Case Study

   “Mr. Tom Murphy is 79 years old and lives with his daughter and her family on the outskirts of a town in the West of Ireland. He was diagnosed with Alzheimer’s disease 5 years ago. He is currently attending a day care Centre. The disease has progressed to the point that he needs increasing amounts of support becoming dependent on others including care for personal hygiene, eating and drinking. He is unsteady on his feet and becoming frail. He has difficulty recognizing people, although he has some flashes of recognition. In the last 2 months Tom has begun to wander, leaving the house saying he is going to see his brother, who died in early adulthood. The family are unable to continue to support him at home and have decided reluctantly (no enthusiastic) that he requires full time residential care. “

Example of letter from the Day Care Centre detailing Mr. Murphy’s care needs

Social Worker name

Address                                                                                                                      Nursing Home

date                                                                                                                                   Address

To who may it concern,

Re: Mr. Tom Murphy’s admission

   I am writing regarding Mr. Tom Murphy’s admission to long term care in your nursing home, as the social worker from the day Centre “….”  that he attends. Mr. Murphy is 79 years old and had been diagnosed with Alzheimer’s disease 5 years ago. He lives with his daughter and her family, but as his condition started to deteriorate, they have decided unenthusiastically that he necessitate full time care. He needs support with the activities of daily living as his cognitive abilities are deteriorating. He is unsteady on his feet and has difficulty in recognizing people but with some flashes of recognition and as well wondering. Taking care at home become difficult according to the family.

   As you may know Alzheimer s disease is a progressive disease and Mr. Murphy will require increasing level of care and assistance as time goes by. He needs a safe, healthy, structured environment as your assisted-living facility is offering.  Mr. Murphy’s family will be more than happy for their dad to facilitate of your services.

For further information relating Mr. Murphy’s case do not hesitate to contact me.

Thank you.

Kindest Regards

(social worker)

    Social workers are allocated” cases” where they must advocate on behalf of service users for the fair distribution of resources based on identified levels of needs according to CORU Ireland. Social workers are working towards social inclusion, respecting the confidentiality of service user and using information only for the purpose for which is given as Mr. murphy’s family are aware of this request and relaying on social worker professional help. As Mr. Murphy’s family are aware of request, social worker demonstrate competence in gaining informed consent to provide intervention and understand the issues associated with incapacity and how to deal with service users who are not capable of giving consent (coru.ie), and according to Irish Universities Quality Board (2012)   the communication process must be clear, accessible and acknowledged to all the parts involved  (Dr.B.L.Griffin, 2013).

   Social worker is part of a multidisciplinary team and can contact the local nurse, the community nurse or the day Centre nurse for further information regarding Mr. Murphy case. The Alzheimer disease demands a multi-disciplinary approach and care residential care units with special programs, where service users continue to have a quality of life and live well with the condition as dementia progresses (Katzman et.al,1991) and writing a clear report detailing the care needs of Mr. Murphy  is relevant in empowering and promoting his best interests as Blondheim (2004) states that certain types of communication shape and “transform life’s”.

In order to facilitate Mr. Murphy’s transition from independent living to that of living in a new environment is essential to gather as much information as possible about Mr. Murphy’s background and family to ensure a proper placement and to enable staff to provide the needed services.

   The date should be incorporate in the report as the written information stands accurate as according to principle 4 from the Data Protection Act 2003, the gathered information must be precise and up to date.

Planning the meeting

   Planning a meeting needs different communication techniques and styles in order to establish good relationship with service user and to evaluate the efficiency. As with an understanding and knowledge about imply an effective communication, means care, choice and empowerment for the service user (Lishman,1994). 

   In order to plan the meeting with Mr. Murphy and his family the social worker needs to take in consideration the preparation that include the place and purpose of that meeting.

   Before meeting , social worker should consider , that he might have to deal with some difficulties during the meeting as families comes with a history of how each members of family may feel different toward the person who is ill, and social worker’ s task is not to fix the family but “rather to have everyone on the same side” in caring for Mr. Murphy. Some families during the meeting can work effective and solve the problems of caring for an ill family member, having as a solution the compromise.

 It can occur that during the meeting Mr. Murphy because of his condition, can act or talk unwise and irresponsible, further increasing frustration of family members and create burnout. Social worker can use the politeness theory, that will assist him to uphold his” face strait”, that according to Brown and Lewison (1978:66) face reflect the image of a person and represent respect, plus can be maintained or enchanted, as face is a necessity of social interaction (Goffman,1955). According to Lakoff (1982) Politeness can boost harmony, reduce resistance and avoid conflict (Tanaka& Kawade1982).

Place of meeting

   Individuals exist within different environments, varied “worlds” like for example work, school home, and Mr. Murphy’s “world” and of his family should be taken into consideration as according to Lewin’s Field Theory (1951), each environment can be conductive to positive or negative communication

   According to Social exchange theory understanding how a person can think their communication is rational matching to their world view, where as to others their communication is irrational, like Mr. Murphy’s world view can be different to either his family’s world view or the social worker’ s world view (Gatignon & Robertson, 1986).

