Humana Member Story
Rebuilding Trust And Independence
Through Compassionate Care Coordination
History: 54 yr old member had been unable to contact since June 2024
Barriers: We reached Ms. T in February 2025, and shared that she is currently morbidly obese (approx. 500 lbs). Ms. T added, “my apartment has become my island, I haven't left it in 3 years, and I never leave this chair except to use the bathroom or microwave food. I saw my doctor about a year ago, and the doctor was not very happy with me and my weight. I felt (fat) shamed and I never went back. I can only walk a few steps with a walker, and I can hear my knees crushing and cracking from my weight."
Ms. T has vitiligo on her hands and face, with her face being most severe. Ms. T stated this added further to her shame when leaving the house. The assigned care coordinator, Sue, empathized and connected with the member first. Ms. T felt comfortable in asking Sue she had ever seen the show Hoarders and self-identified with that. Ms. T’s friend Mary was with her during the call and noted she had helped clean Ms. T’s whole apartment to the best of her ability.
Ms. T shared her biggest concerns were getting help at home with ADL's and seeing a psychiatrist for depression. She stated, “no one has visibility on what I look like, people only see my arm and hear my voice as I collect food at the apartment door.” Ms. T added, “my phone is my only method of communication with family, and they all live out of state.” She also reported she is afraid to fall due to broken discs, painful knees and right side that is swollen, and painful.
She shared additional hygiene issues because she can no longer shower by herself. Ms. T reported that her only friend Mary is a certified nurse’s aide and helps with getting up and prepping healthy meals, but requested that she use, "all the help I can get in the home". Ms. T shared she is depressed and has been agoraphobic now for 3 years. She had a psychiatrist, but did not like him and had stopped going.
Interventions: Our care coordinator, Sue, praised Ms. T for opening up and sharing her situation, assuring her that there is no shame in sharing her story. Sue continued to provide reassurance that together with our social work team, we can provide additional resources to support her.
Sue verified with Ms. T that the house is currently clean and clutter-free with the assistance of friend Mary, allowing Ms. T to freely move around as needed without the risk of falls. Sue offered to refer Ms. T to work with a peer, Nurse Care Manager Anita, to assess needs, follow up more frequently, and offer face-to-face assessment. Sue educated Ms. T on additional resources and assistance around medical appointments and transportation. Sue educated Ms. T on our partner Carelon and the importance of initiating a consultation for a psychiatrist, to which she agreed. Sue collaborated with our social worker Evelyn following the call, who outreached Ms. T and completed the social worker’s Needs Survey. Evelyn then referred her to the Department of Rehabilitation for in-home support. Ms. T verified her contact information and was assisted by Evelyn on the process for applying for in-home services.
Outcomes: Sue was able to build rapport and re-engage with Ms. T. With the help of our social worker, Evelyn, Ms. T has initiated the process for in-home waiver services. Ms. T has received a list of psychiatrists from the Carelon consultation and has been reassigned to a nurse care manager who is better suited to work with her based on her current needs. With addressing Ms. T’s top two priorities first, she agreed to a follow-up call by her new nurse care manager, Anita, who was able to complete health risk assessment and further assist Ms. T with additional resources and support.
