Mr. Hernandez is an 87-year old living in a New York City Housing Authority (NYCHA) apartment. He spends most of his time with his daughter and grandchildren, with whom he lives, and frequents the Ridgewood Adult Day Center several times a week. Given his multiple diagnoses of hypertension, hyperlipidemia, coronary heart disease, chronic ischemic heart disease, and depression, he was referred to a Health Home.
Upon enrollment, Mr. Hernandez only requested assistance connecting to a mental health provider, ophthalmologist, and transportation services; however, his Health Home Care Manager, Sofia, suggested she accompany him to his primary care appointments. At one of his appointments, Mr. Hernandez’s primary care physician relayed concerns regarding Mr. Hernandez’s health and a possible diagnosis of prostate cancer. Mr. Hernandez’s physician had attempted to engage Mr. Hernandez numerous times, but his attempts were to no avail. With Mr. Hernandez’ permission, Sofia worked with Mr. Hernandez’ trusted team at the Adult Day Center, to engage him in treatment that worked for him. Mr. Hernandez is now working with his new urologist and gastroenterologist specialist to prepare for his biopsy and determine the appropriate course of treatment. Mr. Hernandez is hoping to get the appropriate treatment so he can continue to live with his daughter and grandchildren and attend the Adult Day Center with his friends for much longer.