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Advanced clinical techniques/family centered practice with populations at risk (aging)

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Medical Social Worker
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  1. Introduction
  2. Family and community support
  3. Description of disabling condition
  4. Care-giving implications
  5. Impact on family relationships
  6. Impact on sexuality
  7. Social work involvement
  8. Legal and ethical dilemmas
  9. Conclusion

On April 29, 2006 at about 5:30 a.m., May C. fell in her kitchen in a rural area 10 miles west of Yakima, Washington. As she fell her right leg was thrust back while the rest of her body fell forward, resulting in a compound fracture of her right femur. May called her LifeLine service for help and was transported to Providence Yakima Medical Center. Surgical repair of her leg was delayed for 3 ½ days due to a doctor shortage in the Yakima area. She is currently placed in Parkside Nursing Home in Union Gap, Washington and is not expected to be able to return to her home. Six years ago she broke her left femur and hip under similar circumstances and returned home after a very poorly tolerated three-month nursing home placement. First names are used in this article after identifying significant characters to avoid confusion. This report is based on the personal experience of the author with her grandmother and family members.

[...] Anne does not want or require assistance with more concrete matters, but does appreciate having her feelings validated by someone who knows May and understands how difficult working with her can be. Much appreciated is the Social Worker checking in with Anne to confirm whether her assessment of May's emotional and cognitive status is accurate. In at least one case staff thought one of May's statements indicated a worsening paranoia but after Anne put it into context if was determined that May was grounded in reality in that situation. [...]

[...] The family consensus at present is to allow the nursing home Social Worker to work with May on accepting that she will not be able to return home. If May questions the necessity of continued placement in either the nursing home or an Adult Family Home, Anne, Doris and Lance plan to it on government rules that do not allow neglect of the elderly. They will appeal to May's law-abiding nature in the event she does not understand the necessity for placement, hoping this approach will preserve their relationship with her. [...]

[...] In the last five years May has been diagnosed with hypertension and has had at least 2 transient ischemic attacks (TIA or ?mini-stroke?) and Type II diabetes. Longer-term problems include urinary incontinence, migraine and irritable bowl syndrome. In the nursing home she is bowl incontinent but this is primarily a result of her inability to get to the toilet without assistance. Before this placement, she used pads for urine leaks but now must wear full adult diapers because the staff often cannot respond quickly enough when she needs the toilet for bowel or bladder. [...]

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