Carla Washburn is a 76 year-old African-American woman who has been widowed for the last fifteen years. She lives alone in Plainville, a small town in the Northwest. Her small home is in a neighborhood that has been steadily deteriorating ever since the paper mill-the city's largest employer went out of business four years ago. Carla and her husband were both employed at the mill until their respective retirements. Carla receives a small pension and Social Security. Unfortunately, the recent economic downturn has put the mill's pension fund in serious jeopardy.
Ms. Washburn recently lost her grandson in Afghanistan. She had raised Roland Jr. from the age of eight; he came to live with her after her son Roland and his wife were killed in a car accident fourteen years ago. Until Roland Jr. turned eighteen, Ms. Washburn was able to collect survivor benefits, funded by OASDI, to enable her to care for him adequately.
During the time that Roland Jr. lived with her, Ms. Washburn threw herself into his care and activities. She found that she had nothing much in common with her old friends, because they had raised all of their children and had more freedom to socialize than she did. Eventually, these friends dropped out of her life.
Roland Jr. decided to join the Army after his high school graduation, to get money to pay for college. Shortly after finishing basic training, he married a young woman, Alice, who he met while at the Army base in North Carolina. Carla travelled to North Carolina to attend the wedding. Although she liked her grandson's new bride, she really did not know her. And when Roland Jr. was killed, the Army focused its family outreach services on the young widow.
Although Carla and her sister spoke weekly by phone for the last fifteen years, Carla has made no attempt to contact Anna since Roland Jr.'s funeral eight months ago. When Anna called, Carla questioned over and over how it could be that both her son and grandson were no longer alive while she, an old woman, still lived. Anna has told you that her sister told her of a recent fall she had had in her home that left her with difficulty walking. In the course of the conversation, Anna also mentions that Carla has Type II diabetes, and is insulin-dependent.
When you contacted Ms. Washburn, she refused at first to have you visit and expressed irritation with her sister for contacting the AAA. However, when you explained how worried her sister had been and how Carla could ease her sister's concern if she would consent to a visit, Carla finally agreed to see you. But she was adamant that she neither wanted nor needed help.
- Carla insists that she has no concerns that you can help her with. But she does consent to a psychosocial history. From this history, you identify a number of concerns:
- Diabetes care: is the fall that now impairs her ability to walk in any way related to her diabetes self-care?
- Are there any fractures as a result of her fall that were not set?
- Depression: although Ms. Washburn's grief reaction to her grandson's death was normative, was there any way to help her deal with her overwhelming sense of loss?
- Carla is a woman of modest means. But you notice that she has a large number of medications out on her kitchen table. Is the Medicare drug program benefit adequate for her medical needs?
- As a result of the paper mill closing, the unemployment rate has skyrocketed to fourteen percent. As the graph shows (see: Mapping a Social Problem, under the Assessment file), unemployment and crime are closely related, and indeed there has been an uptick in property crimes in Carla's neighborhood.
- Is Carla's isolation willfully self-imposed, or are there social supports, in the form of neighbors, church, bereavement groups, etc. that might make her life better?
As a result of your great skills in relationship building, Carla agrees to continue to see you. She identifies the following goals for the work:
- Help getting her diabetes under control
- Identification of resources to help her cope with her loss
- Come up with solutions to fear of neighborhood crime (crime is up because the recession has lowered housing values, resulting in lower property tax income for the city. This in turn has required the city to lay off policemen, and to release people from jails earlier).
Review Ms. Washburn's support system, as shown on the ecomap.
Critical Thinking Questions
These core questions, specific to each client, will help you better understand and assess your client. Refer back to your answers throughout your assessment.