1. PT is a 54 year old female with Multiple Sclerosis who was residing with her spouse who had a TBI and terminal cancer. Spouse passed away in February leaving PT with reduced income and lack of informal support. Could no longer afford housing. Worked with County Protective Services for Adults to ensure:
• Relocation to affordable independent housing-/ emergency moving assistance.
• Application for Medicaid/ Home Care Services
• Temporary non-Medicaid housekeeping/ personal care
• Application for a pooled needs trust to assure Medicaid eligibility while preserving available income
• Application to NHTD Waiver for ongoing Service Coordination
Without these services PT would be at high risk for institutionalization with high costs to the consumer and the Medicaid system
2. RR is a 64 year old male who is a retired school bus driver who is deaf from birth and has Parkinson’s Disease which forced his retirement. Center assisted RR to apply for SSDI. He is having difficulty affording medical care and prescriptions as his retirement plan limits reimbursable expenses. He also has a significant credit card debt and has unpaid income tax burden. Consumer has elderly parents and one sister who is caring for them. The sister is experiencing difficulty in dealing with RRs new need for support and assistance. Center is assiusting the consumer with:
• Exploring additional medical coverage- Medicaid application with Pooled needs Trust to protect available income
• Assistance with working with credit counselors and the IRS to manage existing debt.
• Provide peer counseling to support consumer with his transition to retirement
• Appropriate referral for psychiatric evaluation
Without IL interventions RRs future independence could be jeopardized with the possibility of expensive institutionalization. Sister was already discussing the potential for an “assisted living” placement. RR is very protective of his independence and lifestyle.
3. FS is a 54 year old female with spinal and other orthopedic disabilities as the result of a car accident over 10 years ago. Center involved with consumer and her 84 year old mother for over 4 years. Accomplishments include:
• Secured funding for a ramp to the family coop
• Facilitated legal representation when coop board and managing agent refused construction of ramp- outcome StaTE Division of Human Rights ordered the coop to allow ramp construction.
Ongoing issues:
• Consumers refusal to accept the permanency of her disability leading to lack of future planning and resistance to application for supportive services.
• Reliance on mother for housing and personal care
• Family relationship dysfunction
• Undiagnosed and untreated mental illness
• Poor grooming and self-care skills
Ongoing Interventions
• Staff building trust and a functional helping relationship
• Assisting consumer to get DSS payment for MedicaRE Part B through the SLMB Program.
• Continue exploration of Medicaid application
• Future housing planning
• Exploration of acceptance of mental health interventions
Without intervention consumer is at high risk of compromised independence and future expensive institutional placement
4. EL is a 19 year old recent high school graduate with a developmental disability, A graduate of the Project Search Program, he is working as a peer leader/counselor with WDOMI staff. He co-facilitates a self advocacy/ empowerment group for students in the Project Search program sharing his experience and personal insights. The consumer benefits by developing his counseling and leadership skills.
5. MW is an 86 year old woman with chronic asthma/emphysema living in subsidized housing for people with disabilities. Hospitalized in September 2012 and placed in a local nursing home for “short term” rehabilitation. Due to lack of discharge planning by nursing home staff no discharge was scheduled until February 2013 (five months after admission). Discharge lasted less than 24 hours due to inadequacy of home care authorization. WDOMI intervened as follows:
• Advised consumer and adult daughter regarding expectations for an appropriate discharge plan.
• Advocated with Nursing Home Social Work staff to develop a adequate discharge plan.
• Advocated with Yorktown Section 8 to maintain housing subsidy- It was due to be terminated in April 2013 because consumer was out of apartment for more than 6 months. Proved consumers absence was not for more than 180 consecutive days.
Without WDOMI intervention Consumer would have lost Section 8 and her
ability to return to the community.