CMCT01_Case_Studies 2015

CASE STUDY 15 – JOE

Joe is a thickset 70 year old gentleman who resides at home with his 65 year old wife, Maria, a gaunt, small statured women and his full time carer since he suffered a stroke 2 years ago. Joe has dense hemiplegia of his dominant right side, severe dysphasia and an ileostomy. Fully dependant on Maria for all aspects of his care, including feeding, hygiene, toileting, mobility and communication, Joe was recently discharged from the local hospital following a 6 day admission arising from an untreated urinary tract infection. His recent hospitalisation follows a routine admission the month prior when paramedics were urgently called to the home to lift Joe from the tiled floor of the shower cubicle. Maria reports that she lost her balance when transferring Joe out of the shower however she is adamant this has never happened previously despite transferring Joe (190cm) solo from the bed to chair (vice versa) at least four times daily. Both Joe and Maria have been waiting for a Home Care Level 4 package since the decision to bring Joe home almost 18 months ago. Currently Maria receives 2 hours per fortnight from the local Shire Council and 3 hours per fortnight in home respite from the Carer Respite Centre. Maria’s caring role for Joe is starting to impact on her health and she has recently been diagnosed with hypertension and depression. Her general practitioner has warned her that she will not be able to continue to care for Joe without additional support. Maria receives a carer’s pension and a carer allowance and supplements the family income from the sale of fruit from the small orchard she maintains on their 1 acre retirement property. Contact with family is infrequent as their only son is overseas on his seventh tour of duty in Afghanistan and their daughter-in-law and 4 grandchildren live busy lives in a major capital city 12 hours away by rail. Joe has a strict daily regime and Maria is insistent that any support you provide must be in accordance with his existing daily routine. Maria tells you Joe is an early riser and gets out of bed for his shower at 5.00am each day. He returns to bed at 12.15pm for 2.5 hours in the afternoon prior to having his afternoon shower and changing his clothes for dinner. Joe will have 1-2 glasses of wine with his evening meal and watches the late news at 10.30pm before being assisted with his hygiene and toileting prior to retiring to bed. ►► Maria is fixated on the huge responsibility of maintaining a large property in addition to caring for Joe. She has indicated that she does not want to accept any extra services other than lawn mowing/gardener; that this will solve her problems. ►► Maria has refused in the past to consider residential respite for Joe. ►► Maria manages the finances well but struggles with finding time to ensure all accounts are paid. ►► Maria has to leave Joe home alone to do shopping and run errands and is reliant on public transport to/from the shopping district. The bus trip takes an hour each way and Joe is left at home unattended for a minimum of 3 hours on each occasion. ►► Maria and Joe struggle to attend medical appointments due to Joe’s extremely limited mobility. Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Joe? (i.e. individual, diverse and special needs, including his aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Joe’s rights? (including developing Joe strengths to advocate for himself) C. Addressing Joe’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Joe? (i.e. balances Joe’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Joe, Maria and other Key Stakeholders) Additional information Instructions: 1. Please answer each of the questions below. 2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

15

COPYRIGHT © 2013 Case Management Society of Australia and New Zealand (CMSA)