Orthopedic Floor Case Study

I was given the opportunity to experience a new floor today while Jamie oriented a new social worker. Cori let me shadow her on the orthopedics floor. It was nice to see the differences amongst patients since this floor is mostly all elective surgeries and planned hospital admissions, whereas, the cardiac floor, where I usually reside, is mostly unexpected hospital visits. The assessment process is the same, although, there is a different focus. On the cardiac floor I’m taught to assess the patients’ living conditions before their medical event and paint a picture of how things have changed and evaluate whether or not the patient can return to their previous living status or what needs should be addressed before the patient is released.

Probably the toughest client of the day was not an elective surgery, instead, she an 87-year old female on comfort care who suffered a major fall and was now so weak she was barely thriving.

The physicians and nurses spent some time trying to explain to the patient’s daughter how a blood transfusion was not necessarily a life saving measure, but a way to make the patient more comfortable. To me, it seemed like a possible ethical issue. The daughter obviously viewed it as a lifesaving measure which went against her mother’s wishes. Cori and I, for the most part, stayed out of the blood transfusion discussion. Instead, we focused on how the daughter was going to manage her mother’s care once they left the hospital. Previously, the patient was living alone, in the country, approximately 20 miles from the nearest rural community. The daughter lived in the community, with no other support close by to help. There was no way the patient could return to her home alone

and the daughter feared she would not be able to take on her mother’s care alone. Hospice was an option Cori mentioned, which the daughter became very interested in. Unfortunately, there was no hospice house near the patient’s community. There was a hospice service that would be able to come into the home, but then the daughter would still be handling most of the care for her mother. The other option was a nursing home with hospice. The hard part was explaining to the daughter the out of pocket cost for room and board at a nursing facility. She was under the impression Medicare or hospice would cover all expenses. We spent most of the day talking with the daughter as she kept trying to find some loop hole to get Medicare to pay for her mother’s care.
It really made me think about how anyone gets through these moments with their parents.

Facing the hard fact of caring for your parents while trying to manage other things in your life or take on a $7,000-$8,000 bill per month. Seems to be a theme I’m seeing more and more as I continue my internship. It really shows me how important it is to hope for the best, but plan for the worst. I’m sure you could never be prepared for everything, but having those difficult conversations before your parents are too ill to explain their wishes might save a lot of heartache and hard decisions for the rest of the family in the

future.