Case Studies for Chapter 11: Challenges and Rewards of Aging

Case Study #1

Vada & Grant did everything together. They planned fun family vacations with their children Don and Anita, they were active in their church and community, and they spoiled their grandchildren. Despite their worsening arthritis, Vada kept crocheting and Grant continued to hook rugs and wall hangings. After Grant retired, he and Vada were occupied as very active babysitters for their grandchildren, but now their grandchildren have grown and some have moved away.

Recently, Vada and Grant celebrated their 60th wedding anniversary. They love their two-story home and nearby neighbors. Grant’s rheumatoid arthritis has worsened and he now spends much time in his rocking chair. Vada still tends to their meals and rides along with her daughter to do weekly grocery shopping. When daughter Anita arrived for their weekly shopping trip this week, she smelled a pan burning on the stove. In talking with neighbors, Anita learned that this wasn’t the first time that her mom had left items on the stove to burn. Yesterday, Vada felt dizzy and fell down the front steps. Her accident occurred two days after Grant had been rushed to the hospital for heart failure. Don and Anita are trying to decide what to do next to help their parents.

1) What options might the family have for caring for their parents? Consider multiple geographic locations.

2) How can the hospital and community health social worker effectively communicate and collaborate together?

3) When did the caregiving responsibilities change and the roles reverse?

4) To what extent does this scenario depict the current “sandwich generation’s” reality?

5) How might Vada and Grant feel about someone having to care for them?

Case Study #2

During the 1930’s Dick was a young boy of seven or eight and money was in short supply in his family. Actually, money was nonexistent, but Dick tried to improve his status. As a little kid he operated a lemonade and Kool-Aid stand at the curb in front of his house. The only problem was that in his small village, there was no traffic and few people walking by. As the ice melted and Dick ended up drinking everything, he learned a valuable lesson about the importance of location in setting up a successful business. Later, jobs held by Dick throughout his teenage years taught him to respect money and spend it wisely. Dick developed a good work ethic and a sense of financial responsibility that continued into his adult life. Consequently, Dick has been blessed with a wife who has always been a good money manager with simple tastes. Dick’s wife made him feel secure by never making demands for material possessions, and their three children grew to be successful adults, accepting the limits of what Dick and his wife were able to provide for them. From these experiences, Dick has concluded that money is not the key to happiness. It is how one controls money rather than how money controls him that is important.

1) How can social workers respectfully discuss the role of money in people’s lives and retirement planning?

2) What values has Dick shown in how he has lived his life across the years?

3) How might it feel for an older person if she/he was careful about spending money throughout life, yet still ends up in later years depending on family or the government to get enough money and resources to survive?

4) What speaks to you in the content found in Dick’s poem about money that is featured below?

Case Study #3

At age 99 Inez never imagined herself living in a shared nursing home room, requiring a wheelchair to maneuver, and needing an aide to help her bathe, dress, and toilet.  As a child who grew up in Cairo, Egypt, she’d left her family of nine brothers and sisters to fight in the British Army, and to eventually marry at age 32.  Her husband, thirty years her senior, spoiled Inez and their young son with a life of luxury.  For a short-lived and extraordinarily happy period of time, Inez and her son vacationed across Europe, meandered through the highlights of Italy and scaled the Swiss Alps as her husband’s business flourished. Because they were Jewish, amidst the Suez Crisis of 1956 Inez, her husband, and son feared for their lives, fled Egypt, and landed in France. Taking only a suitcase containing essentials, they left behind all their worldly goods, photos, and memories.  Feeling like an expatriate, alone with no other family support, Inez was unprepared for her husband’s sudden death and her subsequent need to flee again—this time for America.  Guided by Jewish values for over 130 years, HIAS (Hebrew Sheltering and Immigrant Aid Society, an international group operating in fourteen different countries, across five continents in 24 different cities that rescues people whose lives are in danger for being who they are and protect the most vulnerable refugees), helped Inez and her son build a new life and reunite with their family in America. Ever since the historic Suez crisis, Inez craved safety, security and self-sufficiency and repressed painful memories.

Now, as the certified nursing assistant awakens and dresses Inez at 6:00 AM for 8:00 breakfast, and the day progresses into 10:00 AM and 2:00 PM activity times, ample downtime exists for Inez to reflect on earlier times—both happy and sad—as she receives 24-hour care that her single, older adult son can no longer provide. As a long-term care nursing home resident, Inez represents a minority still of older adults who require around the clock care. Her mind is sharp, her sense of humor is keen, yet her appetite and spirit wanes as she resiliently faces each day.  When asked how she’s doing today, Inez responds, “What can I tell you, I’m still getting up, going from the bed to the bathroom to the chair to the dining table, and then back to bed again.”

Inez exemplifies many nursing home residents who are bound by routines, diets, and treatments prescribed by the nursing home where they live.  Also, residents like Inez’s roommate are unable to advocate for themselves because of cognitive, medical, physical, or financial limitations.  In the U.S. two-thirds of nursing homes are investor-owned for-profit institutions.  In the United Kingdom, where Inez’s 95-year-old brother and sister-in-law reside, more than half of the healthcare beds that belong to independent nursing homes for older people are operated by for-profit institutions.  In America older adults still prefer to ‘age in place’ at home; only 5-6 % of older adults require a nursing home residence.

1) Imagine you are a social worker at a nursing home. What sorts of programs and initiatives do you think would be most important to implement in order to improve the morale and overall health of the home’s residents? (Keep in mind that you would likely have a very limited budget.)

2) Inez is fortunate not to be dealing with any degree of dementia or mental deterioration. What sorts of things might be more important for the health and mood of a resident like Inez as opposed to some of the other residents? 

3) What would it be like for you to work in a nursing home? What would be difficult, and what would be rewarding?