The Challenge
Patricia has been attending weekly GP appointments for leg ulcer management over several years. Despite this regular contact, concerns were raised about her ability to manage at home, including personal care and worsening mobility.
On assessment, it became clear she had been sleeping in an armchair for years, declining both social care support and previous recommendations for a hospital bed. Much of her need had been masked during routine or remote interactions.
Our Approach
Through consistent home visits alongside the frailty nurse, we focused on building trust and gradually introducing support. We arranged for grab rails to be fitted at her front door to maintain community access and, over time, supported her to accept a hospital bed downstairs.
As the relationship developed, she began to open up about wider challenges, including limited awareness of her finances and benefits. We coordinated with social prescribing services and supported a referral to social services.
The Impact
Patricia is now sleeping in a bed for periods during the night, enabling improved positioning and the ability to elevate her legs, supporting healing. She has engaged with social services and is now receiving ongoing support.
This intervention has improved her safety, reduced risk of further deterioration, and enabled access to longer-term care.
