That will help if possible. Thanks.
On Mon, Jan 5, 2026, 11:59 AM Timothy Thomas <tt@thekey.com> wrote:
> I meant to add that their is no prescribed process outside of our
> regulated states where any change of condition necessitates a visit from
> our RN supervisors who are on a per diem.
>
> I can ask to see their process if that helps?
>
> On Mon, Jan 5, 2026 at 12:53 PM Amelia Howard <amelia.howard@thekey.com>
> wrote:
>
>> Ok, on it. Thanks for the direction and feedback.
>>
>> On Mon, Jan 5, 2026, 11:43 AM Timothy Thomas <tt@thekey.com> wrote:
>>
>>> Hi Amelia,
>>>
>>> Thank you for raising this and for the way you’re thinking about it. I
>>> agree with your assessment and with the importance of stronger RN oversight
>>> during changes in condition—these moments are critical for family
>>> confidence, client safety, and long-term retention.
>>>
>>> Your clinical perspective is an asset to the Chicago market, and I want
>>> us to leverage it intentionally. Rather than prescribing a rigid process,
>>> I’d like you to recommend how RN involvement should be structured—when you
>>> should be looped in and how you can best support the team and families
>>> while maintaining role clarity.
>>>
>>> I appreciate you proactively exploring home health and behavioral health
>>> partnerships. Please continue and bring forward any recommendations you
>>> believe will strengthen care and retention.
>>>
>>> Once you’ve outlined your approach, let’s align on next steps. I trust
>>> your judgment here.
>>>
>>> Best,
>>> Tim
>>>
>>> On Mon, Jan 5, 2026 at 11:54 AM Amelia Howard <amelia.howard@thekey.com>
>>> wrote:
>>>
>>>> Hi Tim,
>>>>
>>>> I hope you’re doing well. I wanted to ask about our current protocol
>>>> for resident change of condition and how we partner with home health in
>>>> those situations.This is the client ride-along I attended and during this
>>>> assessment I recognized risks and unfortunately in the thread you will see
>>>> the outcome. With the CSM's not being nurses, it's hard for clinical issues
>>>> that may arise to be discussed with family or clients. I know we are non-
>>>> medical but I am trying to see how I can support, to help with retention.
>>>>
>>>> I think I need to be looped in to all resident change of conditions
>>>> where I can help family's coordinate care with Home Health or a
>>>> Concierge Physician, also PT/OT vendors are needed. I think as of now if a
>>>> resident has a clinical change of condition we rely on family to get the
>>>> help the client may need and I think we need to help families
>>>> eliminate another task and offer options in a more processed manner,we will
>>>> see the outcome in longer client retention. I asked Malin what her plan
>>>> included when speaking with family at 10am and she really didn't have a
>>>> plan. I suggested increasing hours, including possibly overnight Care. Home
>>>> Health order for both Clients. Husband and wife could benefit from
>>>> increased home PT/OT exercises. Also we need a Home health that has a psych
>>>> component to help with an option for Dementia behaviors and depression. I
>>>> have a few meetings set up this week with Claudia to possibly partner up
>>>> with a home health that can help us track our resident change of
>>>> conditions a bit better.
>>>>
>>>> From a nursing perspective, I’m interested in exploring ways I can more
>>>> actively contribute to early identification, communication, and
>>>> coordination of care with home health agencies. My goal would be to help
>>>> support timely interventions, improve continuity of care, and ultimately
>>>> help residents remain with us safely for as long as appropriate.
>>>>
>>>> If there is an existing process or best practice you’d like me to
>>>> follow—or opportunities where additional nursing involvement could add
>>>> value—I’d appreciate your guidance. I’m happy to support in whatever way
>>>> aligns best with our clinical and operational goals.
>>>> I look forward to your direction.
>>>>
>>>> Amelia Howard
>>>>
>>>> ---------- Forwarded message ---------
>>>> From: Malin Maleegrai <malin.maleegrai@thekey.com>
>>>> Date: Mon, Jan 5, 2026 at 8:39 AM
>>>> Subject: Re: ATTN: Jinny - Caregiver Intro for Mr. and Mrs. Eskilson
>>>> 1/2/26 12pm
>>>> To: Jinniefer Castillo <jinniefer.castillo@thekey.com>
>>>> Cc: Chicago Office <chicagooffice@thekey.com>
>>>>
>>>>
>>>> Good Morning Jinny,
>>>>
>>>> Thank you for the update. I have scheduled a conference call with Mr.
>>>> Eskilson's children, Christine and Stephen, at 10am today.
>>>> Will update team after my phone call.
