You are a social worker intern in a regional hospital. You have been called into the emergency room by a nurse supervisor to talk with Mrs. J., an 80 year old widow who is hard of hearing. The nurse, while leaving to respond to another emergency, asks you to “deal with this senile patient”. The nurse continues to complain about all the seniors that come into the ER for the last six months and further says; “They should be sent to rest homes where someone can watch over them”. She kicks Mrs. J’s chair on her way out.
Mrs. J. is sitting in a chair besides her 55-year son, Mr. P., who brought her to the emergency room. Mr. P. has been living in his mother’s apartment for the past six years, moving in when his wife left him. He has a history of mental illness and heavy drinking. He has been unable to hold a steady job for the past 10 years. He tells you that he needs some training and work to help himself. Currently, Mrs. J. cooks, cleans, cares for his needs, and supplements his income. She tells you that her cupboards are empty and struggles every month to put food on the table. She also reports that her home is falling apart on her. “The window in my bedroom is broken…I can’t hold on to anything in the bathroom…I keep slipping…I want to stay in my home until I die”.
Mrs. J. is disheveled and has visible bruises on her face and arms. You learn from a medical school resident that she is waiting to have her broken right wrist set. You greet Mrs. J. and ask what happened and Mr. P. answers for her. He says he found his mother after she had fallen off a chair when trying to change a light bulb. As he reports the incident, Mrs. J. is silent and has no response. Mr. P. tells you that both the hospital intake worker and emergency room nurse admonished her for climbing on a chair, saying she should have known better. Mr. P. states, “She’s always running after that damn kid like if it is hers…my sister needs to find herself another babysitter!”
Mrs. J. looks away. She looks confused and tells you that she couldn’t find her Medicare card when the intake worker asked for it. She says she can’t remember whether she took her purse with her when she left home. She remembers paying for the bus fare and doesn’t know if she left it on the bus. She asks you, “Do you know about any bus or transportation services that cost less than what I pay now?”
When Mrs. J. is taken into an examining room, Mr. P. insists on accompanying her. She begins an agitated monologue that does not seem to make sense. Mr. P. explains to you that her behavior is typical and there is no point talking with her. He will answer any questions. Mrs. J. becomes increasingly agitated.
While Mrs. J. is being treated, you leave to confer with the intake worker who informs you that Mrs. J. has been to the emergency room twice in the last six months. She has another family member who wants information on how you could help in facilitating a family meeting to discuss caregiving and housing issues. Mrs. J calls out to her youngest grandchild and tells him that she will be home soon to watch him while mommy is at work. She continues to say to him, “I miss you Johnny…have you eaten?…come give me a hug”.
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FIRST SECTION: Each correct response is worth up to 1 point for a possible 5 points in total! Use a separate piece of paper to write your responses on a word doc or handwrite as desired.
As a social worker or other mandated reporter, where might you start to intervene/advocate on Mrs. J.'s behalf if hospital staff behavior is questionable?
If other staff is unwilling to report any suspicious behavior or observations about the client or family members, what formal action should you take?
Name the agency that you should contact and telephone number you will call to seek counsel or file a formal report?
What type of consequences exist if you don’t seek counsel or report and or the abuse leads to a high risk, dangerous or deadly incident?
What are other matters you should assess in this case
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