M. is a 49 year old male.  He is currently residing independently in an apartment in Chicago.  Lifecare Innovations, Inc. (LCI) has been providing Lifecare Management services to M.  since July 2007.  M. has a developmental disability and also appears to have a significant history of depression and anxiety.  Previously, M. managed to live in the community and manage his own affairs.  He was employed as a janitor for over 25 years, was married, drove independently, and ran a household.  His now deceased father provided him with the monitoring and direction he needed to maintain his quality of life.  This “coaching” he received from his father was essential in his ability to be successful in the community.  

Following his father’s death, M. experienced a decline in his status which resulted in him neglecting his home, personal grooming, and medical care.  He had gone several years without seeing a physician, his personal care was extremely neglected, and he had no means of getting food.  M. began to hoard things and amassed a very large collection of shop vacuums (in excess of twenty) and other tools which he anticipating needing because he wanted to return to work.

His apartment became cluttered to the point that you could no longer see the floor and it was difficult to navigate from room to room.  His bathtub was full of things preventing him from being able to bathe and every surface in his apartment was unsanitary.  In addition to his apartment, M. also had two storage units that were full of belongings.  His belongings had significant meaning to him and he was resistant to getting rid of anything.  M. was unable to manage his finances and was spending all of his funds on purchasing more tools, rather than buying food.  The condition of his apartment had resulted in his landlord threatening to terminate his lease and was on the brink of becoming a public health issue.

LCI attempted many interventions to get M. evaluated by a physician, but he was uncooperative and refused all medical care.  LCI was able to quickly set up an account at a local diner so he could easily receive regular meals.  LCI worked closely with M.’s property manager to negotiate a lease extension if M. were to improve the condition of the apartment.  With M.’s cooperation and assistance, his apartment was cleaned out by Lifecare Home Solutions.  This process took nearly one and a half years; however, once his apartment was cleaned, M. took great pride in having accomplished this goal.  Through this process, M. built a therapeutic, trusting relationship with his Lifecare Manager who now is “coaching” him through the needed steps, as his father had previously done. 

LCI has been successful in getting M. some of the medical care he needs.  In February 2008, M. was seen by a primary care physician.  During the appointment, M. received a Tetanus booster and had blood work completed.  The results indicated that M. has high cholesterol, but the physician did not recommend that M. take medication.  Instead, he believed that his cholesterol could be lowered by adjusting his diet.  The doctor was very concerned regarding M.’s hygiene and expressed specific concerns regarding his foot care.  He counseled M. on the risk of infection if he did not improve his personal care. 

The doctor recommended that M. be seen by a psychiatrist for further assessment.  M. did attend an appointment with his physician with LCI present; however, during the appointment, M. became upset and ran out of the office.  After further discussion, it became apparent that M. became upset when the doctor stated he thought he would benefit from medication.  Multiple physicians indicated that they had concerns regarding M.’s competency and ability to manage his own affairs; however, neither was willing to complete the documentation needed to pursue guardianship.

In June 2008 LCI arranged for a psychiatrist to visit M. at his home for further assessment of his competency.  M. was cooperative during the visit.  The psychiatrist determined that with assistance, M. could manage his affairs.  He also stated that M. did retain testamentary capacity and as a result, he executed a new Power of Attorney for Property and Health Care Power of Attorney which name his mother as his agent.  Both documents name LCI as successor agent.  This allowed his mother to re-file his previous income taxes which had been filed incorrectly.  LCI also assisted with retaining a lawyer so that divorce proceedings could be initiated. M. has had numerous appointments with his dentist over the last year.  This has resulted in several extractions and partial dentures.  M. has indicated that the partials are somewhat uncomfortable and as a result does not always wear them.  This issue has been discussed with dentist who has stated that the partials fit appropriately and the discomfort will lessen as M. becomes more used to them. 

Currently, M. remains generally cooperative.  He seems pleased with the progress that has been made.  He does at times have periods where he does not return call and misses appointments, but generally this only lasts a short period.  He takes pride in participating in his treatment plan and is much more receptive to recommendations.  M. will require ongoing monitoring and “coaching” to ensure that he maintains his apartment and personal care.  Additionally, now that M. is functioning at a higher level, LCI will begin to assist him with some of his higher level goals, such as finding employment.  This will assist with giving M. a sense of purpose in life and more independence.  LCI will also continue to utilize M.’s improved level of cooperation to encourage him to seek regular medical attention, including psychiatric care.