Question

Case Management Action Planning Case Study (250 words)

A case manager, Marie, is meeting with Michael Cornell, an individual in need of services, and his granddaughter Jennifer. Michael age 86, took a bad fall six weeks ago and has been receiving rehabilitation services at a local nursing facility. Discharge planning was not thorough as Michael insisted he was ready to go home with services in place or not. Jennifer is not able to provide Michael with all the assistance he needs, but is willing to help as much as she can. However, it has become apparent to both Michael and Jennifer that he will not be able to remain at home without assistance. As a result of the fall, Michael had a hip replacement and a broken arm which was put in a cast. He also has diabetes, (two toes amputated in the last two years), and macular degeneration. Michael has become quite confused since his stay at the nursing facility and currently his decision making skills are severely impaired. He needs extensive assistance with dressing, bathing, toileting and transfers. Michael is not eating well and continues to lose weight. Michael tells Jennifer and Marie that he has no energy, feels down a lot and doesnt even care about tending to his garden this year. He previously enjoyed socializing with people and hobbies like woodworking, gardening and painting, but they dont interest him much now. Michael attended the local Congregational Church, but has not been to church services since his fall. He agrees that it might be helpful to talk with the pastor, have people around during the day and is willing to accept services that will help him to be able stay at home. Michael and Jennifer are interested in agency directed services at this time and clearly want to receive case management services. Michael, Jennifer and Marie are now developing Michaels Action Plan together.

Some simple questions to start:

List all the potential issues regarding Michaels needs

What goals do you think Michael might have?

List all the possible services Michael would need

For each goal (based on the issues), write a plan including strategies and timeframes

Remember to:

Address the following in the plan:

The processes involved in addressing the clients needs

Recommendations regarding services, supports and referrals

Details of (potential) meetings conducted with the relevant professionals

Continuous improvement strategies

Support from the literature

Answer 1

Michael would need assistance in walking, eating and going to the washroom as he has had a hip replacement surgery and has gotten his toes amputated.He would also need assistance in taking his medications on time. These are the physical drawbacks that Michael is currently facing, however, there are a few mental issues that need to be adressed here as well.Like mentioned earlier, Michael has lost interest in his hobbies and feels lost and confused most of the times.He needs counselling and psychiatric help as well.His grandaughter, Jennifer, should talk to him and help him regain his confidence and will to live.His diet must also be kept under observation.

Michael's golas should be to

A) Focus on his health, take his medications on time and be encouraged to improve his health: For this he would require a nurse or special assistance to ensure that Michael is doing what is required.

B) Keep a positive mindset and be optimistic because at the end of the day a positive mindset would result in a healthy body:Jennifer and Marie should encourage Michael by taking to him and motivating him to do better and have a positive mindset.They should encourage him to try to do activities of his interest such as gardening.