CASE 2 Agnes and Mark Thomas are

CASE 2 Agnes and Mark Thomas are 83 and 84 years of age, respectively. They have four adult children and eight grandchildren; all live within 25 miles of the couple. Mrs. Thomas likes the family to have dinner together at least twice a month at her home. Over the past six months, her children have noticed that their mother often forgets her grandchildren’s names. Mr. Thomas, a retired firefighter and once avid swimmer, has arthritis in his spine, which has decreased his mobility. The Thomases’ elder daughter, 58-year-old Arlene, is developmentally delayed and has lived in various state-run residential facilities since she was 5 years old. Arlene’s siblings had little contact with her when she was growing up except on birthdays and holidays. Recently, the director of the facility sent the Thomases a letter to inform them that the state is closing the facility and that they need to find housing for Arlene. Laura, a nurse from the residential facility where Arlene lives, phones Agnes to arrange a home visit. Agnes tells Laura that Arlene cannot live with her and Mark, and she asks Laura to talk to her youngest son Jim, 47 years old. Although Jim has had minimal contact with his sister, he agrees to meet with Laura. He tells her that his parents’ health is declining, especially his mother’s, and proposes that Arlene might be able to move into the in-law apartment in his home. Jim and Laura arrange another meeting that includes Arlene, as well as Jim’s wife and their adolescent twin daughters. Laura arranged a meeting at Jim’s home with his family, Arlene, and Nancy, the social worker assigned to the case. Jim took everyone to see the new facility. Arlene would eat breakfast and lunch at a day program from 7:30 to 4:00 on weekdays and have dinner with the family. Arlene was unhappy with the plan because she does not want to leave her “home.” Jim’s daughters were also upset about their aunt moving into their home and said their life will not be “normal” anymore. Later that week, Laura phoned Jim and Liz to tell them that several vacancies have opened in a residential community. Several of Arlene’s friends are moving there. Although Arlene would receive a small subsidy to move into the facility, the family would have to pay approximately $2,000 a month for expenses. Jim wants to talk to his sisters, especially because their parents’ health is declining. The elder Thomases receive homemaker services through their town’s council on aging. Mrs. Thomas’s dementia is advancing, and she might need placement in an Alzheimer care facility. Mr. Thomas receives a monthly pension, and his savings are limited. The three Thomas siblings have had difficulty trying to agree on care arrangements for both their parents and older sister. The elder of the two, Marilyn, 55 years old, strongly opposes placement. Their sister Alice, 50 years old, is relatively indifferent. Use the Calgary Family Assessment and Intervention Models and 15-Minute Family Interview as guides when thinking about your responses to the following questions: Describe strategies for an open conversation at a family meeting. How would the nurse intervene in the cognitive, affective, and behavioral domains (to provide information, address feelings and emotions, and identify needed actions). What are the family caregiver issues related to Arlene and Mrs. Thomas? How can the nurse assist the family with distributing the tasks, and assuring quality care? Identify the factors that will affect the Thomas siblings’ decisions about placement for their mother and sister. What approaches could help the Thomas family learn about possible placement options? Identify social factors that might influence the Thomas family’s decision-making. What type of community resources could help the Thomas family cope with care and financial issues? How would you support Arlene during the decision-making process?

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