Sunil *

Sunil is a 45-year-old Indian male with chronic renal failure who developed a ventricular fibrillation  cardiac arrest, causing subsequent hypoxic brain injury. He was admitted five months post-injury with significant memory difficulties relating to recently acquired information, sequencing and contextualising past information, executive planning and abstract reasoning.  He also lacks insight into his memory deficits.

Sunil was admitted directly from the acute hospital for a brief active programme.  We believe Sunil would benefit from a period (perhaps three months) of intensive neuro-rehabilitation before returning home, at which point he would require a support programme, tailored to his needs.

CarePlus Partnership assists Sunil in the following ways.

• We manage Sunil’s immediate needs safely in the Harcourt House setting. He is accompanied to dialysis three times a week and adheres to fluid and dietary restrictions recommended by the treating renal team.
• He engages with structured daily living activities such as gardening, finance and budgeting skills, menu planning and support in preparing some of his meals.
• A neuropsychiatrist, a neuropsychologist, an occupational therapist and social worker have assessed him and submitted our multidisciplinary report to the commissioners by week six, as requested.  
• Our specialist social worker is informing Sunil’s employer of progress and assisting with preparations for Sunil’s return home.
• Supporting Sunil's wife and two young children has been an integral part of his rehabilitation programme.  This includes helping his family with the process of loss and grieving.  Sunil has benefited from a pleasant living environment that is close to his family, which enables him to go home at weekends.  We carry out some assessments in his family home and have worked closely with his wife to record and build an accurate and complete picture of his needs.  The clearer his needs are to us, the more we can help his wife to develop skills for managing these needs. The family's continued involvement in his journey will be crucial in ensuring that his improvements are long-term and sustainable.
• Through Care+ Outreach, we plan to support Sunil at home by providing ongoing rehabilitation and by training healthcare specialists who are assigned to his home care. Alternatively we could supplement the existing community team.

* Name has been changed to protect client identity