Question

The question is at the bottom of the page THE SITUATION Recently, Linda, Director of the Hearts Open Home (HOH), a 150-resident assisted-living facility established in 1990 in Southern California, received a phone call from Phyllis, the niece of Ethel Backer. Ethel is 88 years old and has been a resident of HOH for the past 8 years. During the call, Phyllis expressed concern that Ethel’s needs were not being met. Phyllis related to Linda that she was very upset about the care her aunt was receiving and was considering contacting a lawyer. Linda suggested that Phyllis attend the next case management meeting for Ethel, which would be held in 1 week. Phyllis agreed to attend the meeting even though she lives in Salt Lake City, Utah. THE PEOPLE Linda: Director for the past 10 years of HOH. She is Caucasian, 52 years of age, born and raised in the Midwest. She moved to southern California with her husband and family approximately 15 years ago. Suzanne: Nurse, African American, age 38, native of Los Angeles, new to the HOH staff, previous position was Nursing Supervisor at a large urban hospital’s very busy emergency department. Juan: Physical Therapist, age 36, originally from Colombia but completed his studies in the United States. Stephanie: Psychologist, Chinese, age 42, from the Bay Area near San Francisco, married to a man of Spanish descent. She speaks Chinese, English, and Spanish. Maria: Nursing Assistant, age 28, originally from Columbia. Maria speaks with a strong Hispanic accent, immigrating to the United States only 3 years ago. Dianne: Dietitian, age 42, from Venezuela. She has been employed at HOH for 5 years. Phyllis: Niece of Ethel Backer, 68 years of age, a Mormon, retired school teacher living with her husband in Salt Lake City, Utah. THE CASE MANAGEMENT MEETING Linda begins the meeting introducing Phyllis to the HOH care team members. However, before Linda can complete her statement, Phyllis begins addressing the group. Phyllis: I try to come and visit my aunt as often as I can, but I live in Utah and I can’t afford to travel to California that often. We pay HOH good money to take care of my aunt, and we expect you to be more responsible and attentive to her needs. Linda: Phyllis, can you explain your exact concerns regarding your aunt to the group? Phyllis: Well, 2 weeks ago when I came to visit Ethel, she appeared very lethargic and would not consider going for a walk with me using her walker. Also, her hair looked terrible, like it had not been washed in a week, and she looked like she lost weight. I also saw there was a plate of horrible looking food in her room—rice and beans or something similar. She needs meat and potatoes, not that Spanish food! But, what really is upsetting upset me is that I noticed this morning that she has a nasty sore on the back of her shoulder. When I went to look for someone to help her, I saw lots of staff, but they were just standing around, joking, and speaking Spanish. I don’t think they were really caring for the residents. What is going on here, why aren’t you looking after my aunt? Suzanne: I am new here but according to the notes in her chart, Ethel has had a number of colds this year as well as problems with her feet. She has been provided with medication prescribed by her physician and the podiatrist has been treating her feet. Phyllis, you must remember that your aunt is 88 years old. As for the sore, I was not aware of this problem. I will stop in after the meeting and see what is going on. Marie, did you advise the nursing staff of Ethel’s sore? Maria: There are so many residents at HOH with so many needs that I am overwhelmed at times. I can only do what I can do! I have tried to encourage Ethel to use her walker, but she just sits there in her wheelchair and will not move. She tells me to go away and let her be. It is the same thing for everything I try to do for her. When I try to help her take a shower so her hair can be washed, it is a major drama making it almost impossible. Suzanne, I said you need to visit each resident daily, and Dianne, I told you that Ethel did not like the food! (Maria begins to cry.) Dianne: According to my records, it was requested that Ethel be served her meals in her room. There are no specific dietary restrictions or requirements on her chart so she is served the regular daily menu. Here at HOH, we strictly follow USFDA dietary guidelines, but if the resident does not like what is being served, there is not much I can do. Most of the residents at HOH are Hispanic so we design the food menu to be sure that they get foods they are familiar with and that they enjoy. With 150 residents, I don’t have time to visit each patient individually to see what they like and don’t like to eat. I need to stick to my budget. Perhaps the family can get more involved and bring Ethel some of her favorite meals or take her out to eat when they visit. Juan: The last time I saw Ethel was about 2 months ago. According to my records, I have seen her 6 times this year. We have a care plan that includes her walking with a walker daily so she is just not sitting in her wheelchair. As you know, 2 years ago she fell and had a hip replacement, and sometimes it is very difficult for older patients to recover and become active after that type of operation. They need to be motivated, and I believe that seeing family members more regularly is important. Phyllis, maybe you and your family should consider moving to Southern California so you can be closer to your aunt.” Stephanie: Yes, regular visits from the family are very important for the well-being of an older person like Ethel. Phyllis, your family needs to be more involved. Seeing the family will provide stimulus for Ethel and then perhaps she will be more alert overall. Family always comes first. Phyllis: It sounds to me, that although each of you are a member of my aunt’s care team, you are not working together and communicating. As a result, my aunt is not getting the attention and care that she needs. What are you planning to do to ensure that she is getting adequate care? I don’t live in this city and I can’t be flying in every week to check up on her care. Perhaps this Hispanic community is not really interested in caring for someone who is not Latino. Linda: Phyllis, we hear and appreciate your concerns. We will do whatever it takes to ensure that your aunt is getting the care she needs. Although we are located in a primarily Hispanic area of the city and many of our residents are Latino, we try to be sensitive to the cultural backgrounds of all. We embrace the differences that we have and keep this in mind in the foods that we serve as well as our approach to our residents. I would like to think about this situation and meet with my team later this week to see how we can improve the situation. CASE STUDY DISCUSSION QUESTIONS 1. Identify any shared values (cultural or professional) in the group. 2. What is the primary means of communication among the team members? Is there a formal or informal network of communication? What factors are involved? How can communication be improved among this culturally diverse team? 3. Identify where you think the individuals in this case are in reference to stages in the Model of Intercultural Sensitivity? Are they in the Ethnocentric stages (denial, defense, minimization) or in the Ethnorelative stages (acceptance, adaptation, integration)? Explain why you have selected the stage.