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HCMN 413 â€“ Case Study Analysis
Please review the facts in this case in light of what we have learned in this class about Services and Housing for the Long-Term Care Consumer, and provide answers to each question (40 points each; 200 points for the Case Study Assignment)
Honor Thy Elders: The Case of Linh Nguyen
Linh Nguyen immigrated to the US in 1975 after the end of the Vietnam War when she was 20 years old. She and her husband, a doctor and prominent member of the South Vietnamese government, were among the first boat people from Vietnam who fled their country for fear of persecution. When Linh and her husband first came to the US, it was difficult for them to find work despite her husbandâ€™s medical degree. He was able to find work as a medical technician in a local hospital, and Linh completed a course to become an LPN part-time in a local nursing home. Early in 2015, Linhâ€™s husband had a severe stroke while at work, and eventually passed away from complications. Linh was devastated by the loss of her husband of over 40 years and became severely depressed, leading to her resignation from her job at the nursing home.
Thu, Linhâ€™s daughter and a teacher at a local high school, became very concerned about Linhâ€™s depression, and asked her to move in with her after her fatherâ€™s death so that she would not be alone. Linh sold her home when she moved in with her daughter Thu, receiving approximately $400,000 from the sale. She also received $200,000 in a life insurance benefit when her husband passed away. Linh decided to collect her social security benefit when she turned age 62, which amounts to about $1500 a month. Because of the number of years that her husband worked at the local hospital, she was able to receive retiree health insurance coverage through his benefits, although she has to pay $650 a month to keep this coverage. Linh has discussed appointing her daughter Thu as her healthcare proxy to make medical decisions for her, but did not complete the paperwork.
Since the death of her husband in 2015, Linh has been living with Thu in a three bedroom home built during the 1950s. Linh sleeps in an upstairs bedroom (one flight of stairs up with one handrail on the right hand side of the stairs). She has her own private bathroom with a tub, toilet and sink. The home has a large backyard of Â½ an acre enclosed by trees and a fence, a large one car garage with a door that opens up to the backyard. The home is in a quiet neighborhood where the nearest public bus stop is a mile away. Their town has a walkability score of 12 points out of 100. Linh and Thu are active in their local Baptist church, which has a large Vietnamese-American membership. Linh and her daughter, who was born in the US in 1980, are both American citizens.
When Linh moved in with her daughter, her mood improved considerably during the first year, but she began to present with some physical health conditions. She received a diagnosis of Type II diabetes as well as hypertension in 2016. Linh was very reluctant to change her diet and stop her occasional smoking habit (about 5 cigarettes a day), which led to other complications with her vision including the onset of diabetic retinopathy. She started to have trouble sleeping and became very agitated in the afternoon when Thu would return home from work, and wandered away from Thuâ€™s home on two occasions, requiring the local police department to find her and take her back home. Thu is concerned that her mother may be developing dementia as she has shown occasional signs of short term memory loss and confusion. However, Linh has some good days and Thu felt that all older adults have some memory loss. Therefore, she did not take her mother for a diagnosis of this condition.
One evening, Thu returned home from work to find her mother at the bottom of the flight of stairs leading up to her bedroom. Linh had evidently fallen because of difficulty finding the handrail for the stairs. Thu took her mother to the emergency room of the local hospital where she was diagnosed with 3 broken ribs and a fractured collarbone, and admitted to the hospital for 3 days. Due to the fact that Thu cannot take off time from work to take care of her mother, Linh is sent to a local nursing home for rehabilitation and physical therapy. When she was admitted to the nursing home, Linh underwent a Brief Interview for Mental Status (BIMS) assessment when and had a score of 11, indicating that she was showing signs of neurocognitive impairment. Linh did well in her therapy sessions, but developed a urinary tract infection (UTI) and her BIMS score did not improve significantly. During a family care plan meeting in the nursing home, Thu was told that her mother was mostly likely in the early stages of dementia, but such a diagnosis would have to be confirmed with a psychological evaluation by a psychologist.
Thu was appreciative of these conversations with the staff at the nursing home, but remained steadfast that her role is to take care of her mother, and took her home after her physical condition became stronger. The ambulance company that took Linh home walked her up the flight of stairs to her bedroom.
Linh receives visits by a home care aide 3 times a week during the day. Linhâ€™s memory has continued to decline along with signs of paranoia. One evening, after Thu returned home from work, she physically attacked her daughter accusing Thu of keeping her a â€œprisonerâ€ in her home because she wants to inherit her money from the sale of her home and her life insurance from her husband.
Thu has become increasingly frustrated with her motherâ€™s medical needs, and mood swings. So that her mother is not alone while she is at work, Thu increases the amount of home care to 5 days a week for 4 hours a day. However, Linh continues to be agitated in the afternoons, and got into her daughterâ€™s car one evening, prompting a Silver Alert from the local police department for her return. Frustrated by her inability to control her motherâ€™s behavior, Thu calls a local skilled nursing facility 5 miles from their house and makes an appointment to take a tour and see the Administrator.
Case Questions (5 of them; each answer should be at least 200 words in length)
- What are Linhâ€™s current long-term care needs? Look at her living quarters, neighborhood in which she is located, family and social supports, sources of income and insurance, and make 3 recommendations for her future living needs. (Remember the information covered in your Home Fit Assignment to answer this question).
- Identify and briefly describe at least two programs that Linh could participate in that would help her daughter with her immediate daily caregiving needs, and why you chose those programs.
- How does caregiver stress impact this family? What types of problems could result with the interaction of Linh and her daughter (identify and describe at least two problems)?
- What cultural issues come into play with Thuâ€™s assessment of her motherâ€™s needs for long term care services and supports, as well as housing? Are these important factors, and how have they impacted your recommendations for Linh?
- Is Thuâ€™s decision to look at a skilled nursing facility a good residential option for her mother Linh? Are there other residential options that Thu could explore for her mother, and if so, identify 1-2 alternate options and the reasons for your recommendations.
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