Demystifying Value-Based Care: Managing Costs of Care-Minerva Case Study

Minerva Case Study

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Minerva, an 86-year-old female with congestive heart failure (CHF) and Alzheimer’s disease, was recently discharged from Memorial Hospital following a CHF exacerbation with complications such as bilateral leg edema and cellulitis. She has a history of multiple hospital admissions for similar issues as well as a urinary tract infection (UTI) that affected her mental status. Diagnosed with moderate Alzheimer’s six years prior, her behavior has significantly deteriorated over the past 6-9 months, manifested by increased forgetfulness, repeated questioning, agitation during personal care, and episodes of verbal and physical aggression.<br /><br />In terms of social support, Minerva’s primary caregiver is her daughter, who lives with her, while her son (holding power of attorney) visits regularly. Both have reported Minerva's worsening behavioral symptoms. They face challenges in managing her aggression and forgetfulness, such as refusing personal care or asking to eat soon after a meal.<br /><br />Minerva has several chronic conditions, including a history of stroke with minimal residual effects, coronary artery disease (CAD), hypertension (HTN), chronic kidney disease (CDK) stage 3, macular degeneration, osteoarthritis, hypothyroidism, gastroesophageal reflux disease (GERD), and a past mastectomy for breast cancer. Her medication regimen consists of various drugs to manage these conditions, including Donepezil, Memantine, Isosorbide, Furosemide, Metoprolol, and more.<br /><br />During her post-discharge visit, Minerva was found to have a sacral-coccygeal stage IV pressure ulcer and ongoing leg edema. Despite these issues, she remains alert but uncooperative at times, requiring redirection. The primary goals for her care are to manage her heart failure and leg swelling to avoid future hospitalizations, improve her mobility and behavior, and reduce the frequency of UTIs.<br /><br />A comprehensive care plan is proposed, addressing Minerva's complex needs and aiming to optimize her quality of life while alleviating the burden on her caregivers. This plan involves medical management, behavioral interventions, and ensuring adequate support and resources for her family.

Keywords

Minerva

congestive heart failure

Alzheimer’s disease

behavioral symptoms

caregiver support

chronic conditions

medication regimen

pressure ulcer

care plan

quality of life