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Guidelines for field staff to assist people living in ... - Housing NSW

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APPENDIX 8: Case studiesCASE 1An elderly male who has lived <strong>in</strong> the same private rental flat <strong>for</strong> morethan 10 years, was referred <strong>to</strong> a local ACAT by his GP. He receivesan aged pension and although he reliably pays rent, he spends therest of his <strong>in</strong>come on cigarettes and alcohol, leav<strong>in</strong>g no money <strong>to</strong> pay<strong>for</strong> food or medication. He has chronic smok<strong>in</strong>g-related lung disease,high blood pressure and leg ulcers but even though he uses a stick <strong>to</strong>walk and is unsteady, he goes out every day.After a recent admission <strong>to</strong> hospital with a chest <strong>in</strong>fection he wasdischarged <strong>to</strong> a nurs<strong>in</strong>g home. When his health improved, he<strong>in</strong>sisted on return<strong>in</strong>g <strong>to</strong> his home. His flat is very dirty, dark andneglected. It requires pa<strong>in</strong>t<strong>in</strong>g, has several broken w<strong>in</strong>dows and onlyone work<strong>in</strong>g power po<strong>in</strong>t. There are no carpets or floor covers.A local charity group removed a large amount of refuse be<strong>for</strong>e hereturned but quite a bit of rubbish has re-accumulated. He does notwant anyone <strong>to</strong> approach the owner about repairs <strong>in</strong> case the rent is<strong>in</strong>creased. He has been receiv<strong>in</strong>g home-delivered meals but refuses<strong>to</strong> pay the nom<strong>in</strong>al fee and they have threatened <strong>to</strong> withdraw. HomeHelp refuse <strong>to</strong> provide clean<strong>in</strong>g because of the condition of theaccommodation. Community nurses visit every second day <strong>to</strong> dressa leg ulcer.He denies dr<strong>in</strong>k<strong>in</strong>g any alcohol and has been refus<strong>in</strong>g <strong>to</strong> takeprescribed medications even when the purpose <strong>for</strong> these has beenclearly expla<strong>in</strong>ed. He is dishevelled, irritable and suspicious. Ontest<strong>in</strong>g of memory and orientation he per<strong>for</strong>ms well, however he hassignificant impairment on tests of frontal lobe function.Dur<strong>in</strong>g his recent admission <strong>to</strong> hospital, tests showed he hadabnormal liver function consistent with alcohol abuse. A bra<strong>in</strong> scanshowed changes due <strong>to</strong> stroke-related or cerebrovascular disease.His diagnosis is dementia due <strong>to</strong> alcohol and cerebrovasculardisease. He is aware his flat is ‘untidy’ but isn’t concerned anddoesn’t want <strong>to</strong> consider alternative accommodation.DiscussionThis man’s neglected and unclean <strong>liv<strong>in</strong>g</strong> conditions are a concern butdo not appear <strong>to</strong> present a high immediate risk, possibly because ofthe recent clean<strong>in</strong>g. The fact that his home is becom<strong>in</strong>g dirty aga<strong>in</strong>highlights the importance of ongo<strong>in</strong>g supervision and follow-up wherepossible. He shows little awareness of any problems or the potentialrisks of not tak<strong>in</strong>g his medication, cont<strong>in</strong>u<strong>in</strong>g alcohol abuse, loss ofhome services or the state of his accommodation.49

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