In 2022, Catch-A-Ride transported a passenger who uses a mobility device, who we will refer to as Charles, a total of 208 times. His trips were to/from Charles’s dialysis appointments, which he had three times per week until his passing at the beginning of November. Catch-A-Ride was his primary means of transportation and it enabled him to get to his appointments independently, rather than having to rely on family and friends for transportation. Since Catch- A-Ride is public transportation with a low fare rate, Charles only paid $208.00 for his 208 rides in 2022.
Catch-A-Ride provides an important service in the community, as demonstrated by this 2022 survey response from a Decatur County resident (name has been changed), “Catch-A-Ride is crucial for Kim in Greensburg to get to and from her new job at Arby's. She has used Catch-A-Ride since it began service in Greensburg. We appreciate the kind drivers and the consistency of service. I have no idea what Kim would do without it.”
Robert is a very independent individual; he has never been married, has no children, and has no relatives involved in his life. He has been attending the SNAC for several years and those individuals have become his family. Robert enjoys the SNAC and loves to debate with anyone that is up to the challenge.
During the past year, the SNAC Coordinator noticed that Robert’s health had been declining. In a private conversation, she learned that he wasn’t feeling well, was struggling financially, and didn’t always have much food in his house. She encouraged him to go to the Doctor and contact the ADRC at LifeTime. Robert, being a proud veteran, would not go to the doctor, would not ask for help from anyone or even contact the ADRC.
Food is brought to the housing facility from a local pantry and the SNAC Coordinator encouraged him to at least get one of the boxes of food. He did not want to do that.
After being around Robert for several years, the SNAC Coordinator knew how he was. When the pantry would bring the food, the SNAC Coordinator started getting a few items and slowly giving them to Robert a few at a time. He would accept those from her. The SNAC Coordinator was pleased that he would at least accept a few items. Over time, she was able to slowly increase what she gave him.
While the SNAC Coordinator could not get Robert to call the doctor or the ADRC, she was at least able to make a small difference in his life by being there to talk to him and providing some food for him.
JK, age 70, a guardianship client of Sentry Services since early 2019, was admitted to Madison State Hospital in 2018. JK’s sister had previously cared for him for years but was no longer able to manage his declining mental health. JK was found to be a danger to himself and others, so he was placed at Madison State Hospital.
After being appointed JK’s full guardian, among other previously diagnosed mental health issues, JK was diagnosed with anti-social disorder and had a hard time connecting with staff and peers. He also cried a lot for his sister, who would call him periodically. Sentry Services Case Manager visited with JK monthly. At first, JK was very shy and distant. The Sentry Services Case Manager worked with the staff at Madison State Hospital to find out what types of things JK liked and what his interests were and when visiting would talk to JK about these things, which made the visits much more enjoyable for both parties.
In August 2021, the Sentry Services Case Manager attended JK’s team meeting, which is typically with several members of the care team together, so that issues can be discussed and resolved, and was informed that JK’s physical health was declining. He had become almost total care with his activities of daily living, such as needing assistance dressing, putting on his shoes, incontinence, and needing to be in a wheelchair. Because Madison State Hospital is not equipped to care for JK’s physical health and JK had met his discharge criteria pertaining to his mental health, his team reported he would need to be placed in a nursing facility, that was better equipped to handle his care.
Because of JK’s history of people coming into his life and then leaving, the Sentry Services Case Manager wanted to keep JK in LifeTime’s catchment area, to prevent another person no longer being involved in his life. The Case Manager had built a working relationship with the Social Worker at Hanover Nursing Center, who at one time worked at Madison State Hospital and knew JK. The Case Manager reached out to the Social Worker and explained JK’s situation. After assessing JK, Hanover agreed to admit him, and he transferred out of Madison State to Hanover Nursing Center on December 12th, 2021. Since moving to Hanover Nursing Center, JK has made several friends with the staff and one Saturday asked the staff to call the Sentry Services Case Manager. The phone call was brief but, just the thought JK asked to call the Case Manager made it clear that keeping him in our catchment area was the right thing to do.
County: Jefferson
Catch-A-Ride partners with three sheltered workshop facilities in our six-county service area. We provide transportation to the facilities for job skills training or to places of employment in the community. From January 1st through June 30th, 2022, Catch-A-Ride transported a 52-year-old African American female passenger with a disability, who we will refer to as Beth, a total of 178 times to/from Beth’s home in Ohio County to her job at Kroger in Dearborn County; generally, four days per week. Catch-A-Ride is her primary means of transportation to her place of employment, enabling her to get to work independently, rather than having to rely on family and friends for transportation. Beth qualifies for funding that the sheltered workshop has available, so Catch-A-Ride bills the sheltered workshop for Beth’s rides on a monthly basis. This means that there is no out-of-pocket cost to Beth and Catch-A-Ride is able to utilize the revenue for match as well. Beth’s ability to get to work regularly has allowed her to remain an active member of her community.
