Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
December 3, 2019
How might you target your questions for building a health history based on the patient’s social determinants of health?
December 3, 2019

***Each response needs to be ½ page or more***  RESPONSE 1Respond to two colleagues and explain how their assessments support the NASW Code of Ethics (2008). Include two values and/or guiding principles to support your explanation.Colleague 1: GradnetteMagda is an 81-year-old widow, she lives 30 minutes away from her son, John and her daughter-in-law, Helen. Six months ago, Magda appeared to be self-sufficient which means she was able to take care of her daily needs without the support of others. Recently, she experienced an incident where she fell and broke her hip. During her incident a tragic discovery was found that she had early signs of dementia. Since the incident Magda has been unable to care and provide for herself. She has had several caretakers; a church member of her son and daughter-in-law, Helen, and her grandson, Alec. Her daughter-in- law, Helen is the lead caretaker which means she takes on majority of the responsibility for caring after Magda. Outside of Helen, her son Alec insisted on helping her take on the responsibility for caring after Magda. Instead of properly caring for Magda, he causes her health to worsen as he misused her medication, robs her during several occasions, and leaves her unattended for a long period of time. After the incident; Helen had to go in to help Magda recuperate from the damage caused by Alec careless motives. As of now Magda only income is the support she receives from John and Helen. There have not been any signs of injuries to report from Alec living with Magda. It appears as Magda is aware of her surroundings and as of now Helen is her only care taker.The original assessment involving Helen and Magda.           The original assessment will consist of implementing a two month; twice a week family counseling session involving Helen and Magda. During the first session; I will have each participant state their feelings towards one another. Afterwards, I will have Helen state her thoughts towards caring for Magda. Once she gets done, I will have Magda discuss her feelings and thoughts towards Helen being her care provider. After hearing and documenting all discussion; I will next put in place a treatment plan whereas Helen responsibility for caring for Magda can be convenience. During the treatment plan; I will educate Helen on the responsibilities of caring for elderly. I will also recommend her to take some educational courses which will further educate her on caring for Magda along with the funding available. Next, I will educate Magda on the guidelines, responsibilities, and anxieties of a caregiver. I will also educate Magda on several agencies which provides support with medication and proper care. Afterwards, I will ask for Magda’s consent to conduct further research to see if she is eligible to receive senior assistance; if so, I will refer her to a home care agency. Overall, her compliance to this treatment plan will help take the burden and stress off Helen and the family.Questions I will Ask Magda:1. How would you consider your overall physical well-being and health?2. How much social support you receive from your family? Do your family fulfills your needs when you need someone to talk to or transportation?3. How often do you receive support from outsiders and family members when they visit you in your home?4. How are you able to perform everyday activities? Do you need any support to fulfill your everyday activities?5. Are you able to move around within your home and community without supervision?6. Can you complete your own house chores, prepare your own meals, and complete your own laundry?7. Are you able to take care of your own appearance without the support of others?8. How often do you take your medication? How many different kinds of medication do you take? What are the names of your prescribed medication?ReferenceChrist, G., & Diwan, S (2008). Chronic Illness and aging: The role of social work in managing chronic illness care. Council on social work education. Retrieved from: www.cswe.org/getattachment/Centers-Initiative/CSWE-Gero-Ed-Center/Teaching-Tools/Gero-Competencies/Practice-Guides/Assignments-Measurements/CI-Sec-Role-SW.pdf.aspxPlummer, S.B. Makris, S., & Brocksen, S.M.(Eds), (2014a). Sessions: case histories, Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader] The Petrakis Family(pp.20-22)Colleague 2: ChelsieAn assessment was completed on 81 year old Magda Petrakis after concern was expressed by Helen Petrakis  (Magda’s daughter in-law) regarding Magda’s health and well-being.To conduct the assessment, 7 different domains by Grace Christ & Sadhna Diwan (2008) were analyzed regarding Magda’s life including; 1)Physical well-being and health 2) Psychological well-being and health, 3)Cognitive capacity 4)Ability to perform various activities of daily living 5)Social functioning 6)Physical environment and 7)Assessment of family caregivers. When assessing Magda from the first domain, Magda overall is a fairly healthy woman for her age. However, Magda is at an increased risk for falling due to the lost of stability that occurs with increased age. Because of this, Magda recently encountered an event in which she fell and broke her hip, causing her health to begin deteriorating. While assessing Magda from the second domain of psychological health, it was apparent that her physical health and mental health co-existed. According to Paveza (2013), assessing the mental health of an elder individual is often the most important step during the assessment process because the