Reference no: EM133180454

Will is a 93-year-old retired dairy farmer and is recently widowed. He continues to live on the farm which his nephew now manages. His nephew is physically on the farm for several hours each day, however, does live within a mile of Will's farm. His three daughters call him daily to check on him. Recently, the daughters have discovered that the information shared with them by Will on a daily basis does not seem to be consistent with what is observed by the nephew. Additionally, Will's bank notifies the eldest daughter that he comes in daily to check on his accounts. Frequently Will seems confused about the amount in his savings. On occasion, Will has even become angry when he is told about the savings account. Historically, Will has been very pleasant and polite and very intune to his finances. His first career was as an accountant. Will's nephew expresses concern that Will is now accusing the farm staff of stealing from him (the nephew) despite lack of evidence.

The daughters take their father to his internal medicine physician for a physical assessment. Will is given the diagnosis of Lewy Body dementia and suggests that Will should move into a more structured environment such as an assisted living environment. After review of the local facilities, Will determines that he wants to move into the facility that has historical connections with his Lutheran church. Will agrees to be admitted to a studio apartment with a meal plan since he has never cooked for himself.

Upon admission to the facility, Will is very clear to his daughters and staff that he does not wish to be resuscitated should his heart stop nor does he want any significant medical intervention. In addition to his Lewy Body dementia, he has glaucoma and is extremely hard of hearing. His only medication is an eye drop which he self-administers. Will is physically mobile and enjoys walking outside. On the farm he walks several times per day, often a mile at a time. Will adjusts well to his new environment but refuses to participate in any of the activities. His only activity includes going for walks outside multiple times per day and going out with his daughters two or three times per week.

The staff notice that Will seems to be losing weight and they often find spoiled food in his garbage during their weekly cleaning. The dietary aid informs the team that Will takes food from the dining room stating that he is not hungry at meal time. The cleaning staff also note that Will is washing his clothes in the shower and then attempting to hang his clothes to dry in the bathroom and over his furniture causing the floors to become wet and slippery. He refuses to use the community laundry facilities because it costs too much even though it is free to use these amenities. (Will lived through the depression era and often expresses concern about his finances.) The housekeeping staff also notice that his eye drop bottles which still contain medication are in the garbage.

At a routine care conference with the patient and his daughters, the staff express concern that will has gotten lost on occasion on his outside walks. In fact, the neighbors have expressed concern since he has been seen walking several blocks away from the facility. On one occasion, he even walked to his church which is over two miles away. The daughters are adamant that their father be allowed to continue to walk outside. They state they are aware of the risks of these independent walks but it is his only recreation.

Some of the issues that should be considered by the patient and the family and the treatment team:

• Is the present environment safe or does it need to be changed? If so, what type of care is needed?
• What interventions can be used by the staff and family to help Will remain as independent as possible in light of his Lewy Body Diagnosis?
• Is palliative care appropriate? Is hospice appropriate?
• How will Will finance his care?
• Are there regulatory bodies that will influence Will's care?
• What are some of life's milestones that Will and his daughters will face?
• Does Will have specific transportation needs?
• Other concerns/issues?

3. Once you have evaluated the care needs of Will (identified in number two), consider how these needs can be met if the specific location you have selected. For instance, if your assisted living facility has other levels of care, this may be an option. If not, are there additional services that can be brought into your assisted living to meet Will's needs? Or are their other facilities that will better meet Will's needs? A table format may be helpful to succinctly demonstrate how each identified service need (as identified in the second bullet) will be met.