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Module 6: Application Paper 3: Practice in Context in a Geriatric Health Setting Purpose The purpose of this assignment is to promote critical thinking and for students to demonstrate medical social work practice skills, use of theories, knowledge of appropriate medical social work interventions, ability to identify the role of culture, and the ability to identify/predict medical outcomes based on using the Health Beliefs Model (HBM). Course Outcomes CO 4: Examine the application of social work interventions with vulnerable populations coping with acute, chronic, and terminal illness. CO 5: Examine ethical decision-making regarding diagnosis and treatment of illness and end of life decision making. Points 500 This assignment is worth a total of 500 points. Due Dates 8/8/21 Case Study - The Case of Erma: Erma is 58 y/o African American female. She is a devote Christian and has a very high-level of faith. Erma attends church regularly and openly professes her love for God and her belief in his powers. She has several comorbidities and primary diagnosis of end stage renal disease and has been on dialysis for approximately two years. Erma is fairly noncompliant with her treatment regimen and picks and chooses what medications she will and will not take. It is approaching flu season and all dialysis patients, including Erma have been educated on the risks associated with ESRD and on the importance getting the flu vaccine. Erma is well aware that ESRD makes her a high-risk patient and that getting the flu can be deadly, yet she refuses the vaccination. Erma reports that she is “protected by angels” and that getting a vaccination is not necessary because the “angels” will prevent her from getting the flu. Erma’s family is very upset that she is not compliant with her dialysis treatment regimen, especially as it relates to get the flu vaccine. Her adult children report that at home Erma is very forgetful and she’s “aloof”. Her children further explain that early onset dementia runs in their family and that Erma’s mother suffered from Alzheimer’s Disease. They also report that they do not think their mother understands the risks of not taking the flu vaccine, because she is “not at herself”. Erma’s husband, Joe (63 y/o African American male) is very loving and very supportive of Erma he brings her to all her dialysis appointments, cooks for her, and is her best friend. Joe believes that their children are too hard on Erma, and he understands why Erma does not want to take a flu vaccine. Joe reports that his children are from a different generation and that they rely too heavily on medication. Joe explains that “medicine is not the cure” and that “more people need to put their faith in God.” Joe further explains to the social worker and the nephrologist that the flu vaccine is “unhealthy”, it gives people the flu, and that he does not want doctors “experimenting” on Erma. Erma’s nephrologist is appalled and wants the MSW to contact Adult Protective Services because Erma is risking her health and potentially her life by not getting a flu vaccination. This Assignment will be graded based on your response to the associated case. You are expected to read the case and to critically apply the Practice in Context Framework to the case as well as other applicable medical social work models/frameworks and the NASW Code of Ethics. You will also be graded on your use of citations, use of Standard English grammar, sentence structure, and overall organization/effectiveness based on the required components as summarized in the directions and grading criteria/rubric. 1. Create your paper using Microsoft Word. 2. Follow the directions and grading criteria closely. Any questions about your assignment may be posted under the Q & A Forum. 3. The length of the paper is to be no less than 5 pages pages excluding title page and reference pages. And any words from the reading material 4. APA format is required with both a title page and reference page. Required Textbook Reading McCoyd, J. & Kerson, T. (2016). Social Work in Health Settings: Practice in Context. (4th ed.). Routledge · Chapter 19: In-home support for Junior: a study of collaboration, boundaries, and use of self · Chapter 20: Geriatric social work in a community hospital: high-touch, low-tech work in a high-tech, low-touch environment · Chapter 21: A framework for working with people with early-stage dementia: a relationship-focused approach to counseling · Chapter 22: The future of end-of-life care as palliative care gains momentum, what is the future of hospice? Required Journal Readings Diffin, J., Ewing, G., Harvey, G., & Grande, G. (2018). Facilitating successful implementation of a person-centred intervention to support family carers within palliative care: a qualitative study of the Carer Support Needs Assessment Tool (CSNAT) intervention. BMC Palliative Care, 17(1), N.PAG. https://doi.org/10.1186/s12904-018-0382-5 (Links to an external site.) Wladkowski, S. P., & Wallace, C. L. (2019). Current Practices of Live Discharge from Hospice: Social Work Perspectives.Health & Social Work, 44(1), 30-38. https://doi.org/10.1093/hsw/hly040 (Links to an external site.) Optional Readings Bybee, S. (2018). Vicarious Posttraumatic Growth in End-of-Life Care: How Filling Gaps in Knowledge Can Foster Clinicians' Growth. Journal of Social Work in End-of-Life & Palliative Care, 14(4), 257-273. https://doi.org/10.1080/15524256.2018.1498820 (Links to an external site.) Hall, J. K. (2018). End-of-Life Resource for African American Caregivers: Reflections on a Field Education Model. Journal of Social Work in End-of-Life & Palliative Care, 14(4), 248-256. https://doi.org/10.1080/15524256.2018.1487901 (Links to