Case Study: Mrs. Barbara Green is an 89-year-old woman who migrated to Australia from Germany 40 years ago. Barbara is a retired primary-school teacher and lives alone in a single-storey house....

Case Study: Mrs. Barbara Green is an 89-year-old woman who migrated to Australia from Germany 40 years ago. Barbara is a retired primary-school teacher and lives alone in a single-storey house. Barbara was married to Henry who was in the Royal Australian Navy; however he died of lung cancer two years ago. Barbara has a son Dominik from a previous marriage. He lives in Germany with his family and visits Barbara regularly. Henry‘s daughter from previous marriage, Tracy and his extended family live throughout Australia but keep in contact and visit regularly.
Barbara retired twenty four years ago, at the same time Henry retired from the Navy. The couple spent their time together traveling around the world and volunteering at the local St Vincent de Paul shop. They participated actively in their local Catholic Church, organising fundraising activities. They were also very active members of the German Association. Barbara is fluent in both written and spoken English and German. She speaks with a strong German accent and sometimes people ask her to repeat herself.
Barbara’s health has been slowly deteriorating over the last two years, forcing her to limit her level of activities. Last year, Dominik and his family visited Barbara. They wanted her to return to Germany with them so he and his family could be close to her, but Barbara decided not to leave her home. She was grateful to her son and family for the offer though. Henry’s daughter Tracy has kept in touch with Barbara since Henry died and visits every three months with daily phone calls.
Barbara’s medical history is as follows:
Dry macular degeneration
Hypothyroidism
 Rheumatoid arthritis
 Osteoarthritis.
Recently, Barbara has stopped driving due to her diagnosis of macular degeneration. She rarely leaves the house due to altered mobility and has lost physical contact with both friends and members of the German Association. Barbara’s house is unusually unkempt and the cupboards have minimal amounts of food consisting of some tins of soup and baked beans.
Barbara feels very connected to her community and wants to stay in her own home. She realises that in order to do this, she may need help. Barbara feels she is already too much of a burden on Tracy and her family. Barbara’s local doctor is concerned that she is not eating properly, is losing weight and becoming too isolated.
Barbara has been referred by her GP to the local community health centre for assessment and review. The referral letter from her GP states the following symptoms:  Joint stiffness. Swollen feet and enlarged joints.  Painful joints particularly, her knee, hip, fingers and back.  Limited joint movement. Constipation Occasional dizziness Vision deficit  Non-significant recent weight loss  Patient states adherence to medications but it is suspected she may forget or skip doses when she is in pain
Medications:
Slow release Paracetamol 665 mg tab ii 3 times a day
Ibuprofen 400 mg three times a day
Thyroxine 150 mcg daily
Hydroxychloroquine 200mg daily
You work at the local community health centre as a Registered Nurse and are assigned to manage Barbara’s assessment and care in her home.