Case Study: 73-year-old Woman with Multiple Chronic Conditions

In-Home Supportive Services (IHSS) are designed to provide essential care targeting people with medical conditions who need assistance daily. The assistance offered by IHSS targets both old and younger people; it is through them that social workers (SW) can identify patients with needs and offer them the needed support. This discussion explores the case of a 73-year-old patient named C with multiple chronic health issues. She is under the IHSS for these ailments, and herein are her medical, physical, and mental limitations and strengths. Her family dynamics and environment, in general, are evaluated, and the necessary support is identified.

Identifying Patient Information

The client the SW identified for support is a 73-year-old woman with a high school education. The patient is currently unemployed and widowed, and her background shows she hails from a middle-class family of the Pashtun ethnicity. Since there is a strict confidentiality policy, certain details about this client have been modified. The client is widowed and is currently living with her daughter and son-in-law, who are also the family’s main financial providers. Living with her family offers her emotional support, and the two offer her the physical aid she needs. Even though this client is living with her daughter’s family, she still needs support because she is suffering from multiple chronic health conditions. These illnesses have limited her physical and mental functioning.

Family Composition and Household Information

The client lives in a multigenerational household and shares the house with her daughter, son-in-law, and three grandchildren. The household is provided for through the financial contributions of the son-in-law and her daughter. Even though the client’s health is deteriorating, in the company of her grandchildren, her daughter, and her son-in-law, she gets the emotional and physical care that she needs. The family members also play a crucial role in supporting the client’s needs and helping her daily with her care as she navigates the house.

Referral or Reasons for Services

The client who needs the IHSS services has severe physical limitations and several chronic conditions. In her state, she depends greatly on her family for caregiving. The referral for IHSS services for A.C. resulted from her increasing needs and the fact that her caregivers need additional support to manage her health and her medical needs, which come with serious psychological implications for her family (Feuz et al., 2019). As A.C.’s health continues to deteriorate, the family needs support from the SW, leading to the first reason for referral (Corey et al., 2018). The role of the SW is to care for the patient’s welfare.

Further, the complexity that comes with her worsening chronic illnesses is putting a strain on her caregivers. Most importantly, her mental health is also deteriorating, and this is putting a strain on the caregivers, thus pushing for the need for a referral. The challenges that pushed for referral appear to be long-term because they originate from the client’s chronic health, which progressively worsens with time (Houben et al., 2019). New issues have emerged over time and have also called for referral. For instance, the mental health of the client is deteriorating. When this is added to the patient’s health condition, it results in the emotional burden of dependency (Corey et al., 2018). It is also possible that the client is not getting enough support system because her condition is overwhelming her caregivers. The referral is meant to deal with the emotional, physical, and social challenges that come with her deteriorating condition.

Assessment of Presenting Problem

The client’s primary presenting problem is her physical limitation and the overwhelming dependency on her caregivers. Even though this is the problem that stands out, there are other underlying problems like emotional burden, mental health and burnout that the caregivers have to encounter in the process of giving care to A.C. Another presenting problem is psychological deterioration, which is a risk the client is also facing and may lead to severe anxiety and depression (Houben et al., 2019). These mental health conditions can also further endanger her physical health. The combination of physical and emotional strain could lead to a crisis if not addressed comprehensively. The intervention should prioritize the client’s chronic condition and mental health (Houben et al., 2019). The client should be provided with emotional support, counseling, and psychiatric services. The caregivers should also receive support to help them cope with the emotional and physical challenges of caring for their sick loved one.

Strengths and Weaknesses

Biophysical

The strength noted in this area is her physical appearance, which appears to be maintained despite her chronic condition. Despite her medical conditions, the client has reached typical growth and development milestones (Houben et al., 2019). Also, there is strength in her physical abilities because she depends mostly on the caregiver for lots of her day-to-day needs and movement. She can also communicate through gestures. The weakness in this area is her health status because she has multiple chronic health conditions and severe physical limitations, which puts her at risk of further health deterioration (Houben et al., 2019). Her physical disabilities are a weakness because they make her dependent on caregivers.

Psychological

The notable strengths in this area are her cognitive capabilities, which are still stable despite her having mental health conditions like depression. Even though she depends on the caregivers, she still can cope using machines because her problem-solving skills are stable (Houben et al., 2019). The weaknesses noted are her mental health issues like anxiety and depression, which can affect her cognitive capabilities and lead to other health conditions. Her health condition is also affecting her emotions and sometimes her psychological health.

Social

The notable strength in the social life of this client is her family. She lives with her grandchildren, daughter, and son-in-law, who offer her emotional support and help her with her needs because she cannot move easily. The family also provides her with the social support she needs (Houben et al., 2019). The client is also spiritual because she is deeply rooted in her tradition, which may provide her hope during her ongoing illness. The only weakness in this case is the emotional challenges the caregivers face due to the ill health of the client and the physical and emotional fatigue that comes with giving care to her.

Environmental/Economic

The strength in this area is that the client has financial support from her daughter and son-in-law and access to medical coverage. Even so, the outstanding weakness in this case is her medical condition, which requires expensive treatment plans. Therefore, her family is likely going to be overwhelmed by the expenses. Additionally, her medical coverage may not cater to all her medical needs and demands.

Diversity

Age can be a contributing factor to the client’s health conditions, and her physical condition is a diversity issue that makes her dependent, thus the need for accommodations. The client’s financial status can also affect her ability to access quality care. Gender, race, and ethnicity can also lead to inequalities in access to healthcare. Religion can also affect the way the client accesses healthcare. These diversities can also affect her perception of the healthcare plan she is given and how she interacts with her extended family.

