LIVE-IN NURSING CASE STUDIES

1. Depression Treatment

Brevin Homecare was approached by the family of a 42-year-old British woman with a history of severe depression. The patient had required hospitalisation for a previous episode and had found it to be a frightening experience. Her depression was sufficiently severe to affect her dietary intake, self-care, and overall ability to function. She had even become convinced that there was no prospect of recovery. The patient and her family were keen to explore alternative models of care.Brevin Homecare was able to allocate experienced nurses immediately to provide 24-hour live-in expert nursing care in the patient’s home following assessment and consultation with the GP and Consultant Psychiatrist. Care plans for each area of need were established such that medication was supervised, and diet and personal care supported, whilst the patient was able to remain at home with her family around her. As she responded to treatment, Brevin Homecare provided a skilled local therapist who worked with the medical and nursing team to develop and supervise a programme of structured activities ensuring a full recovery. The family and patient were delighted with the low levels of disruption and discrete nature of the treatment episode, which they felt was in part responsible for her prompt response.

2. Dementia Treatment

The family of an 82-year-old British man with Alzheimer’s Dementia, approached Brevin Homecare in some distress, having tried for some months to avert the patient’s transfer to a nursing home as his dementia progressed. He was presenting with increasing dependence on his family, but also with agitation, insomnia, and at times, aggression.Brevin Homecare was able to arrange the rapid provision of 24/7 live-in nursing, supervised closely by a Consultant Psychiatrist and the patient’s GP. A combination of skilled one-to-one nursing and minor adjustments to medication was able to moderate the patient’s symptoms, alleviate family distress and provide much needed respite, all whilst maintaining the patient safely in the familiar environment of home. The family appreciated having their relative at home in a familiar and warm environment with high levels of support, which enabled them to focus their energies on positive interactions with the patient.

3. Alcohol Addiction Treatment

A 45-year-old American female lawyer contacted Brevin Homecare. She had a problem with alcohol 5 years ago and attended a residential rehabilitation unit in the USA, successfully becoming abstinent for 3 years. Over the last 2 years, she started to drink alcohol again, associated with increasing work demands and strain with her family. Efforts to cut down were unsuccessful and withdrawal symptoms were severe as she became dependent once more. She was advised to undergo a medical detoxification from alcohol and enter into a residential programme. However, she could not entertain a 28-day inpatient treatment period again due to the degree of disruption this might cause with work. She opted for a home detox.A nurse from Brevin Homecare undertook an assessment and discussed the client’s case with the Consultant Psychiatrist who was responsible for her care. The psychiatrist saw the patient and agreed to manage the detox at home. Over a period of 14 days, the live-in nurse, supervised by the psychiatrist, monitored her physical and psychological health, dispensed the necessary medication and provided support with activities of daily living. The nurse helped the client to attend the agreed therapy programme during the detox, which included individual therapy and reintegration into a 12-step fellowship programme in the evenings that she had previously found helpful. After a successful detox, the client returned to work and continued her recovery with a combination of regular fellowship meetings and individual therapy.

4. Drug & Alcohol Addiction Treatment

A 37-year-old Middle-Eastern man and his family requested help from Brevin Homecare. For some years, the client suffered opiate and benzodiazepine addiction, and misuse of alcohol. He was treated in several residential rehabilitations around the world but relapsed quickly after leaving restricted environments. The client’s addiction severely disrupted his social, family and vocational functioning. This was particularly important to the family as they have a successful family business and the patient was unable to remain abstinent for long enough to help in any capacity. The client and the family wanted to assess whether he could achieve a period of stability and recover to help in the family business. Failing that they wanted a long-term plan for his ongoing care and rehabilitation.The client underwent a full assessment by a psychiatrist and nurse from Brevin Homecare, also involving the family, to determine the best treatment option. A strategy using harm-minimisation with maintenance treatment was chosen. A Brevin Homecare nursing team was allocated to care for the client, initially in rented accommodation at the request of the client, away from the family with the latter supporting his decision. The psychiatrist worked with the client, family and multidisciplinary team (nurse, therapist and nutritionist) to achieve the treatment goals. Over a period of 6 months, the client moved into a flat close to the family home and achieved a degree of stability, physically looking healthier, attending weekly individual sessions with a therapist, and undertaking part-time work in the family business until nursing care was no longer felt necessary.After a year, the client contacted Brevin Homecare again. He was doing very well, now integrated into the family business set up in some capacity, and was slowly reducing doses of substitute medication with a view to becoming abstinent. However, he was finding the last reductions difficult and was concerned about the risk of relapse during this period of time. Brevin Homecare commenced a further treatment episode to support the client; on this occasion, this goal was achieved within 8 weeks with additional support by his therapist. The patient was referred to The Abstinence Centre in Central London for a naltrexone implant to further protect him from opiate and alcohol relapse.

5. Mental Ill-HealthTreatment

A Russian patient with bipolar disorder was in hospital for an acute episode of illness. With his permission, his Consultant Psychiatrist contacted Brevin Homecare to provide nursing care at home and hence allow the patient to leave hospital sooner. After a briefing with the Consultant Psychiatrist and an assessment, Brevin Homecare jointly instigated a plan to manage the patient at home.Historically, the patient continued to suffer deficits in functioning following acute episodes. He was not close to his family either emotionally or geographically and for a period of time he wished to continue to have support from a nurse with activities of daily living, including for business-related travelling abroad. With better adherence to medication and support in a structured programme of activities, the patient became more stable, deciding to undertake individual therapy to help address a number of factors in his early life that he felt remained relevant.Brevin Homecare was contacted again by the Consultant Psychiatrist on the patient’s behalf some time later. Following therapy, the patient experienced a shift in attitudes and wished to approach his family. However, this process led to a mild deterioration in his mental health. Brevin Homecare became involved again, monitoring the patient’s mental state and supporting him during this period of time. Eventually, Brevin Homecare involved an experienced social worker to facilitate communication between all parties.

6. Alcohol Addiction Treatment - (Second Case Study)

A Middle-Eastern family referred a family member to Brevin Homecare. The family were concerned that residential care in numerous units around the world had been unsuccessful in managing their relative’s problematic use of alcohol, which had caused some awkwardness for the family locally. The patient agreed to travel to the UK and live in rented accommodation for an episode of treatment.Brevin Homecare found suitable accommodation and allocated a live-in nurse with extensive experience and cultural sensitivity to care for the patient under the supervision of a Consultant Psychiatrist. He underwent a full range of physical and neuropsychiatric tests, as well as nutritional analyses. A multidisciplinary meeting was convened involving a number of specialists and an individualised programme of therapies and activities was instigated. The patient felt entirely understood and involved in his care, which facilitated his management for a number of years. Although he had brought his own butler with him, he asked Brevin Homecare to arrange for other ancillary staff to cater for the particular dietary needs and help with activities of daily living

Find out more!

To find out more about this great opportunity please email:

Laura Todd
Brevin Homecare
pa@brevincaregroup.com

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