CMCT01_Case_Studies 2015

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: 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.

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