Patient: Mr. S.D., 74 years
Location: Salt Lake, Kolkata

Mr. S.D. is a 74-year-old gentleman living with his family in Salt Lake, Kolkata. He recently experienced a fall that led to a hospital admission. While his medical condition was stabilized in the hospital, the event left him with significant functional weakness and reduced mobility.

Before the fall, Mr. S.D. was relatively independent. Upon returning home, he found it difficult to perform basic activities of daily living. He lacked the confidence to walk without supervision and needed physical assistance to move from his bed to a chair. His family members had professional work commitments and were unable to provide continuous daytime assistance. They recognized that without dedicated support, Mr. S.D. would be at a high risk of falling again and his recovery would be delayed.

Primary Diagnosis: Post-hospital functional weakness with reduced mobility and dependence on assistance for daily activities.

Following his discharge, an assessment revealed that while Mr. S.D. was medically stable, alert, and cooperative, his physical strength had significantly diminished. He required supervision while standing and walking. He was able to communicate his needs clearly and participate in daily activities, but only with partial physical assistance.

Mr. S.D. was admitted to the hospital following a fall. The hospital course focused on ruling out serious injuries, managing his pain, and stabilizing his vital signs. Once the medical team confirmed he was stable and did not require active clinical interventions like IV therapy or specialized monitoring, he was discharged home.

At the time of discharge, the primary concern was no longer acute medical treatment but rather supervised recovery. The discharge summary emphasized the need for fall prevention, gradual mobility improvement, and assistance with personal care.

Transitioning from the hospital back home can be challenging for elderly patients. Although Mr. S.D. was medically stable, his physical limitations meant he could not safely manage alone. His family needed a reliable solution to ensure his safety while they were at work.

A trained patient care attendant was arranged to provide structured non-clinical support at home. The goal was to help Mr. S.D. remain safe and comfortable in his familiar surroundings while reducing the physical and emotional burden on his family members. Professional home nursing teams were available for coordination if any clinical needs arose, ensuring a complete care ecosystem.

The care plan was designed to provide comprehensive non-clinical support, focusing on safety, hygiene, and mobility. The attendant coordinated with the family and the clinical team to follow the prescribed daily care routine.

Daily Support Provided:

• Personal Hygiene: Assistance with bathing, grooming, and maintaining cleanliness.
• Feeding and Hydration: Support with meal preparation, feeding, and ensuring adequate fluid intake.
• Mobility and Transfers: Safe bed-to-chair transfers, supervised walking using a walker, and position changes to prevent stiffness.
• Toileting Support: Assistance and supervision during bathroom visits.
• Environment Management: Basic room organization around the patient to maintain a clutter-free, safe space.
• Companionship: Providing reassurance, conversation, and emotional support during recovery.

Note: Specific laboratory and vital sign values were not documented in the available non-clinical records. The following data is based on functional and observational assessments.

Functional Assessment at Start of Care

Risks Monitored During Care

Dr. Ekta Fageriya, MBBS

Specialization: Geriatric Medicine

RMC Registration No.: 44780

Clinical Experience: 7 Years

Treating Doctor Details

Qualification:

Hospital:

Medical Registration:

Clinical Comments:

Future Recommendations:

The formulation of this care plan was based on a review of the following documents (specific confidential patient identifiers have been excluded):

• Hospital Discharge Summary
• Initial Home Care Assessment Notes
• Daily Attendant Care Logs
• Family Observations and Feedback Reports

After 12 weeks of dedicated care, Mr. S.D. demonstrated measurable improvements. His confidence with supervised mobility increased notably. He required less physical assistance with selected daily activities, transitioning more toward standby supervision.

The family reported a significantly reduced physical burden and greater confidence in managing his routine at home. They understood the importance of maintaining a safe environment and continuing the established daily routine to prevent future setbacks.

• Value of Non-Clinical Support: Patient attendants provide invaluable daily support that directly impacts a patient’s physical and emotional recovery, even without performing clinical procedures.
• Fall Prevention: Consistent mobility assistance and environmental safety checks are highly effective in reducing avoidable falls in elderly post-hospital patients.
• Role Boundaries: Clear boundaries between attendant and nursing responsibilities ensure patient safety and appropriate clinical care.
• Family Involvement: Educating the family remains vital for sustainable, long-term home care success.
• Adaptable Care: Care plans must be continuously adjusted according to the patient’s changing functional needs and recovery progress.

Service Coverage in Kolkata

AtHomeCare provides professional home healthcare services across Kolkata and surrounding regions. Whether you are located in Salt Lake, Howrah, Bidhannagar, Chandannagar, Serampore, Barasat, Naihati, Bhatpara, South Dumdum, North Dumdum, Madhyamgram, Kamarhati, Baranagar, Rajarhat-Gopalpur, Maheshtala, Rajpur Sonarpur, Bally, Barrackpur, Hooghly-Chinsurah, or Uluberia, our trained caregivers and clinical teams are available to support your recovery at home.