Depending on the case study, George and Shirley are already old. This means that they lack the strength required to manage their lives appropriately. Therefore, even though the couple seems okay, there is a need for more specialized care or assistance to manage the condition appropriately. Shirley’s condition keeps deteriorating, and her husband could get overwhelmed, especially when Shirley finds it difficult even to remember him. The worse she becomes, the more the responsibilities. Therefore, quick action is required to ensure that the couple has the amount of care and provision to help manage both the emotional and physical requirements of the couple.
As a social worker, I would give several recommendations. First, it would be appropriate to conduct a thorough assessment of the couple’s needs. Since they are old, they may lack adequate resources to cater for their physical and emotional needs (Ives et al., 2020). They both have different needs, which could become easier to manage when catered for the condition. For instance, Shirley’s condition gets worse from time to time. She cannot remember the names of her close relatives, and she has also forgotten about her cat, which keeps her motivated when around. At the same time, her husband seems to start getting overwhelmed by the situation. When Alana visits them on the weekend, he is devastated that she failed to visit them as usual, and he also gives Shirley all her pills for both Saturday and Sunday for one day. This shows they need someone to stay with them always, or at least be with them for some part of the day or take them to a care facility. This would help them deal with the stress and anxiety associated with Alzheimer’s disease.
George and Shirley have several strengths that a social worker can use to help them. Although taking care of Shirley is difficult, George’s determination enables him to handle all the roles at home, including taking care of his wife. This shows that he is not only dedicated but also resilient. On her part, Shirley still maintains her gardening passion which gives her heart joy and keeps her engaged. Therefore, these strengths would help me identify the appropriate care resources to offer them support. For instance, available local support groups or gardening programs that support such people would help improve the life quality of the couple.
Additional care would involve connecting the couple to a professional therapist to help with the symptoms and signs of Alzheimer’s. Offering guidance on managing the changing symptoms could make the condition more manageable. Still, having a homecare assistant would ensure George has some breaks, enabling him to manage his wife appropriately. This could be facilitated through their children offering enough financial care or calling them regularly to remain in touch for a long.
The approach would be different if the couple were experiencing poverty instead of wealth. Since there are inadequate funds to support the couple, government programs or charity organizations could be appropriate. This means the couples would receive more support through food, transportation and free medication services. Such organizations could also provide free counselling sessions to the family, which would help them avoid the stress and depression associated with managing the condition. As a result, they would still enjoy high life quality.
Theoretical approach
I would use the Person-Centered Approach and the Psychodynamic Theories in the case study. In the Person-Centered theory, the social worker helps the clients to realize themselves by encouraging them to strengthen what they have. A social worker who employs the Person-Centered Approach would primarily emphasize establishing a secure and encouraging atmosphere within which George and Shirley would be allowed to express themselves openly. In contrast, the social worker listened empathically and without passing judgment (Ives, Chapter 2 ). In addition, the social worker’s primary focus would be developing a solid therapeutic relationship with George and Shirley founded on trust, respect, and genuineness between all parties involved.
In this scenario, the Person-Centered Method might assist George and Shirley in experiencing a greater sense of being heard and validated. It would be helpful for George to have a place where he can voice his thoughts and concerns without fear of being judged or coerced into choosing if he does so. It would require an individual to regularly listen to her endless stories, even if she keeps repeating the same stories every time. For instance, having Alana visit them more regularly and listen to her stories without getting tired or offended by the fact that Shirley keeps forgetting her name every time they meet. This theory perspective could help improve the overall mental health of the couple. However, this theory has some limitations as it requires the clients to be quite aware of themselves and have a certain mental functioning level. Therefore, while the theory could help George easily manage his life, it would be difficult for Shirley as she keeps losing her mind and her condition worsens. It would still be difficult to handle the couple’s goals, especially when giving Shirley her medicine at the right time or amount.
