ive never seen her look any better,, and another reported that Since shes been in Roosevelt Park with Eric, I think Wow, what a difference! every time I see her. She cares about herself now. Martha has her hair styled routinely and has professional nail services, both of which also help to boost her self-esteem and aid in the maintenance of her personal grooming. Martha is able to participate in some basic, light housekeeping, and she does so to some extent daily. She may wash dishes, put items away, or fold laundry. She does not engage in heavy cleaning or jobs which would entail her to engage in bending, stooping, kneeling, excessive energy, etc. The washer and dryer in the home are in the basement, and Martha does not go down the stairs in the home at all. Eric, therefore, does the laundry, however does bring it upstairs at times to enable Martha to participate in the folding and taking care of clothing. A housekeeping service has been hired, and has in the past, been used for occasional heavier cleaning needs. For the most part, this is unnecessary, per observation and discussion with Martha and Eric (please see also Environmental section of this report) and therefore is not identified as a consistent need. Marthas outdoor chores seem limited to her gardening hobbies and simple tasks such as spreading salt on the drive with a small container that is manageable for her. The winter weather, of course, limits her time outdoors as compared with the summer. She states I only do the things I feel comfortable doing. I dont want to fall again.



Documents

Wellness Assessment Executive Summary