After a series of falls, Mr.
Davies's PCP has requested in-home services from a local home health
agency. As part of an initial assessment, a social worker is called to
meet with Mr. Davies. The purpose of this assessment is to identify Mr.
Davies's physical, social, and psychological strengths and needs. As needs
are identified, available services in the community will be arranged to
help meet these needs.
Mr. Davies is an elderly white
male who resides in a 1-story house (slideshow)
in a rural town outside the city of
Ithaca. He is currently 78 years old and has resided in the same town for
most of his life. He has a high-school education, and has worked
throughout his life at a number of skilled labor jobs including masonry,
lumberjacking, and blacksmithing. Mr. Davies speaks very proudly of his
past working career and of his accomplishments. He occasionally drives to
the grocery store, approximately 7 miles from their home, but not during
the winter months. Mr. Davies was married for over 40 years; his wife died
approximately 2 years ago. He often speaks about how he misses her and
feels quite lonely without her companionship.
The client struggles with a
number of chronic medical conditions including Type
2 diabetes, coronary artery
others. He states that he smoked cigarettes for 30 years, but quit
sometime in the early 1980s. In addition, he was hospitalized in the 1990s
with intestinal surgery; recuperation included a three-month stay in a
nursing home. Over the past several months, Mr. Davies has been
experiencing repeated falls which he blames on his "clumsiness."
His hobbies include woodworking, which has decreased significantly since
his arthritis has gotten worse, and writing poetry which takes up much of
some of his free time, but has difficulty holding writing instruments.
Overall, Mr. Davies seems content and relatively outgoing. Although he
wasn't intoxicated, I noticed numerous empty beer cans in the kitchen
In regards to social support he
lives alone, but his neighbor Mildred, a 73-year old female, visits him at
least three times per week. She stops by to visit Mr. Davies a couple of
times during the week to socialize and sometimes to have lunch.
Occasionally, Mildred will drive Mr. Davies to the store to buy groceries
and medications if he is unable or not interested in driving. He has a
son, Jim, who works in construction and lives about 2 hours away from Mr.
Davies; he is not married and has no children. Mr. Davies states that he
sees his son every couple of weeks, but that he phones him at least twice
Mr. Davies manages to take care
of himself in regards to most ADLs and IADLs, although he does have FoodNet
On Wheels) deliver him lunch each day. He describes how proud he is to be able
to cook his breakfast each morning. After talking about the client's diet
and looking in the refrigerator, Mr. Davies seems to eat modest quantities
of meat and dairy products, but relatively few fruits and vegetables. He
mentions how he would like to go out of the house more often, but doesn't
feel comfortable driving long distances. He did not seem concerned about
falling. The client also described his reluctance to ever be admitted to a
nursing home regardless of how sick he became.
In regards to medication, the
client is currently managing six different prescription drugs. When asked
how he is managing his medications he says he occasionally forgets to take
all of them, but that he probably doesn't need them all anyway. He also
commented on the costs of these medications which are not covered by
Financially, the client lives on
a small pension and social security benefit totaling about $16,000 per
year. He receives health benefits from Medicare (HMO/managed care plan)
and is proud that he never took any "handouts" from the
government for any of his needs. He currently does not receive Medicaid
benefits although he is likely to be eligible. His house is paid for,
although the roof and exterior look as if they will need repairs soon.
There are also a series of stairs the client must utilize to get to the
sleeping and laundry areas. He lives modestly and has about $5,000 in a
savings account. The client spends about $600 per month on prescription
drugs. Mr. Davies continues to handle the finances and pays all of the
Mr. Davies seemed to show possible symptoms of depression, the "Geriatric
Depression Scale"* (short form)
was conducted. Mr. Davies
scored an "8" out of "15"; a score greater than
"5" suggests depression. The Michigan
Alcoholism Screening Test - Geriatric Version (MAST-G)** was also
administered to Mr. Davies who scored 10 out of 24; a score greater than 5
indicates possible alcohol problems. Upon completing a financial
assessment, it appears as though the client will qualify for Medicaid
assistance as well as other state and local healthcare discount programs.
* Sheikh, JI, Yesavage, JA.
Geriatric Depression Scale: Recent evidence and development of a shorter
version. Clinical Gerontologist. 1986; 5: 165-172.
** Mudd, et al, Alcoholism
Clin Exp Res, 1993, 17:489
- Assist client to remain independent in his home
- Notify the client's PCP about
symptoms of depression, possible alcoholism, and request
pharmacotherapy and counseling.
- Assist client financially through Medicaid benefits,
prescription drug program, home improvement plan
- Incorporate 8 hours of chore services
to assist the client
with laundry and housecleaning.
- Work with therapeutic recreation
specialist to investigate social day services program for
client to interact with other seniors, possible senior center
and Maintained by Penny Bianconi
Last Updated May, 2003