CMCT01 Case Management (National Certification) Competency Training

CASE STUDY 19 – VALERIE

CDC is a way of delivering services that allows consumers to have greater control over their own lives by allowing them

to make choices about the types of care and services they access and the delivery of those services, including who will

deliver the services and when. Under a CDC approach, consumers are encouraged to identify goals, which could include

independence, wellness and re-ablement.

The consumer on a CDC package decides the level of involvement they wish to have in managing their package, which

could range from involvement in all aspects of the package, including co-ordination of care and services, to a less active

role in decision- making and management of the package. The key principles of Consumer Directed Care are;

Consumer choice and control; Consumer rights; respectful and balanced partnerships; participation, wellness and

transparency (including financial). Please consider the CDC philosophy and requirements when reading and responding

to this case study.

Valerie is a 66 year old woman who has discharged herself from hospital (to home) against specialist medical advice.

Valerie is able to weigh bear for a short period of time but is unable to walk more than a few steps with her walking

frame. Due to her inability to ambulate, Valerie has gained a significant amount of weight. Her current weight is 110kgs.

Valerie has a formal diagnosis of Paranoid and Histrionic Personality Disorder and has no support network. She divorced

15 years ago and has no children. Her estranged husband Jim now refuses to have any contact with her. Medical staff and

the hospital social worker are of the professional opinion that Valerie should move into residential care as without ongoing

nursing care, Valerie is at risk of losing her right leg. Valerie has a large venous leg ulcer on her right shin measuring

approximately 12 x 16 centimetres. The ulcer requires daily dressing and the application of a compression bandage.

Prior to Valerie’s hospital admission, she was receiving support from another service provider. The service provider

discharged Valerie upon her hospital admission, citing that Valerie’s care needs and behaviour exceeded the ability and

expertise of the agency.

Your agency has been supporting Valerie on a Level 4 CDC package for 6 weeks. She has been receiving daily visits from

the Registered Nurse along with support for her personal care, shopping and cleaning.

During this time you notice an alarming increase in Valerie’s erratic behaviour. She has “fired” her General Practitioner and

you have been unable to find a replacement medical officer to visit her at home. Administration staff receive at least 10

phone calls per day from Valerie voicing complaints about the care staff. Valerie accuses staff of moving her items on top

of her dressing table in the bedroom and stealing food items from the refrigerator. Care staff report that Valerie speaks to

them in a derogatory manner each time they attend the home, calling them “stupid”, criticising their work and accusing

them of trying to “sabotage” her health. When you approach this in conversation with Valerie, she denies treating the

staff in this manner. One by one, care workers in attendance have left the home refusing to provide any further care.

Today, Candice, the only care worker agreeable to still visit Valerie, phones you in tears and informs you that she will

“never go back there again”. She reports that she has been banned from the supermarket at the local shopping centre

because of Valerie’s behaviour. Candice tells you that Valerie phones the supermarket whilst Candice is shopping and

demands that supermarket staff call Candice to the service desk (over the Public Announcement system) in order for

Valerie to provide her with additional shopping instructions. Further, when Candice returns to the home, Valerie will

inspect the purchased fruit and vegetables, stating that Candice has deliberately purchased “substandard” quality. In

conversion with Candice she discloses tearfully that Valerie threw a cabbage at her head telling her it was “rubbish”. With

Candice withdrawing her services, you are now without any staff to replace her.

In addition to staffing problems, the Registered Nurse, Gina, is regularly being called back to the home (at least 3 times per

week) to redo the compression bandage on Valerie’s leg ulcer. The numerous phone calls to the office commence several

hours after the Gina’s initial visit.

Gina reports that Valerie interferes with the bandages telling her that they are “too tight”. Valerie denies touching her

dressings when you question her, explaining that the Registered Nurse is “lying” “incompetent” and “unable to her job

properly”. Gina informs you that she is increasingly fearful to attend the home alone due to Valerie’s accusations and

threats to report her “incompetent practice to the nurse’s board”.

Valerie’s care requirements far exceed the financial resources of the package. Your Manager has informed you that you must

urgently review Valerie’s care plan to ensure all resources, services and supports are within the allocated CDC Level 4 budget.

Instructions:

Please answer each of the questions below.

Please complete this activity with reference to the resource materials provided.

Please document and report your findings back to the group.