TL is a 36-year-old female that has an IQ of 66 and diagnoses that include autism, anxiety disorder, antisocial personality disorder, and mild intellectual disorder. TL grew up in foster care and has been in and out of group homes and state hospitals from a young age. In 2005, TL was admitted to Madison State Hospital and Sentry Services was appointed TL’s guardian in 2016.
One of Madison State Hospital’s goals is to pursue a discharge plan for each patient. Since 2018, when the current Sentry Services Case Manager became involved, TL has exhibited inappropriate behaviors such as physical aggression, harm toward staff and other patients, selfinjuries, and verbal aggression, which have resulted in her being placed in the quiet room at Madison State Hospital from time-to-time for several hours as well as isolation in her room. While TL has been placed on the discharge list several times since 2018, the Sentry Services Case Manager has never agreed with TL being on the discharge list and has voiced those concerns in hopes of keeping TL and other individuals safe from the harmful behaviors she exhibits.
In September 2021, TL was once again placed on the discharge list. The Sentry Services Case Manager voiced disagreement; this time, noting that TL’s behaviors had increased to an even higher level than in the past. From September 2021 to March 2022, TL had 57 reportable incidents where she caused harm to herself or others, including the staff at Madison State Hospital.
One of the ethical principles of guardianship is to advocate for an individuals’ needs. The Sentry Services Case Manager has never wavered in her belief that TL is in the safest environment possible, not only for her own benefit, but others as well. The Sentry Services Case Manager attended several meetings at Madison State Hospital with TL’s entire care team, as well as a potential community provider, State of Indiana Bureau of Developmental Disabilities Services, to ensure everyone was aware of TL’s behaviors. Each time, the Sentry Services Case Manager had a chance to voice her concerns regarding the discharge of TL and her concerns for the safety of TL and others. Even though the team at Madison State Hospital continues to work with TL to get her to the point where she may someday discharge, as of March 2022 TL was no longer on the discharge list.
The Sentry Services Case Manager continues to advocate on TL’s behalf whenever the discussion of discharge is brought up. The Case Manager is confident that TL would have been discharged and caused harm to herself or others had she not had a guardian to advocate on her behalf. County: Jefferson
Joe is a 75-year-old Medicaid Waiver participant residing in senior housing apartments in Aurora, Indiana. Joe has been diagnosed with A-Fib, Muscle weakness, Diabetes, COPD, Heart Disease, Heart Failure, GERD, Emphysema, Dyspnea, syncope and collapse, weight loss, loss of vision, repeated falls, high blood pressure, amnesia, high cholesterol, insomnia, tremors, and Major depression. Due to these issues and diagnoses, Joe requires assistance with nearly all Activities of Daily Living (ADLs), as well as Medication Management. Joe receives assistance with bathing, dressing, homemaking tasks, and mild meal prep through the use of an Aid for a few hours a few times a week. He receives prepackaged medications from George’s Pharmacy, manages incontinence by using adult diapers, and a walker. Joe’s struggles with his memory and insomnia cause him to be very forgetful to the point of forgetting to eat. He has lost a significant amount of weight, as a result. He receives Home Delivered Meals (HDM) twice daily in addition to Nutritional Supplements. Joe utilizes Catch-A-Ride for transportation, when his friend and main support, Sarah, is unable to give him a ride. Joe has a few friends/acquaintances that have helped him on occasion but does not have any family to provide support.
Joe’s referral came through the ADRC back in June 2019 after a fall left him with a broken leg. At the time, Joe did not have Medicaid, but needed to get to a nursing facility for rehabilitation. The Care Manager at the time, Stephanie Hood, was able to find a Nursing Facility to accept Joe while pending Medicaid approval and coordinated transition back to the community upon discharge in September 2019, as well. One thing that could not be coordinated/obtained prior to discharge was a bed set; however, Joe was able to purchase a blowup mattress to utilize as an alternative.
In January 2022, LifeTime received a grant from Anthem to be utilized on direct client services to combat health disparities relating to the Social Determinants of Health. With Joe being on a fixed income and having no additional funds to purchase items outside of what he considers necessities, the previous Care Manager, Stephanie, checked into Joe’s case to see if he was ever able to obtain a proper bed set. After finding that this was still a need, Stephanie submitted a request on Joe’s behalf for a bedframe, mattress, and box spring. She shopped and purchased all requested items at a local reuse store near her home and solicited two volunteer family members to assist with pickup, delivery, and setup. Joe was so surprised and grateful for the bed and stated, “I will finally be able to sleep at night, and maybe won’t have to nap so much.”
