Case study: Rosie
Rose is a 56 year old lady who has a number of physical health issues which over the years have impacted negatively on her mental health. She has low self-esteem and has been addicted to lorazepam for over 25 years and is currently being treated for depression. Her physical health problems include arthritis, asthma, obesity, heart disease and most recently psoriasis. On average she takes about 6 different medications each day for these ailments as well as being a moderate smoker. She does not like taking medication and feels that some of drugs interact and make her feel worse. Both her grown up children have left home and she has a carer Josh who is a 19 year old man with Asperger’s syndrome. He seems to enjoy spending time with her and running errands, cooking and doing the shopping. He is there most days even though he does not get paid for all the hours. On occasions Rose looks after her grandchildren, when their mother has to work late or goes out for the evening. She looks forward to seeing her grandchildren although Jack her grandson is very demanding as has recently been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). In the past Rose suffered from agoraphobia but managed to overcome this with the help of a community mental health nurse who developed a good rapport with her. She does not really get on with her new mental health nurse and has been asking Josh to do more and more errands and she now hardly ever leaves her flat. This is due in part to her psoriasis which has spread to her face. When she has felt able to venture outside, she has been subjected to verbal and physical abuse by local youths who make fun of her physical conditions.
Answer the following questions.
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What do you consider the safeguarding issues to be?
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What would be the short and long term safeguarding issues that needed to be addressed?
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What do you feel about the suitability of Josh being Rose’s carer?
- There are a number of safeguarding issues with this case study. There are the obvious abuses such as Rose being subjected to abuse in the locality. There are also safeguarding issues with regards to her health with the use of polypharmacy (use of many medicines). Each medicine is being used to address a single condition but the combination may be doing overall harm to both her physical and psychological health. This can be a problem in health care as specialists or practitioners treat individual parts but never the whole. There are also potential safeguarding issues with two young children being cared for by someone with obvious health issues. One of the children has ADHD so would be a challenge for any carer let alone someone with these many health issues.
- Some of the short term safeguarding approaches would be to address the community issues. A community police officer could be contacted to have a word with the youths and support from neighbours could be sought. A medication review would need to be taken as a matter of urgency to ensure that medications were not interacting with each other and making matters worse for Rose. She may need to make compromises in terms of the conditions that can be treated. For example, she may be able to have acupuncture for pain rather than painkillers for arthritis. A careful assessment of risk for the child minding activity would need to be undertaken or additional advice or support provided to both Rose and the grandchildren’s parents. Longer term strategy would involve building up Rose’s self-esteem and confidence in order to improve her mood and limit the reoccurrence of her anxiety state in going outdoors. Remember that safeguarding is about being proactive and empowering the client and carers/family. Obviously, her weight would need to be reduced in order to potentially make some of her physical health conditions better such as asthma, arthritis and heart disease. It would also help in reducing the risk of developing other conditions such as diabetes. Improvements in these areas may well have a knock on effect of improving mood.
- Some of you may have had real concerns about Josh being Rose’s carer as he has Asperger’s syndrome. It is important to see beyond this label and diagnosis and make an objective appraisal on his effectiveness and suitability. There are many people with disabilities who make a significant contribution to society and often their biggest limitations are the negative opinions and low expectations of members of the general population. Josh will have some difficulties (as we all do) particularly with social interactions but in some circumstances this can be viewed as a positive rather than a negative. Some individuals on the Autistic spectrum have difficulties understanding social rules of interaction and they often do not understand why people develop prejudices against others. For example, they may not pick up on the non-verbal signs of prejudice or engage in anti-oppressive behaviour. Ironically, they would need to be specifically taught to hold negative views about others when most of us pick this up incidentally from others as we are socialised into developing our own values and beliefs about the world. People with disabilities can teach us a great deal on how to value others if we are prepared to listen and act on what they tell us. Professionals really do need to listen to their stories and change practice accordingly to improve professional practice.
