Introduction

Contributing Factors

Identifying Symptoms of Depression

Treatment

“Real” Intersection of Systems

Action Ideas That Work

Resource Links

Resource Pages

References

"Real" Intersection of Systems

Case Study
Paula, is an 85-year-old woman in poor health who lives alone in a senior housing high-rise. She has no family. She has been an active member of her church for 50 years, but has been unable to attend in recent years due to transportation and physical disabilities. The parish nurse saw Paula as part of her homebound visitation ministry. At the visit, the parish nurse noted that Paula’s apartment was in disarray and that there was old food on the kitchen counters. She also noted that there were several prescription bottles of the same medication half empty. Paula told the nurse she takes 1 pill every morning. She occasionally appeared disoriented during the visit and had an unstable gait. Knowing Paula had a history of strokes, the parish nurse regularly assessed her orientation, coordination and assured that she was seeing her physician on a regular basis utilizing the church’s senior transportation program and the local municipality senior van.

The parish nurse continued to visit Paula and assess her ability to manage her medications, medical care, activities of daily living and home maintenance. With Paula’s permission, she met with the building social worker to let her know that she was visiting Paula. The social worker described the concerns of the staff regarding the cleanliness of the apartment and her ability to function independently.

It became obvious to the parish nurse that there needed to be a multi-pronged approach to caring for Paula so that she could safely stay in her apartment and maintain her independence, which she valued so highly. Knowing that Paula was on a very limited income, the parish nurse contacted the local county’s senior waivered services and Paula’s MD to discuss the possibility of having a public health nurse do medication set-ups and for a home health aide to assist with cares and household chores. The parish nurse also contacted the Care Team coordinator to have volunteers help in an initial apartment cleaning and regular visitation to prevent isolation. The parish nurse utilized the Senior Links section of the library web page to locate other senior services for Paula, as well as leaving a Senior Linkage Line magnet on her refrigerator so she would know where to call with her questions regarding foot care. As all these changes were occurring, the parish nurse felt it would be beneficial for Paula to have a BeFriender who could be her spiritual support on a regular basis.

Paula often told the parish nurse how happy she was be surrounded by her church family and that she was well cared for by her home health aide. Paula was able to remain in her home for another five years before she died of a stroke at the age of 90.