case study
Case Study One: Andrew: Maintaining a Life Hi, my name is Andrew and I am a 74 year old man starting to experience physical and psychosocial decline linked to getting older and I live in a large regional town in Australia. I currently live in an independent unit within a retirement setting provided by a specialised aged care service. I recently had a stroke and a referral was made for support and assistance as my family and the acute medical team agreed I seemed to be sad. While I am often referred to as a ‘pleasant man’, as a subacute rehabilitation patient I am being observed to have a persistent flat mood and lack of plans for the future. I experienced a right frontal lobe cerebrovascular accident (CVA) with left-sided hemiparesis and worsened urinary incontinence. Although I experienced dramatic deterioration in most areas of functioning, my greatest concern and origin of most of my anxiety surrounds my urinary incontinence and subsequent changes in privacy. I have never married and have no children. I was an independent and successful accountant until my recent CVA. After retirement, I played golf, participated in a community gardening group as treasurer and continued to do tax returns for family, friends and those on low incomes. I describe my work on local NGO boards as my “life mission,” and I find great purpose and meaning in serving others. The biggest blow to my self-esteem is that now I am a patient who relies on others for care, which is an extremely difficult reality to face. Staff and family report that Andrew’s thought process was often focused on the fear of not getting to the restroom in time, sitting in a wet diaper, and/or the possibility of recurrent urinary tract infections (UTIs). Andrew reported experiencing worsening urinary frequency and occasional urinary incontinence starting approximately 3 years ago, altering his quality of life. Over the years he increasingly focused on this physical symptom, while his social and professional life declined, and he started to reduce his community activities. Since the stroke he has became more self-conscious of his perceived “disability.” While in rehabilitation, Andrew interacted with staff and residents, used humor in most social environments, asserted ideas of hope and recovery, but has not stayed in contact with friends and his few family members in the community. As time progressed Andrew would remain isolated in his room between rehabilitation sessions, rarely spoke with other residents, and presented with increased anxiety and depression. Andrew would use his call light at least every hour to request to go to the restroom, often focused his attention on physical symptoms that could be related to a UTI. Even after results from multiple urinalyses were negative for an infection, he continued to question the accuracy of the results. Some staff describe him as a “problem resident” as they viewed his frequent requests for assistance as attention-seeking behavior. Andrew expressed feelings of hopelessness and helplessness and displayed a poor self-image. Because he had developed good insight and empathy for others through his professional training and life experiences, he was able to pick up on negative non-verbal cues from the staff members, such as poor eye contact, quick and abrupt body movements, sighs and groans, and rapid speech. Andrew interpreted these cues as an act of not caring. Andrew often felt abandoned. As a result of the culminating stress, his concerns about his urinary incontinence and requests for help continued to increase. What direction would you support Andrew in taking to ensure he rebuild a good life? Disability Case Study This case study is in relation to a 22 year old adult, Samuel who lives with an intellectual disability. Samuel’s parents are from East Africa and the Punjab in India. The family speaks Punjabi at home. Samuel lives with his parents who work full time, two brothers, a sister and grandmother, who doesn’t speak English. Samuel’s family are not devoutly religious but it has been observed that they value their Muslim traditions. Regarding Samuel’s learning disability, his speech is impaired and he has limited physical mobility and requires assistance with personal care tasks. Although Samuel lives with impairments he considers himself like other young adults, does not wish to be seen as tragic and want to have a life typical of other young people his age. Samuel likes sport (to watch and play) music, fashionable clothes, movies and misses his friends from school. Samuel has a speech and language therapist, Jean who is working with him around computerized assistive technology. Samuel has been working at an Australian Disability Enterprise (ADE) three days a week for the last 12 months. Samuel has some funding from the NDIS to support his engagement in work, to learn independent living skills and build capacity around social and community engagement. In addition to he has a support agency, visiting at home twice times a day, for one hour at a time to assist him with simple everyday tasks and activities of daily living. Samuel is getting more and more frustrated and angry every day. There are many reasons for his verbally abusive out bursts. After interviewing him, this is what I came to know about his family background and the way things are going for Samuel. Samuel feels he is a burden on his parents, as both of them