I) Introduction of client: Mildred Lester is an eighty-three-year-old Caucasian female, who resides alone at her first-level, senior independent-living apartment. She is low-income and needs assistance to apply for homemaker services. Mildred has an adult daughter, Carrie, and Carrie’s husband John who reside in the same city, but both are still working full-time jobs. Carrie and John take turns stopping by to assist Mildred with housekeeping, grocery shopping and to check on her, a couple times per week after they are off work but this is becoming taxing for them. Mildred was recently admitted to this hospice for diagnosis of End-Stage Lung Cancer, is alert and oriented to all aspects but has periods of mild forgetfulness. She was diagnosed with lung cancer 3 years ago, and decided after her last round of chemotherapy ended, that she did not want any more progressive treatment. Mildred is short-of-breath(SOB) at rest, dependent on oxygen, fatigues easily and requires assistance with ADL’s. Mildred has a history of mild depression but does not like taking medications because of the side effects. Mildred is originally from Chicago, IL where she had met her, now deceased husband Frank, worked as a supervisor at Montgomery Ward for twenty years and moved out to Las Vegas ten years ago after Frank passed away. Carrie and John had already been living in Las Vegas and convinced Mildred to move to near them so she would not be alone. Mildred reports that she is Christian but has not regularly attended church in many years.
II) Clinical conversation: This social worker is completing initial homevisit with Mildred Lester at her apartment to complete psychosocial assessment to determine her needs and develop plans of care for patient while on hospice services. This worker phoned prior to visit to schedule the visit at Mildred’s convenience. Upon Mildred answering the door when social worker arrived for visit, this worker smiles and greets Mildred, “Good morning Ms. Lester. I am Monica Coulter, one of the social worker’s for hospice. I am the social worker who called you yesterday to schedule today’s visit.”(Welcoming) Mildred replies, “Oh yes, please come in, have a seat and you can call me Mildred”, as she slowly, and with unsteady gait, walks across her small kitchen to sit at the table across from this worker. This worker thanks Mildred, closes her door and has a seat at the kitchen table where Mildred indicated. This social worker provides Mildred with this worker’s business card, and states, “I know there has already been several hospice staff out here to talk to you, who have discussed hospice and asked you plenty of questions, which can be a bit overwhelming and confusing. “First I want to ask if you remember the admitting nurse discussing confidentiality with you, and obtaining your signature on our confidentiality and Patient’s Rights forms, which should be in your hospice folder?” Mildred states, “Yes I remember the nurse discussing my right to confidentiality and Patient’s Rights and don’t have any questions about that.”(Statement of confidentiality) Mildred states, “It’s been very busy here this week with calls and visits from lots of your staff. They said you would be contacting me but I don’t remember what they said you do exactly.” “I’m sure it has been a little overwhelming with the various staff calling and visiting this week. That will slow down after this first week, because the nurse will usually come on a regularly scheduled day that you choose.(Reflection of affect) As part of my responsibilities as your hospice social worker, I’m here to ensure you receive the best services from our staff as well as assist you with obtaining any community resources you may need, such as Medicaid, Meals On Wheels, private pay caregivers, etc., or may need in the future”, this social worker responds. “Oh, well that’s good to know. I really could use someone to come in once