>>>>
>>>> Thank you,
>>>> Malin
>>>>
>>>> Malin Maleegrai, LCSW
>>>> Client Success Manager
>>>> malin.maleegrai@thekey.com
>>>> 847-853-7777
>>>> [image: TheKey]
>>>>
>>>>
>>>> On Sun, Jan 4, 2026 at 6:56 PM Jinniefer Castillo <
>>>> jinniefer.castillo@thekey.com> wrote:
>>>>
>>>>> Hi Malin,
>>>>>
>>>>> Mr. Eskilson fell twice yesterday, once in the morning and once in the
>>>>> afternoon. I called his son Stephen twice to talk about getting more care
>>>>> for Mr. Eskilson, but he never returned my call. I called the house number
>>>>> twice, but Mr. Eskilson cannot hear me at all. I believe his daughter is in
>>>>> town, but I do not have contact information for her. Mrs. Eskilson is still
>>>>> in the hospital Friday afternoon due to weakness and not eating well. I
>>>>> haven't received any updates yet, as I haven't been able to reach anyone. I
>>>>> called Amy, and she informed me that I needed to contact their children,
>>>>> which I did; however, I still haven't received any response. Please follow
>>>>> up with his son again by tomorrow. Kristine is filling out an incident
>>>>> report for the Saturday fall. I updated the notes for the introduction and
>>>>> for the follow-up that occurs 24 hours later. Please let me know if you
>>>>> have other questions.
>>>>>
>>>>> On Thu, Jan 1, 2026 at 6:58 AM Malin Maleegrai <
>>>>> malin.maleegrai@thekey.com> wrote:
>>>>>
>>>>>> Hello Jinny,
>>>>>>
>>>>>> Thank you for doing the caregiver intro for Mr. and Mrs. Eskilson
>>>>>> tomorrow while I am on PTO. Mr. and Mrs. Eskilson live in a 2 story home
>>>>>> with basement in Evanston - Mr. Eskilson is currently sleeping in his
>>>>>> bedroom upstairs. Mrs. Eskilson is sleeping on the couch in the living
>>>>>> room as she is not able to manage the stairs due to a recent
>>>>>> hairline fracture of her pelvis.
>>>>>>
>>>>>> Mr. Eskilson has two children - a daughter who lives in Boston and a
>>>>>> son who lives in Chicago. Mrs. Eskilson has a daughter who lives in
>>>>>> California.
>>>>>> Key person is Amy - she is a family friend who is like a daughter to
>>>>>> them. She has been helping with shopping, laundry, dishes and taking out
>>>>>> the garbage for the past two weeks. She will continue to assist in the
>>>>>> mornings.
>>>>>>
>>>>>> Key points to know for Mrs. Eskilson:
>>>>>>
>>>>>> - She has untreated depression and anxiety. One of the triggers
>>>>>> for anxiety is having someone she does not know in the home. This will be
>>>>>> challenging for the caregivers. Caregivers will be providing stand by
>>>>>> assistance with transfer and ambulation. She has had increased episodes of
>>>>>> incontinence so will need assistance with cleaning up. When caregivers are
>>>>>> not providing care or safety oversight, they should give her as much space
>>>>>> as possible by taking care of Mr. Eskilson, doing tasks in other areas of
>>>>>> the home.
>>>>>> - She does have pain related to the fracture and takes tylenol
>>>>>> for the pain.
>>>>>> - Nutrition and hydration is important - caregivers to make sure
>>>>>> that she eats lunch and dinner during their shift, has water nearby, and
>>>>>> offer Ensure between meals.
>>>>>>
>>>>>> Key points for Mr. Eskilson:
>>>>>>
>>>>>> - For the past two weeks, he has been having issues with poor
>>>>>> balance and little to no energy. He was taking care of Mrs. Eskilson and I
>>>>>> think that took a toll. He is independent with transfers and does not use
>>>>>> a cane while in the house - will benefit from stand by assist for safety
>>>>>> oversight esp with going up / down stairs.
>>>>>> - He is taking medications for heart failure including blood
>>>>>> thinners - he has had recent nose bleeds that has taken a long time to
>>>>>> stop.
>>>>>> - Nutrition is one of the biggest concerns - he has not been
>>>>>> eating well - having no energy to even warm up food in the microwave. -
>>>>>> Caregivers to make sure that they prepare lunch / dinner during their shift
>>>>>> and make sure he eats. Offer ensure in between meals.
>>>>>> - It seems that he has become socially isolated - he will enjoy
>>>>>> having conversation and companionship.
>>>>>>
>>>>>> The care plan for both Mr. and Mrs. Eskilson are completed. I have
>>>>>> sent the welcome email with the schedule, caregiver bio and Jinny's contact
>>>>>> information to Mr. Eskilson, his son Stephen and daughter Christine. I
>>>>>> will check in on Monday upon my return.
>>>>>>
>>>>>> Thanks again and happy new year,
>>>>>> Malin
>>>>>>
>>>>>> Malin Maleegrai, LCSW
>>>>>> Client Success Manager
>>>>>> malin.maleegrai@thekey.com
>>>>>> 847-853-7777
>>>>>> [image: TheKey]
>>>>>>
>>>>>