social worker needs to be cautious that the information they are receiving is accurate. In Magda’s case, as a result of her fall, Magda begins experiencing early onset of dementia which has caused her to lose most self-sufficiency. During the assessment process, it was apparent that Magda’s cognitive capacity and ability to perform basic ADL’s was severely impacted by her dementia. Magda is now unable to comprehend how to pay her bills, cook her own meals, or even keep her medications in track. Magda does not have much social interaction due to being confined to her home most of the day but does speak with her caregivers daily which include her daughter-in-law, grandson, and a woman from church. It is apparent from the assessment that caring for Magda is taking a toll on her caregivers as Magda’s daughter-in-law has expressed a large amount of stress. Magda’s grandson has also been stealing money and medications from Magda. To include Magda in the assessment, I would ask Helen to bring Magda to a session with her. Because Magda is only experiencing early signs of dementia, she is most likely still able to answer questions regarding her health and well-being. If Magda was unable to present to the meeting, I would ask Magda if I could make a home visit where I would be better able to assess the situation. I would work closely with Magda to develop a safety plan to follow for when caregivers were not present and would work with Magda to look into assisted living facilities. During the assessment, to gain further insight into Magda’s current situation, there certain questions that would be important to ask. I would ask Magda questions such as ‘what care do you feel you need? Are you satisfied with the care you currently receive? What activities are you able to do without assistance? Have you thought about the idea of an assisted care facility? What activities do you engage in to keep your brain thinking?’ I would also ask questions to Magda’s doctors such as ‘What is the severity of Magda’s dementia? Are there activities that can slow the progress of Magda’s dementia?  Christ, G., & Diwan, S (2008). Chronic Illness and aging: The role of social work in managing chronic illness care. Council on social work education. Retrieved from: www.cswe.org/getattachment/Centers-Initiative/CSWE-Gero-Ed-Center/Teaching-Tools/Gero-Competencies/Practice-Guides/Assignments-Measurements/CI-Sec-Role-SW.pdf.aspxPaveza, G.J. (2013), Assesment of the elderly. In M.J. Holosko, C.N. Dulmus, & K.M. Sowers (Eds), Social Work Practice with Individuals and Families: Evidence-informed assessments and interventions. (pp177-195). Hoboken, N.J.: Wiley.Plummer, S.B. Makris, S., & Brocksen, S.M.(Eds), (2014a). Sessions: case histories, Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader] The Petrakis Family(pp.20-22)RESPONSE 2Respond to at least two colleagues by suggesting alternative strategies on a micro, mezzo or macro level.Colleague 1: ChristineThe quality of life for older individuals who are experiencing elder abuse largely decreases the quality of life in many areas. Typically, this can been seen in multiple ways as functional and financial status decline, limited self-reported health is evident, and possibly feelings of hopelessness and loneliness increase in regard to psychological distress. Research also suggests that older individuals that are abused tend to die earlier than those that have not been abused. With limit reports from individuals that are experiencing elder abuse it is difficult to weigh in how one is experiencing abuse. With consideration to this, there is no single pattern of abuse proving that there is a cycle of long-standing patterns to violent/physical abuse, and emotional/financial abuse within families and nursing homes. While performing assessments with someone that is suspected of elder abuse there are several attempts to secure accuracy in reported or non-reported cases. There are many signs/and or symptoms to be aware of as a service provider, for which these should prompt further investigation to determine and remedy the cause. Service providers working with someone experiencing elder abuse can approach assessment with the following cues: 1) Perform assessments while inquiry about risk factors. 2) Using effective tools to do this such as the Elder Abuse Suspicion Index. Which was developed to raise awareness to a level to which it may assist in further investigation. 3) Screen for cognitive impairment. 4) Understanding medical concerns and medications that individual is currently taking to know the difference and comparison of similar traits. 5) While performing assessments and screening; know that these should be separate from the caregiver (possible suspected abuser) and the person that is being abused. 6) Identifying your client for specific patterns of injury. Other factors to consider while performing assessments will weigh in the symptoms of: physical abuse such as; bruises, repeated unexplained injuries, dismissive behavior about injuries, and refusal to seek medical attention. Verbal and emotional symptoms can play a large role here while assessing the lack of social connections, the observation of isolation, and the lack of communication with outside resources. Sexual abuse can also go undetected as someone will experience bruising or an increase in diseases. The list of these symptoms can also weigh in on care that is received in nursing homes. Financial exploitation is also something to look at while inquiring about bank accounts and financial assets. Interventions toward elder abuse can happen on all levels to address. prevent, or stop abuse within the elderly. As the rights of of individuals must be guaranteed everywhere ending and