Reference no: EM133878766

Respond to a colleagues and explain how their assessments reflect the NASW Code of Ethics. Include two values and/or guiding principles to support your explanation.

Magda is an 81-year-old widow who had been living on her own until recently. She was active in her community and church and maintained close relationships with her family. She was fully independent and did not require assistance with daily activities. However, her circumstances changed significantly after she experienced a fall that led to a hip fracture, requiring surgery. Since then, she has been dealing with ongoing pain and has also been diagnosed with early-stage dementia. These changes in her health and lifestyle have occurred rapidly over the past five months. Along with her dementia and chronic pain, these issues put her at risk for depression. Depression is a common issue among older adults, but many do not receive help from mental health professionals. Brandell (2020) explains that older adults often hesitate to seek treatment, partly due to stigma and a strong belief in self-reliance.

Magda's son, John, and his wife, Helen, initially arranged for a dependable caregiver to support her, and things were going well. However, the cost of this care became unsustainable. As an alternative, they decided, without consulting Magda, to have their adult son, Alec, move into her home. Alec has a history of substance abuse and legal troubles. Magda was distressed by the sudden loss of her caregiver and began to feel like a burden. She remained optimistic about the situation, hoping to regain some independence. Helen allowed Alec to assume the caregiving responsibilities to give him employment and reduce the financial strain of Magda's care despite being aware of the risks due to his troubled past. While John and Helen support Magda, they lack the financial resources, time, and understanding to take on full-time caregiving. After Alec stole from Magda two times, Helen was left to take over as her primary caregiver. However, she often leaves Magda alone for extended periods during the day.

Physical well-being and health: Magda, 81, is a widowed woman whose health declined after a hip fracture five months ago. She now experiences chronic pain, reduced mobility, and early-stage dementia, affecting her memory and judgment (Walden University, 2022.). Once independent, she needs daily support.

Psychological well-being and health: Brandell (2020) suggests that individuals are often raised to value independence, and losing that independence can have significant emotional and psychological consequences. Even when support is clearly needed, individuals may resist accepting help or do so reluctantly. The experience of dependency and reliance on services can lead to feelings of inadequacy, resentment, and anger. Magda reports experiencing sadness and perceives herself as a burden to her family. The decision to alter her living arrangements was made without her input, leading to emotional distress. Although she initially expressed hope regarding her grandson Alec's involvement in her care, the lack of consistent support and his subsequent behavior have contributed to feelings of isolation and diminished self-worth (Walden University, 2022.).

Social Domain: Before her injury, Magda maintained an active social life, regularly attending church services and family gatherings. Following her surgery and resulting decline in mobility, her level of social engagement has significantly diminished. Her relationship with her daughter-in-law, Helen, has remained generally supportive, though it has become strained under the pressures of increased caregiving responsibilities (Walden University, 2022). While Magda initially shared a positive bond with her grandson Alec, his recent actions and behavior have likely negatively impacted this relationship.

Environmental Domain: Magda currently resides in a suburban apartment. While some support is present, the living environment has become increasingly unstable and potentially unsafe due to Alec's behavior. Significant concerns have been raised regarding financial exploitation and improper medication management (Walden University, 2022.). In response, Helen has taken steps to reduce these risks, including securing Magda's valuables and increasing the frequency of her visits.

Cognitive Capacity: Magda has been diagnosed with early-stage dementia and is exhibiting signs of cognitive decline, including confusion and short-term memory impairment (Walden University, 2022.). Specific concerns include misplacing medications and failing to notice missing personal items. Her ability to independently manage medications and finances is compromised, increasing her vulnerability to potential neglect and financial exploitation. According to Hopper et al. (2023), the biopsychosocial model of dementia suggests that cognitive functioning is influenced not only by biological and physical health factors but also by psychological and social influences, all of which contribute to cognitive health and dementia risk.

Ability to perform ADLs: Magda requires support with ADLs, particularly in medication management, meal preparation, financial tasks, and transportation. Her recent cognitive decline, paired with chronic pain and limited mobility, has significantly reduced her ability to manage these tasks independently.

Assessment of family caregivers:

Helen has taken on most of Magda's caregiving duties, including preparing meals, managing medications, cleaning, and handling finances. This role has placed a heavy emotional and financial burden on her, especially as she tries to balance caregiving with her household responsibilities. Support from other family members is limited. John is mainly withdrawn, and Alec, though he initially intended to help, has relapsed and is now taking advantage of Magda financially. His presence in the home has added stress and created an unsafe environment.

Supporting Magda's Self-Determination

To support Magda's self-determination, involving her in decisions about her care and living arrangements is essential, as well as using clear communication and offering choices that reflect her values and preferences. Social workers should advocate for their voices to be heard, particularly regarding personal matters and future planning. According to Brandell (2020), a social work perspective that emphasizes understanding individuals within the context of their environment is valuable in helping people address challenges in creative ways while identifying supportive resources and systems. Creating a safe environment that encourages independence, such as using assistive tools and supporting social engagement. Monitoring for potential exploitation, especially from family members like Alec, is critical. Finally, empowering family caregivers with education and resources can help them respect Magda's autonomy while ensuring her safety.

Questions for Magda

How have things changed for you since your fall and surgery?
How do you feel about the support you are receiving now?
What are your biggest concerns or fears now?
What would help you feel more independent or comfortable at home?
Who do you trust the most when making big decisions?

For Healthcare Providers

What is your clinical impression of Magda's cognitive and functional status?
Have any observed changes in her behavior, mood, or cognitive abilities?
What medications is Magda currently prescribed, and are there any concerns regarding adherence or side effects?
Given her physical and cognitive status, do you think Magda is safe at home?
Are there any resources or support that are recommended based on her current health and recovery status?
Is there any indication of neglect, abuse, or exploitation that should be further investigated?

Questions for Helen and John

What changes have you observed in Magda's behavior or physical abilities over the past few months?
How are you currently managing the caregiving responsibilities, and how is it affecting you personally?
Do you feel adequately supported in your role as a caregiver?
Have any incidents or concerns at home that need further attention or support?
What are your thoughts on Magda's current care arrangement? Do you feel it is sustainable and appropriate?

Questions for Alec

What is your understanding of your role in Magda's care?
How do you think your presence has impacted Magda's well-being?
Are you open to support services?
How can you rebuild trust with your family and contribute to a safe environment?