A Social Work Case Study

¶ … patient suffering from several mental health issues including dementia has recently been discharged from a medical facility prematurely. The patient has been sent to a homeless shelter that offers no ambulatory or out-patient care, and no continuity of care program has been offered by the patient's medical team. Because the patient is indigent, he has no recourse.

Ethical Principles

The primary concern for the social worker is the patient, and ensuring that the patient's current home status is safe. In this case, we have assessed the conditions at the homeless shelter and have identified several problems related to the safety of the shelter itself and the ability of the shelter to provide what the patient needs. For several years, this patient has been unable to properly care for himself. He does not practice good enough personal hygiene on his own and needs daily assistance in this regard. He does not eat properly and likewise needs assistance preparing his meals. In fact, recently his motor skills have deteriorated, he has lost several more teeth, and has proven some difficulties swallowing. All of this points to underlying issues that the medical care team has yet to fully address, as they have discharged the patient prematurely because the acute presenting factors had been resolved in critical care and emergency units. Therefore, this case illustrates what Wickersham (2007) identifies as the core differences between the ethics of acute versus long-term care. With acute care scenarios, the immediate needs of the patient are the end result, whereas the long-term care goals require more different levels of ethical decision making.

Additionally, we have assessed the conditions of the homeless shelter and have recognized some concerns regarding its cleanliness and hygiene. The bed sheets and towels are the responsibility of the guests, and due to his dementia and other mental health and physical impediments, the patient has not been doing his laundry. The patient has no family members who check in on him regularly. He has a few acquaintances who also frequent the same shelter. Those friends care about the patient but are not close enough to him to provide him with additional support. The patient needs medications, and has not been taking them regularly. It is our belief that the patient needs to be placed in a more suitable assisted living or in-patient setting in which proper care and therapy can be provided.

An integrative approach is strongly recommended in cases like this involving patients with dementia, who cannot necessarily speak for themselves cogently and who have no immediate family who can do the same (Johnson & Karlawish, 2015). In cases like this, the social worker can resolve the issue by focusing on the core elements of protecting the dignity and worth of the person, which we believe is not being addressed either by the homeless shelter or by the medical care team (NASW, n.d.). Moreover, the NASW (n.d.) recognizes the value of human interpersonal relationships as being integral to the long-term care needs of this and other patients; it is our ethical obligation to provide for the social and psychological support that the patient currently lacks: "Social workers understand that relationships between and among people are an important vehicle for change. Social workers engage people as partners in the helping process," (NASW, n.d., "Ethical Principle: Importance of Human Relationships").