Case Study: The Paramount at Somers Rehabilitation and Nursing Center (April 2021)

Concierge: Julie Lavadhi
Patients Age: 85-years-old
Admission Date: 1/20/21
Admitted From: Montefiore Medical Center
Discharge Date: 4/10/21
Length of Stay: 80 days
Discharged To: Home
Reason for Stay: Encephalopathy, acute kidney failure, and hyperosmolality and hypernatremia.
How did this patient hear about the The Paramount at Somers Rehabilitation and Nursing Center? Hospital Referral

Details of Experience:
Franco Dedvukaj is an 85-year-old patient referred to The Paramount Rehabilitation and Nursing Center from Montefiore Medical Center. The primary diagnosis wass encephalopathy, acute kidney failure, and hyperosmolality and hypernatremia. His past medical history included hypertension, hyperlipidemia, heart block, cerebral vascular accident, ascending, prostate cancer, covid-19, and aortic aneurysm. Prior to hospitalization, he was independent in all self-care and activities of daily living.

Prior to admission, he lived at home with his wife and son and was independent in all his activities of daily living.   He enjoyed spending time outdoors and spending time with his family and friends.  Franco’s primary language is Albanian.  Upon admission into the community, Franco was greeted and welcomed by The Paramount staff and immediately made comfortable.  The team worked hard to develop a plan of action to support Franco’s goals of returning home to his family.  

Upon evaluation, Franco was alert and oriented, with the ability to follow one-step directions. He showed confusion due to the primary speaking language being Albanian. His current level of activities of daily living required total dependence from a therapist and frequent rest breaks. Bed mobility, transfers, and ambulation were all at a total dependence level. In addition, he was totally dependent during upper body dressing, lower body dressing.  He had poor sitting tolerance, poor sitting balance, and poor standing endurance. 

During his therapy sessions, Franco would practice transfers from multiple surfaces; He was able to consistently ambulate with Front Wheel Walker with decreased number of rest breaks to eventually none taken. He would complain of bilateral knee pain from his arthritis. He would also practice bed mobility tasks, such as: coming from supine to edge of the bed and rolling from side to side. 

During occupational therapy, Franco worked on self-feeding, demonstrating improved sitting tolerance, sitting balance, upper extremity strength to feed himself throughout the whole meal. He also improved nutritional intake and alertness during meals. During upper body dressing, the patient demonstrated improved sitting at the edge of bed balance and tolerance, as well as upper extremity strength to be able to raise his arms and clear over his head. The patient became modified independent, utilizing a wheelchair on the unit and performing self-propulsion safely. 

Franco had great family support, who was very involved and very caring. They visited and FaceTimed with him on a weekly basis.  Franco’s main goal was “to get better” and go home to his family. While his focus was rehab, Franco enjoyed his independent pursuits such as watching TV, talking to his family on the phone while in the confines of his room.  Sometimes he would read the paper in his language and a few books that family provided for him.  Activities provided a tabletop activity packet to use at his leisure. Franco participated during the happy hour and really enjoyed it. In addition, the Concierge provided 1:1 visits to increase socialization and extra support, as she spoke the same language and he felt more comfortable.  He was so sweet and pleasant.  Everyone fell in love with him. Every time you walked in the room, he would offer you candies. 

Throughout his therapy, Franco was able to perform all activities of daily living above his evaluation levels.  Franco was recommended a front wheeled walker to ambulate short distances at home, for which he was educated and fitted prior to discharge. The Resident’s family requested a wheelchair so that they are able to take him to excursions that require long-distance ambulation. Upon discharge, he required minimal assistance for all his activities of daily living. 

Franco demonstrated excellent progress and returned home at the highest practical level. Franco shared with the concierge that he is so thankful of the staff and the care he received here. “Special thanks to my therapists who worked with me and helped me regain my strength”.  The team is proud to have been a part of his therapy recovery journey. We are very grateful to our patients for choosing The Paramount for Rehabilitation and Nursing Care. 

From everyone here at The Paramount we wish you Good Luck.