Imagine you are a Community Options Case Manager for older clients and clients with disabilities.  You have just read the following case note for an older client, Mrs Bigg, who receives in-home care twice weekly.  The note was written by the brokered care worker. You are considering what action you should take to best support Mrs Bigg.  Read the case note then answer the questions that follow:

Mrs Bigg appeared quite confused today during my visit.  She had not remembered that I was coming, and demonstrated some difficulties with short-term memory and sequencing of tasks.  She was not dressed when I arrived and appeared as if she had not showed for several days.  She was quite odorous and her hair was not brushed.  This is unusual for Mrs Bigg as she is usually well presented and takes pride in her appearance.  She was unable to successfully make herself a cup of tea and required assistance to organise the steps into
order.  I intervened, as I had concerns for her physical safety and I made her tea for her.  She could not recall if she had taken her medication this morning and could not tell me what she had eaten for breakfast.  We had a cup of tea and a chat, and then went for a short walk around her garden.  She fatigued quickly and was content to return inside and listen while I read aloud to her from a book of poems from her bookshelf.

1. What life stage is Mrs Bigg likely to be at?
2. Provide at least four factors that may be affecting Mrs Bigg’s appearance and behaviour (be specific).
3. Where and/or from whom could you seek further information about Mrs Bigg to guide your decisions about the actions required in this situation?
4. What questions could you ask Mrs Bigg to help you learn more about her current situation and needs?  (provide examples of exact questions you would ask). Explain the appropriate style of questioning.
5. What problems might exist for Mrs Bigg in terms of continuing to provide in-home care?

Tiana is a 35 year old single mother of a young son.  She has been identified as having autism.

1. Conduct some research and describe how autism might impact on Tiana’s social and cognitive development, and how such a developmental status might increase her needs.
2. Analyse Tiana’s information in relation to planning services to assist Tiana at home.  Give a list of services that could be utilised to meet Tiana’s needs.  Indicate why these services would benefit Tiana.
3. During an assessment of cognitive development using Piaget’s model, it was noted that Tiana was able to think logically, but she often needed concrete objects to do so. Socially it was observed by those working with her, that she showed little interest in others and avoided eye contact. However, it was also noted that she showed a sense of pride in her accomplishments and abilities. Analyse this information to identify specific development issues for Tiana. (HINT: think of her cognitive stage according to Piaget and psychosocial stage according to Erikson)
4. 4.Tiana dislikes being treated as a child. Using researched information identify the likely impact of interventions to assist Tiana with the care of her baby, and with social, personal care support.
5. 5.Tiana has type 1 diabetes which can cause hypoglycaemia if her blood sugar levels fall (usually if she skips a meal, exercises heavily or takes too much insulin. How might you take this information into consideration (as a contraindication) when planning service delivery?
6. 6.Complete a Diabetes Action Plan for Tiana (use the provided template).
7. You visited Tiana today and she showed symptoms of hypoglycaemia. Create a current, complete, accurate and relevant record for this event.
8. To monitor the impact of services on Tiana, you ask her to provide feedback about the services she is accessing. During discussion with Tiana (as her senior worker) she reports that she really appreciates these support of all her care workers, but she does not enjoy the skills training with the psychologist. How might you respond within the scope of your own work role and organisation policies and procedures?
9. Explain how you would maintain records about Tiana.
10. Conduct some research to find the mini-mental state examination (MMSE) which is a tool that you might use when working with clients in a community services setting to assist in determining client status.

    (A) Briefly describe the tool
    (B) Explain how you would recognise normal readings and what scores would fall outside the normal range