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]
>>>>
>>>