Through an innovative partnership, Abramson Senior Care and Bridges Palliative Care support low-income, vulnerable seniors by providing crucial palliative care services for managing chronic illness.  The following story demonstrates how telehealth combined with psychosocial expertise and geriatric care management is improving lives, while enabling seniors to safely age in place.   

Sheila is a homebound 91-year-old living in subsidized housing in Philadelphia and receiving palliative care services for advanced chronic disease.   Although Sheila is alert and independent in many ways, she has chronic obstructive pulmonary disease (COPD), a lung disease that makes breathing and coughing very difficult.  While Sheila needs constant medical oversight, it is difficult for her to get to the doctor.

A referral was made to Abramson Senior Care for in-person palliative care management and psychosocial support. “The first thing I did while being with Sheila in her home was assess her living situation,” says Brie Yousaitis, Director of Psychosocial Support at Abramson.  Brie discovered three urgent needs that required immediate attention:  1) a safer way to get around her home; 2) organization of her medication and 3) supplemental nutrition.

Sheila has regular telehealth appointments by phone with Dr. James Tweedy, a Bridges Palliative Care physician.   While these telehealth sessions are very helpful, Dr. Tweedy and the Bridges team wanted an opportunity to assess Shiela in person to determine what additional support was needed.

Brie learned a lot during her first visit.  Despite the best efforts of Sheila’s children, there were significant gaps in her care.   “Sometimes family caregivers simply don’t know what they don’t know.”

Brie was able to provide the Bridges team and Sheila’s family with crucial information.  “I pointed out Sheila’s need for a rolling walker to allow her to move about her home more easily and safely. We went through her medicine cabinet, one pill bottle at a time, to organize her medications, which were dangerously disorganized, and we addressed Sheila’s weight loss by adding nutritional supplements.” 

For many homebound seniors, telehealth is the best opportunity for them to receive desperately needed healthcare.  However, certain conditions are difficult for a telehealth practitioner to assess when not in person, especially since many seniors lack the technology or skills to make full use of telehealth. Using Facetime on her cell phone, Brie was able to provide a visual of Sheila, and together with the palliative team was able to prevent unnecessary injury or hospitalization resulting from medication errors, falls or significant weight loss.

Thanks to the Abramson/Bridges partnership, Sheila is both safer and better equipped to continue living independently in her home.