In 2021, Catch-A-Ride transported a legally blind passenger, who we will refer to as Donna, a total of 254 times. Nine of those trips were for various medical appointments and the remaining 245 trips were to/from Donna’s dialysis appointments, which she has three times per week. Catch-A-Ride is her primary means of transportation and it enables her to get to her appointments independently, rather than having to rely on family and friends for transportation. Since Catch-A-Ride is a qualified Medicaid provider and Donna schedules the majority of her trips through Southeastrans, her out-of-pocket cost for all of her 2021 trips combined was only $8.
James is a participant at a Senior Nutrition Activity Center within the Housing Facility where he resides. One day, the SNAC Director noticed that James was not saying much and that he hung around after everyone else had left, so she asked if everything was ok. At first, he did not want to share, but after a while, he revealed that he was going to be evicted from his apartment and did not know what he was going to do. The SNAC Director also learned that James has a son with whom he has little contact, that his driver’s license had expired during COVID, and that he is a Veteran.
The SNAC Director contacted her supervisor and asked for advice. After checking with LifeTime’s Business and Housing Director, the supervisor learned that there is a lengthy process to go through to evict someone and it did not sound as though the housing facility had gone through that process. The supervisor relayed this information back to the SNAC Director, along with phone numbers obtained from the ADRC for Veteran’s assistance.
The SNAC Director gave James all of the information she had gathered. James had also become good friends with another SNAC participant, who was helping him look for another apartment, working with him to get his driver’s license back, and giving him rides, in the meantime. Although we do not have full details as to why, the housing facility decided not to evict James after all.
The SNAC Director’s attentive and proactive behavior allowed LifeTime to work together as a team to gather and provide information as well as monitor the situation, while also allowing James to remain resourceful and handle as much as possible on his own, boosting his self-confidence.
The case presented is a 47-year-old male who has been diagnosed with Melanoma and a mast cell blastoma in the temporal lobe of his brain. He requires total care and is bed bound. The individual is returning home with Hospice care, after having the mast cell blastoma excised. Post-op, the individual experienced a stroke and several seizures that caused severe neuromuscular deficits and weakness. His family is able to care for the individual’s needs but was faced with financial constraints. LifeTime Resources Home and Community Care Division was able to assess the individual and develop a service plan, utilizing Medicaid Waiver to provide Structured Family Care so that the family can be paid a per diem rate to provide his care and will not have to worry about finances while they care for him during his final days. Inpatient acute hospitalization or Long-Term Nursing Facility placement would have been needed to provide for his care if the family had been unable to provide for his care.
Catch-A-Ride's public tranportation service currently tranports a married couple, age 85 and 82, who live in Madison. They are both in wheelchairs and are no longer able to drive. They have been with Catch-A-Ride since 2017. We have transported each of them over 500 times in the past 4 years and our service has allowed them to continue to reside in their home and remain independent. Catch-A-Ride is fulfilling its mission of “working together to provide services that help people maintain their independence” by providing this couple with transportation for a variety of purposes including receiving the Covid Vaccine, health/beauty appointments, doctors’ appointments, shopping, recreation/social activities, personal business, employment, and dining. They are always very appreciative of the service Catch-A-Ride provides and they complement our customer service representatives and drivers on their helpful, friendly attitudes.
SD is a 72-year-old woman who has resided at The Waters of Clifty Falls since July 2017. Sentry Services was appointed SD’s guardian June 29, 2018. Due to SD’s family living in Alaska, they could not be effective at advocating successfully for SD from such a long distance.
In October 2019, the Sentry Services Case Manager (SSCM) was told per the NF Nurse Practitioner, that SD needed to have a bone density test due to her osteoarthritis and a mammogram due to family history of breast cancer. SD was a little apprehensive but agreed to the test if the SSCM would stay with her throughout all of the testing. On December 5, 2019, SD had both the bone density test and the mammogram completed.
The bone density test came back fine but due to some spots being found on SD right breast the mammogram led to the need for an ultrasound. The ultrasound showed a lump, and a biopsy was ordered. The biopsy was completed on December 16, 2019, with findings of an Invasive ductal carcinoma, (grade 1). SD saw a surgeon on January 14, 2020, who recommended a lumpectomy with radiation treatments, if SD was found to be a candidate for this type of treatment. If not, a mastectomy would be the best option for her.