According to psychodynamic theory, a person’s unconscious mind can influence how they carry themselves or respond to issues. As a social worker, this theory would help to understand the past experiences of the couples (Stokes Chapter 2). The couple seems to have a deeper attachment in the past, which could be associated with their experiences when they were okay. Therefore, understanding their attachment and relationship can help in assisting them. The experiences could help to understand their inner feelings, especially for George, who seems more stable mentally. Some feelings that would help in this case could involve security and trust. There could be possible reasons that make George want to remain with his wife and avoid any talk that would touch on taking Shirley to a facility. It could be possible that George is too determined to take care of his wife because of fear of having her taken into a care facility. Still, the worry that Shirley has could result from maybe past traumatic experiences or events that may have contributed to her current condition she has at present. The couple’s kids could play a significant role in ensuring that their parents’ feelings and behaviour have a source, and therefore they would be patient with them and respond to their needs with less stress. This theory has some drawbacks as it demands a lot of time to achieve the set goals for the couple. Still, the theory could be more practical as Shirley has cognitive challenges, and George must also remember some issues.
The most appropriate theory for George and Shirley is the person-centred approach. This is because the theory offers more support in terms of therapy being provided. This theory can help create empathy with the client and offer the required emotional support. The strategy would help employ their strengths to empower their positive experiences and thus make life more manageable or bearable. The approach would also help the social worker identify and connect the clients with reliable support groups for physical, emotional and resource provision as part of providing the required care to them.
Ethical dilemma
In this case study, the ethical dilemma would involve deciding between honouring or going against the decision George makes regarding having Shirley remain at home even with her deteriorating condition. The fact that Shirley’s condition keeps worsening over time could mean an increased risk of having her under her husband’s care, which also seems overwhelming sometimes. For instance, Shirley is fearful whenever her husband is away, which could make her want to look for him. Due to her mental condition, she easily forgets where she is and, as a result, gets lost. This would add more problems for George and his kids, who are not always at home. This means that unless there is always someone left in charge of Shirley, George will have to remain with her throughout, which could hinder him from accomplishing responsibilities outside the home compound. Therefore, as a social worker, it is appropriate always to make decisions that will promote the client’s overall well-being regardless of the stabling blocks that seem to be challenging the entire process (CASW Code of Ethics, 2005). Regarding the case of George and Shirley, I am responsible for promoting good health and safety for the couple, which may demand I go against George’s choice to have Shirley remain at home. However, the process would involve several steps guided by the Social workers and the BCASW Code of Ethics.
BCASW requires social workers to remain responsible for strengthening and promoting the well-being of the people they serve, either individually or as a group (CASW guidelines for Ethical Practice, 2005). Also, the Code of Ethics for social workers demands that social workers make decisions whose main interest focuses on the client’s well-being (CASW Code of Ethics, 2005). Using ethical values, I would first organize for discussion with George to deeply evaluate the situation and listen to his side of the story. I will be able to know why George still wants to have Shirley at home, even though her condition is worsening. Still, I would get an insight into the challenges he could be going through regarding a healthcare facility.
If George still holds on to his decision, I would devise an alternative way to ensure that Shirley remains safe always. For instance, I would request George to devise a plan on how he would manage Shirley and ensure she remains safe as expected. The plan could incorporate regular checkups to ensure everything happens as planned. Additionally, I would involve Alana in the process and discuss how we could cooperate with her to ensure adequate care for her parents. Connecting them with the community support groups would facilitate the effectiveness of the entire process. Also, I would ensure regular meetings with Alana and George on appropriate patient care. Still, I would have a record of the conversations with the parties to show the steps involved in arriving at that decision. This shows that balancing Shirley’s health and respecting George’s decision is a complex task which requires social workers to be adequately equipped with social work code of ethics to ensure the most recommendable results.
Discussion Question
- How might George and Shirley’s cultural backgrounds and values influence their perception of Shirley’s illness and appropriate care? How can social workers ensure that their interventions are culturally responsive and respectful?
- Should Alana have contacted a seniors centre without George’s consent? What ethical considerations should a social worker consider when dealing with situations where family members disagree on the best course of action for a client?
- How can a social worker navigate the tension between supporting George’s desire to care for Shirley at home and ensuring that Shirley is receiving the necessary medical and emotional support?
- Despite the distance, how can a social worker engage George and Shirley’s family members who live in Alberta in the caregiving process? What role do remote interventions and technology play in supporting older adults and their caregivers?
References
CASW Code of Ethics 2005
CASW guidelines of for Ethical Practice, 2005
Ives, N., Denov, M., & Sussman, T. (2020). Introduction to Social Work in Canada: Histories, Contexts, and Practices (2nd Ed.). Don Mills, ON: Oxford University Press
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