are working; they do not have the time to look after him. This also frustrated Samuel as he needs more time from people who love him and are close to him as well as more engagement with peers and the broader mainstream community. Samuel does get some amount of support from his grandmother but that is not enough as he cannot openly communicate with her in Punjabi. Samuel feels uncomfortable being left as a responsibility for others. Even though he cannot perform everyday tasks by himself, he still finds this inconvenient. For example, he does not like to go to bed early. Samuel is disturbed by the thought of not attending the ADE even though he is engaging in menial packing tasks; without this employment he would not have any activities to do. It costs him more money than he earns to attend the ADE. Although Samuel portrays a friendly attitude towards support staff, he is not comfortable with their presence and is feels somewhat abused and like he does not have an ordinary life. Another important issue in Samuel’s life is about what will happen to him in future. Samuel would like a relationship with a woman, but is uneducated around relationships and sexual health and using online apps and sites so is unsure and uncertain. Samuel’s parents plan on marrying him through an arranged marriage, to which he does not give a favourable response. CA 1.2 Case Study Review: Tips and advice • 750 words for each case study (1500 total – you will write about both case studies, do not choose just one) • No introduction or conclusion (use headings below) • Do not rehash information on the case study (see lead in example below) • Remember, in your recommendations, you are seeking to promote the voice/aspirations of the individual In lieu of a student exemplar, I’ve outlined an example structure below with some additional tips using a hypothetical case study of ‘Anna’ – a migrant woman with complex physical and mental health presentations who is struggling to negotiate a new and fair lease with her landlord, but very much wants to stay in her home because she feels safe there after leaving a violent relationship. She does not have any friends in the area so she feels safe staying at home, even though she used to enjoy going out quite a lot. Example structure 50 words lead in (sets it up without rehashing the case study) Case Study Name: Anna Age: 45 Medical history: Multiple Sclerosis and domestic violence-related trauma Presenting issue: Anna is at risk of homelessness; her case worker is trying to move her to a residential facility against her wishes, but she strongly prefers to maintain her own home Critical Review 400 words critical review/inventory (addresses marking criteria one worth 25%) • Type of care/service (e.g. medical model, social model, combination? For example, ‘Anna’s’ case worker might be from a health service and she is working from a medical model of trying to get her to move to a supported residential facility for medical reasons, but this might overlook other factors that might be more associated with a social model, or an empowerment frame) • Policy context of care/service (e.g. NDIS, neoliberal policy contexts etc. What is the policy context shaping care/service provision?) • Strengths, skills, aspirations (hint: you might find clues for the voice of the individual in the case study here) • Needs, challenges – including any devaluing experiences or stigma (hint: you might find things to address for your recommendations here) Recommendations 300 words x 2 recommendations (150 words each) (addresses marking criteria 2 worth 25%) • Recommendation one: what do you recommend and why. What is your rationale for the recommendation and what evidence can you give? (reference) • Recommendation two: what do you recommend and why. What is your rationale for the recommendation and what evidence can you give? (reference) Example one: Recommends community supports to assist Anna to stay in her own home, including support with negotiating a lease, and supports to assist daily living (what we recommend), because control over decision making is a crucial factor for mental health recovery work for women who have experienced domestic violence (why we recommend it), and Anna has clearly indicated that staying in her own home is very important to her (highlights the voice of the individual and their aspirations). Referencing the theories and argument = evidence. Example two: Recommends working with Anna to identify what sort of things she used to like doing when she went out, and exploring community options/groups with similar interests to connect her with (what we recommend), in order to assist Anna to identify her own solutions for reducing social isolation and improving mental health (why we recommend it). Referencing the theories and argument = evidence. Note Anna’s voice and aspirations coming through these recommendations. Also note the hierarchy of needs here in addressing housing first, then social participation. Disability and Ageing: Diversity and Discrimination: Continuous Assessment 1.2: Case Study Review: 1,500 words: 35% STANDARDS Criteria Task Outstanding Performance HD/D Exceeds Core Requirements C Meets core requirements P1/P2 Does not meet requirements F1/F2 ANALYSIS [30%] Critically analyses models of care using a critical disability studies and ageing lens and relates it to the policy context within which the care is being