On January 21, 2020, SD saw the oncologist who reported the pathology report showed SD had Stage 1A breast cancer, which is driven by estrogen. He stated this is curable and was caught in the early stages. His recommendation was for SD to have a lumpectomy with Sentinel lymph node removal and then a medication regimen to decrease her estrogen level and annual mammograms. The oncologist stated for women over 60, radiation could be omitted due a 90 % chance this type of cancer not coming back and if it were to come back, it would be at least 10 years. On January 29, 2020, SD saw the surgeon again and based on her breast exam, the surgeon felt the lumpectomy with Sentinel lymph node removal would be the best option for her. Without the requested procedure to treat the diagnosis of cancer, this could spread and cause further medical issues. After pre-surgery tests were completed and SD’s primary care physician could not identify any acute illness or conditions that could require timely interventions and treated promptly to maintain her health and clinical stability, the decision was made for her to go through with the surgery.
Surgery was completed on February 13, 2020. The surgeon was able to remove the lump and after the pathology report was completed, SD was told she is cancer free.
During the whole process, the SSCM attended all the appointments, tests, and hospital surgery. The SSCM also kept SD’s family informed of the outcomes.
SD has had several follow ups since her surgery, her last mammogram was in March of this year, and she saw the surgeon on April 27, 2021. At this appointment SD was given a clean bill of health and does not have to go back until next year after she has her annual mammogram.
The Aging and Disability Resource Center (ADRC) received an e-mail from a LifeTime Resources employee asking if we have ever heard of a particular medical equipment company and wondering if her 78-year-old family member, Joe Smith, was a victim of Medicare fraud. As the contact person for the agency’s Senior Medicare Patrol (SMP), the I&A Supervisor, Diana, reached out to Joe to discuss the details of the case and report findings to the officials, as appropriate.
Diana called Joe the same day to get more information and find out what happened in regards to him receiving a back brace in the mail. Joe reported that he received a call from a medical equipment company about two weeks prior and they asked him if he had arthritis and he said, “yes”. Then, they asked Joe where his arthritis was located, to which he responded, “back”. The medical equipment company asked if they could send Joe a back brace and Joe said “no,” he didn’t want a back brace. The next thing Joe knew, he was receiving a back brace in the mail 2 weeks after the phone call. Joe said he did not give the caller his Medicare number, social security number, or any other personal information. Joe’s wife said the package came with 6 pages of packing lists and included an order confirmation sheet, Rights and Responsibilities, Return Policy, etc. Diana advised Joe and his wife that LifeTime Resources would report the details to the state’s SMP and to be on the lookout for a call from them in the near future. Additionally, Joe and Diana discussed a few tips for avoiding scams in the future, such as screening phone calls that are not from a recognizable number.
Diana called the SMP Program Director the same day and gave her Joe’s name and phone number. The Program Director said she would take it from there and thanked us for reporting it. The SMP Program Director called Joe the very next day to investigate what happened. It turned out that the medical equipment company billed Medicare $1,375 for the back brace and Medicare paid $983 to the medical equipment company. Medicare is issuing Joe a new Medicare card to prevent this from happening again, and SMP will report this to the Administration for Community Living and the Department of Justice for the claim for the back brace to be rectified.
Emily is 86 years old, living in her own home in the Dillsboro area. For the past year or so she has been a regular participant at the Senior Nutrition Activity Center (SNAC) at Dillsboro Village Apartments, but also wanted to find a safe way to get some exercise. She was in luck, as the property manager at Dillsboro Village Apartments manages the Walk With Ease program.
Although the most recent program had ended, there were several individuals that wanted to keep walking and had formed a walking group. The Property Manager urged Emily to join. Emily decided that she would and joined the Property Manager and a few others for a walk a few times per week. At first, Emily could only walk 10 minutes at a time, but was making progress when the Covid-19 pandemic hit. Group walks were canceled for the foreseeable future but that didn’t break Emily’s stride. During the pandemic, Emily and her granddaughter would go to the Dillsboro Park and walk around the trail, which allowed Emily to build up her strength and stamina to the point where she could walk a full mile!
This past fall, we were able to have a socially distanced Arthritis Foundation Walk With Ease Program outside at Dillsboro Village Apartments. The Walk with Ease program allows people who suffer from arthritis and other ailments an opportunity to be active and learn techniques that may decrease pain and stiffness brought on by arthritis and other chronic ailments. Emily was able to participate in the program and continues to remain actively involved with the walking group outside of the program when possible. She is proud of her accomplishments and hopes to remain independent longer as a result of her efforts.