   Meeting can take place either in the day Centre as Mr. Murphy and the family are familiar with it or inn Mr. Murphy family home, as surroundings and environment for a person who suffer with Alzheimer can trigger challenging behavior as they face difficulties in understanding the unfamiliar environment.

The decision of the place should be transparent, inclusive, consistent and respectful and can be done through a phone call, text message or email with Mr. Murphy’ daughter as long as appropriate boundaries are kept. According to Peterson (1992) boundaries are “the limits that allow for a safe connection based on the client’s needs” (Handon,2009). In collaboration with Mr. Murphy’ daughter the social worker can arrange date, location and create the agenda for meeting.

Who should attend?

   This decision must be made in collaboration with Mr. Murphy’s daughter, as some people appreciated a relationship based on equality and problem sharing with the social worker, according to Rees and Wallace (1982, p.39) this relationship is called “an orientation to problem solving” (Lishman,1994).

   The decision of who should be present should take in consideration if Mr. Murphy has more children as sometimes family members may need to share with each other thoughts on feelings that involves the loved one or if family wants someone from outside (for example the community nurse) as it is helpful to engage an outside facilitator that will help family communicate about difficult subjects. Family needs to feel comfortable at he meeting as social contacts required people to interact in a manner whereby all parts involved feels comfortable according to Politeness Theory people needs to respect each other feelings for a good interaction.

The meeting agenda

The agenda should encompass discussing with Mr. Murphy and his family what imply living in long term care, what services the nursing home have to offer to meet Mr. Murphy’s needs, alternative options of nursing homes and financial aspect. Social worker can bring flyers and pamphlets, literature with photographs of the facilities including information about services offered, facility rates, packages description, rooms available, visiting hours, activity programs or what other auxiliary services the place has to offer like the provision of speech and language therapist, occupational therapist, dental or laundry services.

A potential resident should be encouraged to visit the facility before admission or if not possible due to medical condition, brochures or for example videotape recordings, HIQA reports of the facility (Health Information and Quality Authority in Ireland) can be presented (www.hse.ie).

The meeting

   Is important to be punctual as this indicate attentiveness an according to Egan (1986) this emphasis the significance of our vales and attitudes in attending a client. As lack of punctuality indicate lack of concern and if you are late important to apologies. Attentiveness is also conveyed by all the nonverbal communication like: proximity, eye contact, active listening, body posture or nodding our heads that are contributing to an effective communication.

All information provided to Mr. Murphy and family, both written and verbal should be delivered in a form and manner which is clear, courteous and in a way that is understood by the participants. Mr. Murphy and his family may have insufficient knowledge about the issue and the System Perspective Theory may support social worker in communicating efficient They need to be allowed enough time to reflect on options and ask questions between the information provided, where key information should be repeated to help service user understand and remember it (Lishman,1994). 

Options in favor or opposite to long term care, along with any financial matters. In Ireland the Government introduced “Fair Deal” scheme that makes residential homes more affordable and accessible for elderly (www.hse.ie).

The expression of feelings demands more from social worker than the ability to absorb, recalls and feedback what is said during the meeting, Egan (1986) argues that is significant for further work to attentive listening to clients, as “people are more than the sum of their verbal and nonverbal messages”. Such listening also involves listening for the repeated main topics, rather than concentrating on the detail.

Without the knowledge or ability to practice the practical factors of effective communication, the social worker is improbable to practice meetings with clients for purposeful communication, as involves reflective practice (Lishman,1994).

References:

• Blondheim, M. (2004). Discovering” The Significance of Communication”: Harold Adams Innis as Social Constructivist. Canadian Journal of Communication, 29(2).
• Dr.B.L.Griffin. (2013). Communication and Relationship Skills. Health Promotion Research Centre, NUI Galway.
• Gatignon, H., & Robertson, T. S. (1986). An exchange theory model of interpersonal communication. ACR North American Advances.
• Government of Ireland (2003). Data Protection (Amendment) Act 2003. Dublin: Government Publications. Retrieved from: http://www.irishstatutebook.ie/2003/en/act/pub/0006/
•  Handon, R. M. (2009). Client relationships and ethical boundaries for social workers in child welfare. The New Social Work, 42, 189-199.
• Katzman, R., & Jackson, J. E. (1991). Alzheimer disease: basic and clinical advances. Journal of the American Geriatrics Society, 39(5), 516-525.
• Katz, S. (1983). Assessing self‐maintenance: activities of daily living, mobility, and instrumental activities of daily living. Journal of the American Geriatrics Society, 31(12), 721-727.
• Lewin, K. (1951). Field theory in social science: selected theoretical papers (Edited by Dorwin Cartwright.).
• Lishman, J. (1994). Communication in social work. Macmillan International Higher Education.
• Lishman, J. (1994). Helpful and Effective Communication: Our Clients’ Views. In Communication in Social Work (pp. 6-14). Palgrave, London.
• Tanaka, S., & Kawade, S. (1982). Politeness strategies and second language acquisition. Studies in second language acquisition, 5(1), 18-33.
• http://www.coru.ie/uploads/documents/typeset_Social_Worker_Code_Feb_2010.pdf
• https://www.hse.ie/eng/services/list/4/olderpeople/residentialcare/nursinghomechecklist.pdf