This Signature Well-Being Portfolio is the personal property of the individual Acts Resident with shared ownership by the Acts organization.
It is intended for the personal and interdisciplinary teams’ usage as it relates to the resident’s established personalized well-being journey.
Its’ content is to be handled with the utmost discretion in overseeing the well-being of the resident and is to be held in confidence and in abidance to current HIPAA privacy and security regulations.
Any reproduction of this portfolio is prohibited. Copying of any of its content must not occur without the prior written consent of the resident and/or the authorized responsible power of attorney for healthcare.
TABLE OF CONTENTS
A. Identification Data
B. Prospect to 365 (Sales & Marketing)
C. My Life Journey
D. My Spiritual Life Assessment
E. My Healthcare
a. The Global Ice Breaker Assessment (PDHI)
b. THRIVE Screening with Rehab
c. InBody 770 - Body Composition Screening
d. Nutritional Assessment
e. Primary Care
F. My Fitness Plan
G. My Well-Being Health Recommendations
H. My Well-Being Engagement & Lifestyle Opportunities
Completed with prospective resident in conjunction with the Sales/Marketing team:
♥ Describe your Previous Living Arrangement
Before moving to ABC Estates, I lived with my husband of 42 years (Anthony) in Rhode Island. We actually lived in the house that he grew up in. Anthony’s grandfather built the house in the late 1800’s and it has been passed down from generation to generation.
♥ What is your Marital Status?
Single Married Divorced Widow
♥ Describe your Family
I am the youngest child of 6 and the only girl. My bother Sam is still living but unfortunately, my other brothers have all passed on. We have 2 children and 4 grandchildren.
♥ What is you Cultural Heritage?
My ancestors migrated to the US from Italy some time around 1921. Although I was born in the US, we have many Italian traditions.
♥ What was or is your occupation/previous occupation?
I was a seamstress and worked in a local dress shop for many years when our children were young. After they left for college, Anthony and I opened our own restaurant. I sold the restaurant after Anthony passed and retired shortly after.
♥ What is your Education Level?
High School Undergraduate Graduate Doctoral Other
♥ Did you serve in the military?
Yes No
If yes, what branch?
♥ What is your religious affiliation? I was born and raised Catholic.
♥ Describe Milestones (life)
Raising our children was undoubtedly a significant milestone in our younger years. I didn’t go to college until I was in my 30’s – classes at night and on the weekends. It took me 9 years but I finished with a degree in business. Opening our restaurant was quite a challenge – it took a few years and lots of hard work but eventually it became a staple in the neighborhood.
Prospect to 365 documented/recorded by:
Name: Eva Longoria, LEC
Title: Life Enrichment Coordinator
Date interview conducted: 3/13/23
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My Life Journey is intended to learn all about you – your family life, your work life, your spiritual life, your milestones, your heritage, your traditions, your education, your hobbies, your likes, your dislikes, your preferences and more. As you continue your journey now as an Acts resident, we will continue to build upon your life journey and the many milestones yet to come!
♥ Where were you born?
Upstate New York
♥ Where did you grow up and with whom? I lived in upstate New York until I was about 10 with my parents and my 5 brothers. Then we moved to Connecticut when my Dad received a transfer for his job. He was a civil engineer. We lived in a lovely farm house with the most glorious trees.
♥ Do you have a favorite childhood memory? Many! But one of my favorites is the old porch swing that we had. I used to sit on it and read nearly every night.
♥ In your interview with (MaryJane from Sales) you shared that you are: Single Married Divorced Widowed Would you like to share anything else? My husband, Anthony was a good soul. We were married for 42 years. He died of a heart attack as did his father, grandfather and brother.
♥ What is your husband’s/wife’s name?
♥ What is the date of your anniversary? June 15, 1963
♥ Do you have children? How many? What are their names? Yes, Anthony and I had 2 children, Rosa and Tony. Rosa is married to Michael and together they have 3 children. Tony is divorced, twice.
♥ Do you have grandchildren/great grandchildren? How many? What are their names? Greg, Marsha and Jan are Rosa’s kids. Greg is an orthodontist and got married last year. His wife Cindy is expecting her first baby this year. My first great grand baby!
♥ Share special details about your grandchildren/great grandchildren Marsha is in veterinary school. She will be graduating next year. Marsha is also a wonderful cook. She visits me quite often. We spend a lot of time together in the kitchen! Jan is in college in Arizona studying to be a horticulturalist. She has not been home to visit in quite some time. Greg works locally in an orthodontist practice.
♥ What was your first job? What was your last job? Did you have a favorite job? My very first job was in a hardware store in Connecticut. I worked as clerk and helped stock the shelves. My last job was running the restaurant. I’ve thought about finding a job just to stay busy, maybe in a Hallmark store or daycare center. Although it was hard work and often late hours, my favorite job was working in the restaurant. We had so many friends and neighbors that would come and eat and stay for hours – a lot of laughter.
♥ Describe in more detail your educational background I didn’t have an interest in attending college after high school but eventually I decided that I wanted a degree. I went to community college first then to Rhode Island University. I was already married with children and in my 30s so they were not traditional college years. No keg parties for me!
