Mr. G. was an active smoker. So active, in fact, he developed chronic obstructive pulmonary disease (COPD) and edema in his arms and legs. His symptoms, which included atrial fibrillation and a lung infection, steadily worsened and ultimately led to his hospitalization in 2021. 

But Mr. G was not alone in his fight. He was, in fact, the primary caretaker for his wife — who herself had been unable to find providers to manage her own chronic conditions.  

Mr. G was so focused on his wife’s health, he had regularly neglected his own, skipping out on key medical appointments for himself in the process. 

When Belong Health’s experts first contacted him, Mr. G was unsure how to manage his COPD on his own. He admitted he’d been inconsistent with his medication regimen. In March 2022, he’d been hospitalized for heart arrhythmia, an excess of carbon dioxide in his blood, COVID-19 infection, and pneumonia. 

Life was challenging to manage.  

Because Mr. G. had been discharged from the hospital prior to a notification of admission, he lacked the adequate discharge support — homecare services, scheduled follow-up appointments, and sufficient medical equipment — that would typically care for a weakened body like his after an eight-day hospital stay. 

Help was clearly needed, and Belong Health’s care management team was equipped to provide it. Together, they took the following steps to gain Mr. G some health stability: 

• They educated Mr. G. on when to contact his provider or to seek emergency care — and they coached him through a coordinated outreach plan for securing medications, post-discharge follow-up appointments, and home supports. 
• They spoke with Mr. G’s primary care provider and raised awareness of Mr. G’s hospitalization and his need for discharge support. 
• They requested Mr. G’s primary care provider order home health services including a registered nurse, physical therapist, and occupational therapist. They also requested a walker for Mr. G to use in his home and scheduled a discharge follow-up appointment for Mr. G with his primary care provider. 
• They set an appointment with the pulmonologist and cardiologists who saw Mr. G in the hospital — and even ensured Mr. G’s appointments would all be in same building. This convenient proximity, they correctly concluded, would minimize financial and physical hardship for Mr. G and would increase the likelihood he would attend both appointments. 
• The pharmacist on Mr. G’s care management team reviewed all his new medications and verified all of those medications had been picked up after order. The pharmacist also reached out to Mr. G and to his wife to review the medications, provide medication education, assure prescribed medications were in the home, and clarify the use of pain medication.  
• The team reinforced that quitting smoking would significantly reduce Mr. G’s COPD complications. They told him about the “NY Quits” program, which regularly helps New Yorkers break their addiction. Mr. G had been unaware the cost of this program was completely covered by the state and his health plan. 

Today, Mr. G is proudly smoke-free! He and his wife regularly manage his medications themselves, with the help of a pill box. He daily monitors his own blood pressure and temperature and brings that data to his routine cardiology appointments. He uses oxygen at home and is no longer reluctant to seek support when he needs it. 

On a recent call with his care team, Mr. G. acknowledged his life had significantly improved. He said, “I want to see my grandchildren grow up.” Now he’s regularly taking steps to make that goal more achievable. 

This will surely mean a better quality of life for him — and for those grandkids, too.