At the present moment, one the problems that concern him the most is that given his

condition he will not be able to take care of his brother, and he is not sure how to proceed
with his wife once her condition declines.
Patients who have complex health needs like Mr. Joseph require both medical and social
services and support from a wide variety of providers and caregivers, and the patient-
centered medical home (PCMH) could be one options for him and his wife because they
can coordinate the full range of medical, mental health, and social services that may have
special benefit for them.
Taking into consideration that Mr. Joseph is 76 years old, he suffers from COPD, and in
addition he is hypertensive, it turns out for the very uphill also taking care of his brother
with complex care and functional limitations, which means he often need assistance to
perform activities of daily living, such as toileting, eating, getting dressed, and prepare his
meal. Given the complexity of his brother health problems getting palliative care or hospice
services will be something to consider by Mr. Joseph to alleviate part of his problems.
I will also address with him the fact that there are other options like house-call services.
Those services provide in house assessment, evaluations, and treatment for patients that
cannot go to office, like his brother, and we as his Nurse Practitioner can help him to
schedule an appointment.
We can also help him on getting a care coordinator by sign him in health home program
and thought the navigators that the program offers he will be able to obtain the help that he
needs, the care coordinator is an expert clinical staff that is always in contact with primary
care providers.
I will encourage him to include his sons in the plan of care, it is very important to include a
family member in the care team.
References
Franz, B. A., & Murphy, J. W. (2017). The Patient-Centered Medical Home as a
Community-based Strategy. The Permanente journal, 21, 17-002. doi:10.7812/TPP/17-002

Hi Maria,
I know that the goal that you have imposed will be achieved. You are a human being
endowed with many values. Congratulations!!!