♥ Describe in more detail your cultural heritage. Are there special traditions that have been passed on from generation to generation? How important is your cultural heritage? We have many Italian traditions. Holidays are most significant. Christmas Eve is the Feast of the 7 Fishes – sometimes we change up the menu but usually it consists of baccala (salt cod), frutti di mare (shellfish), cappitone (eel), calamari (squid), scungilli (conch meat) and vongole (clams) and always homemade pasta. My preference is linguini. On New Years Day, Momma always said you must eat pork never chicken (Chickens scratch backward but pigs scratch forward).
♥ What is the primary language that you speak? Do you speak any other languages? English. I know a few Italian phrases.
♥ Have you ever been interested in learning another language? I always wanted to learn more Italian. I also find sign language intriguing but would probably not have an opportunity to use it.
CLUBS & ORGANIZATIONS
♥ Do you belong to any groups or organizations? YES NO Before I moved, I played cards with a group of friends every week; I was also a member of the local theatre and a bookclub.
♥ Do you vote in elections? YES NO I vote typically in the presidential elections but not otherwise.
SPIRITUALITY
♥ Are you active in your church/synagogue/other religious group? YES NO Not as active as I once was. I would be interested in learning more about the services offered at the community.
♥ Do you participate in any volunteer work? YES NO I do not object to volunteering. But I have not had many opportunities.
♥ What type of volunteering would you like to be involved with? I really am unsure but would like to find out more from the Chaplain.
HOBBIES
♥ What do you like to do in your free time? Exercise, cook, read and decorate. I like crafts on occasion (I recently made a wreath for my new apartment). I like to dance (but don’t have many occasions to); I like to shop and in the nice weather, I love to sit at the beach.
♥ What kind of music do you prefer, if any?
Upbeat, fun (dance) music. On occasion, I will listen to jazz.
♥ Do you like to play games (card games, board games, others)? YES NO
What kind of games do you prefer, if any?
I really like many different types of games – card games and board games but I also like outside games as they are more active.
♥ Do you enjoy arts and crafts? YES NO
To an extent. I've never been much of an artist or even very good at it. I'd prefer to do more active things.
♥ Do you enjoy sports? YES NO Do you have any favorite teams? I do like a good competition. Baseball is my favorite sport but I also like football. The New York Yankees, of course!
♥ Are there any computer activities that you enjoy? YES NO Once in a while, I may play a game on the computer but mostly I use it for online shopping or researching.
♥ Are you interested in learning about computers? YES NO They are like a necessary evil. They offer a great deal of opportunity but I feel I spend enough time using it.
♥ Do you watch television? YES NO
What TV shows do you prefer to watch?
In the evenings I will watch a little television before bed. But I make it a habit not to watch TV during the day. I much prefer to be up out and doing things. I will usually find a good mystery movie but I also like to watch some of the 80-90 sitcoms.
♥ What reading materials are preferred, if any? A good mystery book. And occasionally I’ll pick up a cookbook.
♥ Do you have any interest in seeking new hobbies or activities? YES NO Although, I’m not sure what.
PHYSICAL ACTIVITY
♥ What fitness or exercise activities do you participate in? Walking (outdoors), some weight lifting, yoga and I play tennis.
♥ Do you or have you ever played any sports? YES NO As a teenager, I played softball, field hockey and volleyball. I still play tennis.
♥ Do you have any preferred outdoor activities? YES NO I like to do as much outside as possible. I've always been an outdoorsy kind of person.
♥ Do you have any preferred outings or trips? YES NO The beach. I very much like outdoor dining as well. I do like to travel to warm weather states when it is called at home.
♥ Are there any fitness or exercise activities that you are interested in trying (such as yoga or kick boxing)? YES NO
I'm not sure exactly what but I'm a big proponent of physical activity so I would be interested in learning what the community has to offer.
♥ Do you have any special talents? YES NO Cooking, particularly Italian dishes.
♥ Are you currently satisfied with your overall physical well-being? YES NO If no, what would you like to improve upon and/or accomplish? I would like to lose 10-15 lbs.
PETS
♥ Do you have any pets? YES NO
We have always had dogs but since Snoopy passed a few years ago, I know longer have a pet.
♥ What kind of pets (or animals) do you like? Dogs and birds.
♥ Are there any animals that you prefer to avoid? YES NO I like animals – I find them intriguing and they are great company.
UNIQUE ASPECTS OF YOU
♥ Of what are you most proud? Our restaurant, my children and grandchildren of course.
♥ What has been your greatest accomplishment so far in life? Our restaurant was very successful but raising a family is my greatest accomplishment.
♥ What do you most look forward to in the future? Travelling to new places that I have not been before.
♥ What gives your life meaning?
Being a part of the lives of my family and friends.
♥ What brings you the greatest joy?
My grandkids. I have really enjoyed being part of their lives as they grew into adults. I am so proud of them and they are as much fun now as they were as kids!
♥ Do you have any pet peeves? Not really. Although I do not like aggressive drivers or rude people.
