Case 1 
Social Worker Assessment

Scenario

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 disease, hypertension, arthritis, and 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 sink.

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 a week.

Mr. Davies manages to take care of himself in regards to most ADLs and IADLs, although he does have FoodNet (Meals 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 insurance.

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 monthly bills.

Assessments Conducted: 

Because 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