Antony is a retired bus driver, he moved to live with his daughter Caterina and her family 10 years ago after his wife died. Antony has two other daughters who live in Italy, who talk on the phone regularly with their father but rarely visit. Antony was diagnosed with vascular dementia 4 years ago. His physical health has gradually declined and he is now requiring assistance with showering and has had 3 falls in the last 12 months requiring hospital admission.

A community care package was arranged to provide assistance with personal care and cleaning, however Antony often refuses to allow the nurse to assist him in the shower and insists that his daughter help him.

Caterina’s is finding her caring role difficult as she is also looking after her 4 and 6 year old grandchildren. She has told the community care case manager that she doesn’t think she will be able to care for her father if he becomes physically more frail.

Her sister Gina is visiting from Italy and is angry that Caterina is considering moving Antony to a nursing home. Antony nominated Caterina as his person responsible for medical and financial affairs soon after his diagnosis.

Trigger:

Family disagreement about care

Assessment:

Functional assessment screen to assess severity of dementia
Assess carer stress

Attendance:

• Caterina
• Gina
• Antony's case manager and the case conference facilitator, Fran
• Antony's care worker to provide input on how to manage his refusal of assistance with care, Michael

Key discussion points:

Speaking with Gina prior to the meeting Fran identified that there was likely to be conflict and difficult decisions to be made regarding Antony’s future care needs and ensured she was prepared for the conversation.

She asked Gina to explain her understanding of Antony’s condition. When it became clear she did not understand the progressive and life-limiting nature of dementia, Fran sensitively provided verbal and written information. She described the services that could be arranged for Antony at Caterina’s house and the amount and type of care that would be required as his condition deteriorated.

Caterina was encouraged to describe the impact of caring for Antony on her, including a lack of sleep, difficulty in also caring for her grandchildren, and restrictions in her ability to visit her daughter interstate. Fran suggested that respite care could be offered in an aged care facility to allow Caterina a break from her caring role. Gina recognised the stress her sister was under and agreed on the need for respite and also offered to pay for further services to support her sister in her caring role.

The case conference also discussed Antony’s physical condition and support needed for activities of daily living.

Strategies to manage Antony’s refusal of outside help are discussed with the care worker, who indicates that visiting early in the morning and telling Antony that he needs to get ready for going out to lunch usually means he will accept assistance.

Outcomes:

• Private physiotherapy is arranged to increase Antony’s physical strength and function
• Day respite services are arranged which take Antony to a local community centre on the days that Caterina cares for her grandchildren.
• Residential respite was arranged for Antony while Caterina visited her daughter
• Gina has an improved understating of the likely progression and increasing care needs associated with advanced dementia and is less resistive of the need for future residential care placement

Last updated 07 December 2015