creating possible solutions among the general public as well as authorities are needed. This can be approached with care toward programming while creating training opportunities for added caregivers within institutions. Setting up community programming that will open up social interactions and increase the level of participation. Building social networks for the elderly within housing units, and creating more programming toward self help options. On another level, supporting the abuser can go a long way while connecting one to mental health resources, providing more jobs and education, and creating new ways caregivers can resolve conflict. On a larger perspective (macro) institutions can provide policies and programming that can address work related stress, develop comprehensive work plans to hold employee accountable, while also improving the social and physical environment of the institution. Robert M. Hoover MD, University of Tennessee Health and Science Center College of Medicine, Detecting Elder Abuse and Neglect: Assessment and Intervention, American Family Physician, (2014, March 15) (pp. 453-460)Colleague 2: ChelsieUnfortunately, elder abuse is a phenomena that will continue to increase as the elder population gets larger. According to an article by Minhong Lee (2008), the causes of elder abuse are in close relation to the stress experienced by caregivers. Other factors also include ‘socioeconomic status, cognitive problem’s, and difficulty with ADL’s (activities of daily living)’ (p. 708). Elder abuse is also most likely to occur when the caregiver see’s the task as a burden.From the study conducted by Lee (2008), he also found that physical and cognitive abilities impacted the rate at which abuse occurred. For example, an elder individual that suffers from severe physical impairments is less likely to be abused compared to an individual that experiences cognitive impairments. The article by Lee (2008) reinforces the importance of assessing potential abuse and neglect among the elderly because it discusses the need for more psychosocial support services for elders. According to the study by Lee (2008), elder abuse decreased significantly when the caregiver had other social support such as groups and classes on family care giving. It is suggested by Lee (2008) for caregivers to attend support groups to ‘share their care management skills and effective coping mechanisms to reduce elder abuse’ (p.711). The article addresses elder abuse from a different perspective by not focusing on the elders themselves, by the mental health of the caregivers. If the cognitive health of caregivers is addressed and stress can be reduced, their will most likely be a reduction in elder abuse.When working directly with an elderly individual, I would want to assess their physical and mental capacity to gain an understanding of what level of care they need. For example, is the client able to still participate in most ADL’s? Is the client mental cognizant or does the client suffer from dementia? Is the client able-bodied or do they need assistance to move around? The physical and cognitive abilities of the client is important, as described in the article by Lee (2008) because elders are most likely to be abused when they suffer from cognitive disability. From the assessment I would then determine if the client would be best served in their home setting or at an assisted living facility and the hours of assistance needed on a weekly basis. If a client needed assistance for multiple hours a week, I would want to assure the caregiver was someone that was compassionate, had good coping skills, and a good support system. From a mezzo perspective I would work to prevent elder abuse by assuring that care coordination was occurring. Care coordination, as described by Christ & Diwan (2008),  is the ‘deliberate organization of patient care activities between two or more participants (including the patient)’ (p. 10). Care coordination is important in prevention of elder abuse because it takes the stress off of one individual and distributes the work load evenly.  According to Paveza (2013) it is also important to assess the rate of satisfaction caregivers experience. A caregiver that is highly satisfied working with elder patients is less likely to commit elder abuse compared to a caregiver that is just doing to job for money. Lastly, on the macro level to prevent elder abuse it is important that organizations provide care for their employees. Employees at assisted care facilities should have weekly meetings with their supervisor to discuss any concerns or stress related issues, residents of the facilities should also be asked on a weekly basis regarding the care they are receiving. Staying up-to-date and aware of the treatment of patients in the facility can reduce the chance of elder abuse because employees are less likely to commit the act if they know they are being closely watched.   Christ, G., & Diwan, S (2008). Chronic Illness and aging: The role of social work in managing chronic illness care. Council on social work education. Retrieved from: www.cswe.org/getattachment/Centers-Initiative/CSWE-Gero-Ed-Center/Teaching-Tools/Gero-Competencies/Practice-Guides/Assignments-Measurements/CI-Sec-Role-SW.pdf.aspxLee, M. (2008). Caregiver Stress and Elder Abuse among Korean Family Caregivers of Older Adults with Disabilities. Journal of Family Violence,23(8), 707-712. doi:10.1007/s10896-008-9195-2Paveza, G.J. (2013), Assesment of the elderly. In M.J. Holosko, C.N. Dulmus, & K.M. Sowers (Eds), Social Work Practice with Individuals and Families: Evidence-informed assessments and interventions. (pp177-195). Hoboken, N.J.: Wiley.

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