Humana Member Story

Stepping In When It Matters Most

J.S. is a 71-year-old male with an aging waiver. Member receives 142.50 hours per month of homemaker services. Functionally, the member is primarily bedbound and requires assistance with all activities of daily living (ADLs) and instrumental activities of daily living (IADLs), such as personal care, meal preparation, housekeeping, laundry, errands, and routine health management. His health conditions include congestive heart failure, hypertension, high cholesterol, asthma, Type 2 diabetes, chronic pain, osteoarthritis, chronic diarrhea, gastritis, and incontinence.

The member recently faced a serious situation. He had been without insulin for over a week, causing his blood sugar to rise to 486. J.S. expressed that he felt worried, overwhelmed, and unsure of what to do. The member was able to contact his Care Coordinator.

At that moment, our Care Coordinator stepped in as a true advocate for his wellbeing. Her efforts included:

• Escalating the issue urgently to ensure the insulin refill request was prioritized

• Maintaining continuous follow up and direct communication with the provider’s office

• Working persistently until the prescription refill was approved and sent to the member’s pharmacy

• Providing emotional reassurance so the member did not feel alone during the crisis

• Ensuring appropriate follow-up visits were scheduled.

• Following up to ensure continued medication compliance.

Because of her persistence, the member avoided what could have become a diabetic emergency. During a follow up call, the member expressed deep appreciation, saying: “Thank you… I didn’t know what I would do without you all.” His words reflect just how meaningful consistent, compassionate care coordination can be - especially for members navigating complex medical conditions with limited resources or support.