Sixty-year-old Hasim, his wife Alysia and their son Ben made the long trip from their home in Orlando to Ethiopia for the funeral of Hasim’s brother. It was on the return flight from Frankfurt to Dulles that Ben noticed something was very wrong with his father. “He was pale, sweating, unable to talk and his face was drooping to the left,” Ben later told me. On arrival, Hasim was admitted to hospital in Washington, D.C. with a CVA.
I am a telephonic case manager for an insurance company, assigned to a large employer group. I received a referral to help this member and his family with discharge needs. I called and spoke to Ben. He became the family spokesperson as his English was so good. Ben told me the family has cousins in Washington and that he and his mother could stay with them, while his father was hospitalized.
Then came the news that Ben would have to fly back to Florida. His young son had been admitted to the hospital with a fever and no diagnosis. His wife was frantic for him to return. Ben flew back, and over the next few months spent his weeks in Florida, and his weekends in Washington.
The cousins in Washington became less supportive, and Alysia had to take three different buses across town to visit her husband. Ben told me she cried a lot. I sent Ben information on SSI disability and instructions on how to apply for Medicaid, as I anticipated Hasim would need long-term care at some point. Ben followed up on all my suggestions.
Hasim discharged from the hospital to acute rehab, but it soon became clear he could not handle three hours of therapy a day and that his needs would be better met in a skilled nursing facility. Complications included a GI bleed and aspiration pneumonia that put him back in the hospital.
On discharge to a different skilled nursing facility after his pneumonia resolved, I was shocked that the clinical picture had changed so drastically. Therapy notes described him as combative, aggressive, disoriented and throwing feces around his room. This was a significant clinical deterioration, with no obvious precipitating factor.
I made an outreach call to the attending, told him my concerns, and asked if he would consider admitting Hasim to the hospital in Orlando, Fla., for a neuro and psych evaluation. I also asked if he would clear Hasim to fly home by air ambulance. This was my chance to reunite this family.
I asked our employer account manager if air ambulance could be covered as an extra contractual benefit and she agreed the flight cost would be covered.
On July 4, the Lear jet touched down in Orlando, bringing Hasim and his wife home. Ben called me the next day, almost in tears, to tell me thank you from him, his mother, and all his family. Hasim eventually stabilized, and is now in a long-term care facility near the family home.
