Age: 73.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: General physical condition abnormal, Homeless, Impaired self-care, Limb injury, Pain
Clinical narrative: Hospitalized 01/18/2022-still currently admitted; COVID-19 positive 01/18/2022; fully vaccinated  ASSESSMENT / PLAN: * Weakness Assessment & Plan Patient d/c'd from hospital today on 1/18. Patient was initially admitted for lack of self care and leg cellulitis as he was displaced from his home due and was living in a local Inn in which the housekeepers found him in a disheveled manor. Patient was evaluated and did not qualify for SAR placement therefore it was arrangement from him to go to a homeless shelter to be near his spouse. He states his plan was to meet her at store. Upon arriving at the shelter, patient was determined to be in worse condition then they were able to care for and he was taken to ED for further medical care. Patient does state it is December 2022 and he is in location. Patient is still adamant that his plan is to meet his spouse at the store because she lives in a facility for all women and he is unable to go there. Patient did say he has a grandson, who reported he is unable to care for him or help him at all. Patient currently is too weak to ambulate, therefore admitted to hospital for PT/OT evaluation and care management assistance for placement and help.    COVID-19 Assessment & Plan Patient was screened positive for COVID 19. Patient c/o weakness and general body aches although unable to state onset of symptoms. Patient did receive vaccination 3/2021 but has not received booster. Patient is not hypoxic but would be interesting in MAB if available.  01/24/2022 note: COVID-19 Assessment & Plan Patient was screened positive for COVID 19. Patient c/o weakness and general body aches although unable to state onset of symptoms. Patient did receive vaccination 3/2021 but has not received booster. Stable on RA. - Continue supportive management - IS and Accepella, Mucinex - DVT prophylaxis = Lovenox  Admission to other Hospital 01/07/2022-01/18/2022 This is a 73-year-old male who came into the emergency room after he was checked on while he was staying at the Inn. The Inn staff came in and stated that he needed to go to the hospital. They found that the patient had significant leg wounds bilaterally. The patient has urinary incontinence and had been wearing disposable underwear, but not able to care for himself. The patient earlier, 2 weeks prior, stated he had been asked to leave his home secondary to being only 51 degrees. He reports there are roaches in his furnace, and this is why it does not work well. I am assuming that the home smelled like urine, as the patient stated he would actually sit on his chair in the kitchen if his wife was on the toilet and he would urinate there. At the Inn, there was a foul stench of urine that pervaded through the entire Inn, and he will no longer be allowed to stay there. The patient was found to have significant urinary retention as well and also had wounds all over his buttocks and on his legs from a chemical dermatitis along with Candida dermatitis and bacterial bilateral lower extremity wounds. He was started on IV Ancef and did well with this, and converted over to oral antibiotic and received a total of a 10-day course in the hospital with resolution of his leg wounds. It is unclear if the patient's home has been condemned or exactly what the situation is. The patient does not seem to know the entire story. Multiple attempts for possible placement were obtained, as the patient does not need to go to subacute rehab. We eventually found that he could not go back to the Inn ever again. Most likely, secondary to the condition that they left the room in, according to EMS staff, it was very strong of urine.  Social workers worked diligently for a week. We finally have settled on the patient going to a homeless shelter in city, which the patient is agreeable to. The patient's wife is currently in city at a subacute rehab. He is prescribed both long-acting and short-acting insulin, and taught an insulin sliding scale. The patient also was given a glucometer while in the hospital, as well as his insulin pens to go home on, and will be given all of his home medications and prescriptions that were sent to city. The patient was agreeable to this plan. They, at the homeless shelter, are going to assist him with permanent shelter and assigned case worker. The patient will go home with an indwelling Foley catheter to allow the wounds to heal and also to help with his urinary incontinence issue and retention. He will have a followup appointment with a urologist at hospital.