Duty of Care vs Dignity of Risk Case studies Case study 1 Mrs O has been receiving CHSP services for several years. She recently been diagnosed with dementia and her needs have gradually increased, but she is still capable of independent living. She has two adult children, a daughter who lives in about 30minutes drive from Mrs O and visits her once a week or takes Mrs O back to her home for a family meal and time together. Her other adult child, a son, lives interstate and visits his mum 2 to 3 times per year. Mrs O used to go over to visit with him and his family but states she is no longer interested in travelling that far. Mrs O gets on well with the staff who come into her home and makes it clear to them that she wants to keep doing as much of her own housework and personal care as she can. However, her daughter expresses concern to the CHSP provider that her mum is no longer capable of making decision that best meet her needs. They ask the provider to add laundry, ironing and bed-making to their duties, tasks that Mrs O has been doing herself until now. The worker reports back to the organisation that they have noticed that Mrs O has been struggling with some of these tasks, for example, they believe she hasn’t changed her bed linen in over a month also that Mrs O who is normally very ‘house proud’ has not been doing any cleaning between visits like before. They also report that Mrs O seems ‘less steady on her feet these last few weeks’ and ‘appears to have lost some weight’.
Questions: •
What are the risks in this situation?
•
What is important to Mrs O? What is important to Mrs O’s daughter?
•
What is the impact on Mrs O if the organisation follows through on her daughter’s wishes?
•
What is the organisations duty of care to Mrs O and to Mrs O’s daughter?
•
How would you put a Wellness and Reablement lens on this situation?
Level 3, 86 Murray St TAS 7000 GPO Box 771, Hobart TAS 7001 p 03/6231 0755 ABN 69 078 846 944
Case Study 2 Mr C has lived alone for the last 10 years, since the death of his wife. Mr C always enjoyed going to the races on Saturdays and meeting up with other regulars and friends at his local pub on Sunday nights. Mr C has been receiving support from CHSP services for some time now, including domestic assistance, transport and a meals service x 5 days per week. Mr C enjoys the interaction with all those who come into his home to provide support. While Mr C has limited capacity to meet his own physical needs, he is part of a ‘phone tree’ in is local community and most days is talking with someone from the neighbourhood. Due to his health, Mr C is now longer able to attend race meets on Saturdays, ‘it’s too far to walk’ but still gets to the pub on Sunday nights as it is located within a short walk from his home. He sometimes has a drink or two, too many, and has been supported home from the pub by a worker from there. Mr C has a standing appointment with his GP on Monday mornings to monitor his health issues and at times has been woken up by the worker who has come to transport him to this appointment. Mr C’s son has spoken to both his dad and to your service, expressing concern about this father and his drinking and his inability to care for himself at home. Mr C’s son believes he should be in residential care where he would receive better care and not have access to going to the pub. Mr C is adamant that he will never go into a care home, that there’s no harm in a few drinks with friends and that he wants to die at home.
Questions: •
What are the risks in this situation?
•
What is important to Mr C? What is important to Mr C’s son?
•
What is the impact on Mr C if the organisation follows through on his son’s wishes?
•
What is the organisations duty of care to Mr C and to Mr C’s son?
•
How would you put a Wellness and Reablement lens on this situation?
These case studies have been adapted from the Aged Care Quality Standards case study examples and the questions have been adapted from the Imaging Possibilities Handbook 2014.
Level 3, 86 Murray St TAS 7000 GPO Box 771, Hobart TAS 7001 p 03/6231 0755 ABN 69 078 846 944