Intervention/recommendation

The goal includes improving the client’s and her family’s quality of life by addressing A.C.’s social, mental, and physical needs. The intervention aims to increase independence and strengthen the client’s mental state. Recommended services include physical therapy, mental health counseling, respite care, and assistive devices. Referrals include occupational therapy, social services, and caregiver support groups. Some services will be essential for this patient, according to Corey et al. (2018). They include mental health counseling, physical therapy, assistive devices, and respite care. Through a multi-disciplinary approach, the patient will receive comprehensive care. The strategy will involve psychological, medical and social service professionals. Frequent medical assessments, mental health evaluations, and regular social work interventions will characterize the plan. Ongoing evaluations and service adjustments will be a core part of the plan.

Theoretical Perspective

The Biopsychosocial model is a theoretical framework that can be applied to this client. It is chosen because it considers the complex interactions between biological, psychological, and social factors in a client’s health (Porter, 2020). It addresses the client’s physical therapy through physical therapy, medical care, and assertive devices. It also addresses the client’s mental health issues through counseling and therapy. This theoretical perspective is also considered because it considers the client’s family dynamics and involves the community in general (Porter, 2020). Since it emphasizes a holistic approach, it addresses the patient’s physical, emotional, social, and environmental needs.

Conclusion

This is a case of a client with mental challenges like depression and anxiety who also has chronic physical health issues. This client has a family that offers her care and emotional as well as psychological help. The client lives with her son-in-law, daughter, and grandchildren and has financial support from the two adults. Despite all this support, the client still needs help from the SW. The client has serious medical challenges that cannot be handled by her caregivers alone. She, therefore, needs support from professional healthcare experts. Secondly, her condition is deteriorating significantly, and so it is taking a toll on the caregivers emotionally, physically, and financially. The SW, therefore, offers the family support by connecting them with medical experts, sources of financial help, and support for the caregivers to help the patient get better.

References

Corey, M.S., Corey, G. & Corey, C. (2018). Groups: Process and Practice. United             Kingdom: Thomson/Brooks/Cole.

Feuz, M. A., Odierna, D. H., Katen, M., Volow, A., McMahan, R. D., Ritchie, C. S.,             McSpadden, S., Dearman, K., & Sudore, R. L. (2019). Leveraging In-Home Supportive      Services Programs to Engage People in Advance Care Planning: Input from Staff,      Providers, and Client Stakeholders. Journal of palliative medicine, 22(11), 1430–1438.    https://doi.org/10.1089/jpm.2018.0429

Houben, N., Janssen, E. P. C. J., Hendriks, M. R. C., van der Kellen, D., van Alphen, B. P. J., &       van Meijel, B. (2019). Physical health status of older adults with severe mental illness:             The PHiSMI-E cohort study. International journal of mental health nursing, 28(2), 457–    467. https://doi.org/10.1111/inm.12547

Porter R. J. (2020). The biopsychosocial model in mental health. The Australian and New     Zealand journal of psychiatry, 54(8), 773–774.             https://doi.org/10.1177/0004867420944464

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Title

(Short Introduction: you do not need to use the heading “Introduction”)

Identifying Information

Age, gender, education, occupation, marital status, economic status, and race/ethnicity.  (You must protect clients by disguising the information sufficiently enough to preserve anonymity and confidentiality)

Family Composition and/or Household Information

Is this a single parent household?  Who lives in the home?  Who contributes financially?  What are the roles and the responsibilities of the family members?

Referral or Reason for Services

Clearly state reason for referral or for need of services.  Discuss the referral source. What factors led to the referral or the client seeking services? Is the problem long or short term in nature? Is it an “old” issue complicated by “new” additional issues or concerns? What resources or supports does the client have to resolve the problem? What is the client’s view of the problem or need for services? What, if any, interventions have worked in the past?

Assessment of Presenting Problem

Clients usually have more than one presenting concern or problem; most clients have multiple issues that need to be addressed.  Which of the presenting problems have the most urgency? What are the risks to the client?

Strengths and Risks

Biophysical

Describe the client’s biophysical strengths and risks, such as, physical appearance, physical condition, health status, physical illness, growth and development, developmental delays, physical abilities, disabilities, and substance abuse.

Psychological

Describe the client’s psychological strengths and risks, such as, cognitive abilities – attention span, concentration, memory, capacity for abstract thought; learning abilities or disorders; stability; emotional issues; behavioral issues; behavior patterns; mental health issues; ability to discern reality; language abilities; self-perception; stress; abuse, trauma; impulse control; problem solving skills; and coping skills.

Social

Describe the client’s social strengths and risks, such as, household and family structure; family communication; family relationships; family roles; extended family; culture; spirituality; social skills; self-care; involvement in – groups, church, organizations, and community; support systems; and support services.

Environmental/Economic

Describe the client’s environmental strengths and risks, such as, housing, neighborhood, safety, violence, finances, income, and medical care. How is the client functioning within the context of various systems in his/her environment (e.g. family, school, work, community)?  Discuss any issues of discrimination, oppression, or poverty.

Diversity

Describe the diversity issues that are important factors in working with this client (age, class, color, culture, disability, ethnicity, family structure, gender, marital status, national origin, race, religion, sex, and sexual orientation).

Intervention/Recommendations

What are the goals for the client?  What services are going to be given/recommended?  What referrals will be made?  What is the plan for the client?

Theoretical Perspective

Identify and describe the theoretical perspective used in the intervention used with the client. Discuss how this theoretical perspective was applied to the client and the intervention used with the client. Be sure to cite your source.

Conclusion

 

 

References