H&Y V — maintenance is not giving up

H&Y V is where honesty about goals earns its keep: what remains winnable is safety — transfers, skin, positioning, comfort — and the caregiver’s survival, and NICE’s palliative-care recommendation applies at any stage, so the referral belongs now rather than at the crisis. The husband’s angina makes manual lifting a cardiac exposure, which ends the technique debate: the lift goes in, the services come in, and the placement question is explored with the whole team around the family. What you do with it: write the maintenance plan like it matters, protect the man who lifts her, and treat “nothing more to be done” as the failure of imagination it is.

• Sacral redness or any skin break — pressure-care escalation today
• Chest pain or breathlessness in the husband during transfers — the lift goes in now and his GP is called
• Coughing at meals or recurrent chest infections — dysphagia review; aspiration is the killer here

• The bent spine — camptocormia and the honest ceilingTier 4
• The backward faller — the pull test and the next fallTier 2

This page carries the case’s first decision. The full sequence — every decision, the examination by domain, and the debrief that grades you — is in the drill, and the library is included with membership.