an external site.) Hovland, C. (2018). Welcoming Death: Exploring Pre-Death Grief Experiences of Caregivers of Older Adults with Dementia. Journal of Social Work in End-of-Life & Palliative Care, 14(4), 274-290. https://doi.org/10.1080/15524256.2018.1508538 (Links to an external site.) McCormick, A. J., Becker, M. J., & Grabowski, T. J. (2018). Involving People with Memory Loss in the Development of a Patient Handbook: A Strengths-Based Approach.Social Work, 63(4), 357-366. https://doi.org/10.1093/sw/swy043 (Links to an external site.) Piercy, H., Fowler, D. S., Dunham, M., & Cooper, C. (2018). Evaluation of an integrated service delivering post diagnostic care and support for people living with dementia and their families. Health & Social Care in the Community, 26(6), 819-828. https://doi.org/10.1111/hsc.12592 (Links to an external site.) The "graying of America" is a term that is used to describe the "phenomenon of a larger and larger percentage of the population getting older and older" (Lumen Sociology, 2020). Americans are living longer, and the life expectancy of Americans is rapidly increasing from year to year. It is estimated that by "2050, the number of people 65 years or older is expected to significantly outnumber children younger than 5 years of age" (Garza, 2016). Although, with that longevity comes complex health issues such as cancer, dementia, increased falls, obesity, and diabetes (Garza, 2016). These health conditions will be exacerbated by age and several other social determinants of health such as disability status and income, and will ultimately cause several challenges for the healthcare system. Those challenges include: · Increased need for long-term care · Decrease in family caregivers · Instability of Medicare and other federal programs · Limited resources · Increase in chronic conditions/comorbidities · Increased costs for medical care. Taking into account the challenges that older patients will face when accessing the healthcare system, social workers in healthcare settings with older adults are in a prime position to impact change for older and assist with them getting the highest quality care possible and having the highest quality of life. Social workers working this special population of patients will be expected to intervene on all levels (micro, mezzo, and macro). Interventions will include: · Interdisciplinary collaboration/treatment planning · Advocacy · Educating patients, patient's families/caregivers, and the community/larger society · Developing and facilitating prevention programs · Facilitating advance care planning · Mediation and crisis intervention · Identifying elder abuse · Facilitating nursing home/long-term care placement. Social Work Practice with Patient’s who have Dementia/Alzheimer’s Disease Older adults are impacted by several health conditions, although dementia is a primary health condition, that is highly complex and highly common among older adults. Despite its commonality among older adults, it is not a normal part of aging (WHO, 2020) Dementia is simply defined as a loss of brain function that affects an individual's memory, thinking, language, judgment, and behavior (Allen & Spitzer, 2015). Whereas, Alzheimer's is a progressive disease categorized by the gradual worsening of dementia symptoms over time to the point where the symptoms become debilitating (Alzheimer's Association, 2020). Alzheimer's disease is a type of dementia and is the most common cause of nursing home placement for older adults. Dementia/Alzheimer's not only impacts the patient but it impacts the entire family. In fact, dementia/Alzheimer's "has a physical, psychological, social, and economic impact, not only on people with dementia, but also on their caregivers, families, and society at large" (WHO, 2020). It is estimated that approximately 50 million people worldwide have dementia and that there there are approximately 10 million new cases annually, and that Alzheimer accounts for about 60-70% of all dementia cases (WHO, 2020). Considering the prevalence of dementia/Alzheimer and the complexity of this health condition; it should be not surpise that patients impacted by this health condition often have frequent contact with the healthcare system through various access points, and require specialized medical care. Therefore, treatment planning for a patient with dementia/Alzheimer's is very complex, and should be interdisciplinary. Interdisciplinary treatment teams serving these patients benefit from the expertise of a medical social worker that understands aging, family systems, and the psychosocial impacts of dementia/Alzheimer's on a patient's life and overall quality of life. Transcript Therefore, healthcare/medical social workers working with patients and family impacted by dementia/Alzheimer's must be equipped to conduct a thorough biopsychosocial-spiritual assessment that is likely built thorough collateral reports from the family/caregiver because the patient may not be a good historian; and prepared to intervene in the following ways: · Reminiscence Therapy- working with patients to recall and communicate memories of past experiences and important life events/milestones · Assisting the patient and family/caregiver with identifying and making modifications to the patient's environment as alternative to psychotropic medications · Educating the patient and family various medical options such as the medication Aricept and encouraging the patient and family/caregiver to discuss a feasible treatment regimen with the patient's medical doctor; and educating the patient and family/caregiver on resources (Allen & Spitzer, 2015). · Nursing home/memory care placement · Addressing issues related to Power of Attorney (POA) and end of life care/directives