♥ What do you do to relieve stress? Exercise. I will also treat myself to a manicure and pedicure and every so often, a message. A nice glass of red wine is also a great stress reliever for me.
♥ If you were to give advice to future generations, what would you say? Be kind, be thoughtful. Follow your heart. Take advantage of opportunities when you can.
♥ Is there anything else important for us to know about you that will assist us in providing you with the best possible experience as an Acts resident?
Although I like to be very active and participate in many activities, I do also like my privacy. I think it is important to do for others and always be inclusive
My Life Journey interview was conducted/documented/recorded by:
Name: Joe Nameth
Title: Well-Being Concierge
Date interview conducted: 4/23 Return
Acts is independent of affiliation with any specific denomination, but maintains its Christian roots through the practice of having a full-time Chaplain at each community. These spiritual leaders provide support for older adults and guidance for residents of all faiths. An initial Spiritual Life Assessments is completed shortly after a resident moves into an Acts community. This information would then inform the overall ministry of the chaplain to that individual resident, shape discussions in future visitations, inform focus areas of support groups, Sunday sermons, Bible studies etc.
1. May I ask you about your religious beliefs? You may. I was raised catholic. My parents were very active in the church. I was in my younger years but not as much of late. I feel I have a solid foundation. I respect all other religious beliefs.
2. What would you like for us to know in relation to your faith background?
I consider myself a humanist. I would like for the community to know the humanist manifesto as I believe it will help all.
3. What role would you say your faith beliefs play in your life? I like to think that my faith is at the heart of everything that I do
4. What spiritual activities, practices, or rituals are most significant to you?
My personal spiritual practice is walking the grounds of the community and greeting people, Christmas caroling during the holidays and the Jewish sader, I have especially enjoyed holiday services.
5. Is there a spiritual milestone, a significant spiritual event, in your life that you would like to tell us?
No. But I would like to learn ore about the offerings at the community.
6. Are you experiencing spiritual struggles that you would like to share? No, I think I can honestly say that for most of my life I have not experienced spiritual struggles.
7. What do you consider to be your spiritual gifts, talents, and skills? My capacity for listening, empathy, respect and the energy of people together. I believe small things can make a difference
8. Would you like to know about the spiritual activities/services we offer? Yes, I would like to know more.
9. Death is one of the realities of life for everyone and I’m curious to hear your thoughts about it.
I see it as a natural process My friend and I have been talking about it lately. I do not believe in the afterlife. I want to be cremated. Ashes scattered at the beach.
10.How may I assist you to achieve your spiritual goals and preferences? Knowing that you are here and available is wonderful. You have already made a difference!
My Spiritual Life Assessment was completed and recorded by:
Name: Reverend Mark Spitz
Title: Chaplain
Date interview conducted: 4/19/23
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RESULTS
The Global Ice Breaker Assessment is a health risk assessment that was completed through an app (PDHI). The app was downloaded to your smart phone for you to complete or it was completed together by you and a member of the Well-Being team. Below is a report of your results.
The Global Ice Breaker Assessment
Global Ice Breaker Assessment Results were reviewed by:
Name: Morticia Adamms, CRNP
Title: Nurse Practitioner
Date interview conducted: 4/6/23
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THRIVE with Acts Screen Results
Resident Name: Carmella Galibino DOB: 10/13/43 Age: 79 Screen Date: 5/2/2023
Level of Care ILU☒ OBT □ WBC □ Tester: ____________________________
ENERGY
□
2 MINUTE WALK TEST : 75 meters
□ 6 MINUTE WALK TEST ___________meters □ 2 MINUTE STEP TEST_________steps
FLEXIBILITY □ OCCIPUT TO WALL TEST : 4 cm □ TIMED UP AND GO TEST _________sec.
□ SIT AND REACH TEST______________ in. □ BACK SCRATCH TEST ______________in
□ CAN YOU GET ON AND OFF THE FLOOR? ___Yes, alone ___Yes, with assist of a chair X No
STRENGTH
□ 30 SECOND CHAIR RISE TEST : 1 rep
□ GRIP STRENGTH TEST Left: lbs. Right: 34 lbs.
□ 5 TIMES SIT TO STAND TEST _______sec. □ ARM CURL TEST L ______reps Right_____reps
BALANCE
□ SELF-SELECTED GAIT SPEED TEST: .7 meters/sec.
□ SINGLE LEG STAND TEST 1 sec. □L xR □FUNCTIONAL REACH TEST_________ in.
□ TIMED UP AND GO DUAL TASK MANUAL TEST______________ sec
□ TANDEM STANDING TEST__________ sec. □ 4 SQUARE STEP TEST sec.
MIND
□ TRAIL MAKING TEST A: 30 sec.
□ TRAIL MAKING TEST B sec.
SEE NEXT PAGE AND SEPARATE NORMS PAGE FOR INTERPRETATION OF TEST RESULTS
Recommendations:
☒ Call the Rehabilitation Department for further evaluation (ext. )
☒ Call or visit your Fitness Director for further information (ext. )
Comments_______________________________________________________________________________________
