Agnes was born and brought up in a farm, she was married for 51 years but her husband died suddenly two years ago. She has five children, but none who live locally. Agnes presents as a frail 81-year-old lady with type 2 diabetes and a heart condition, now living alone in the community. She has recently been assessed and diagnosed as partially blind after receiving all available treatment to improve her eyesight. The likelihood of her losing her eyesight completely is fairly imminent. Nothing further can be done to improve the situation. Her family visit regularly but are unable to provide the intensive support she might require now that the situation is changing. She recently had a stroke resulting in a brief hospital stay. Short term social services input was set up on discharge, but this is due to end within the next few weeks. The need to provide support and educate Agnes regarding lifestyle adjustments is now a necessity. Up until two years ago Agnes enjoyed an independent life, driving wherever she wanted, has regular social activities and is secretary for the local bowling club. She now fears she will not be able to leave her home alone and feels she has nobody to help her. Her greatest anxiety relates to having to live in a nursing home.

What steps would you take to minimise the distress for Agnes?

Agnes is likely to need some reassurance that, at this stage, it is her decision as to whether she stays at home or whether she moves to supported accommodation.

What organisations should you link with to ensure the practical arrangements are made for Agnes?

The local health centre would be the first point of contact because they have existing links with specialist services and social services. Perhaps the best way to approach this is to ask advice from the professionals who are already caring for Agnes.