Gertie was 83 when first referred to St. Michaels’s Hospice at Home service in Wolverhampton.

Case Study 1

Gertie

Gertie was 83 when first referred to St. Michaels’s Hospice at Home service in Wolverhampton. She lived alone in an apartment and was completely independent, slowly mobile and coping well with her rectal cancer and stoma. She was known to her Macmillan nurse, who felt she needed extra support. Following the Hospice assessment, they agreed to ring her regularly and offer a weekly visit for support and company. She was well supported by her daughter Annie, who lived and worked in Birmingham, and often spent her weekends with Gertie. Hospice at Home referred her to the Day Hospice which Gertie attended for six months before being discharged. Annie was referred to the carers support group at the hospice and she attended monthly.

After a year, Gertie’s health slowly deteriorated. Her legs were swollen, which impacted on her mobility, her stoma was prolapsed, and she needed help with the bag. She was referred to social services for a care package. The hospice team continued to visit and increased visits to twice a week, with the occasional evening to support Annie. Annie was still very involved, and Gertie continued to visit Annie’s home while she was still able, enjoying the company of her extended family. Support from the community nurses and the Macmillan team for symptom control also continued.

In October 2011 Gertie had a stroke, leaving her with a left/right sided weakness and with a much-reduced memory. After an admission, Gertie’s care team decided that she had reached the full potential of her rehabilitation and that she was at a great risk of further strokes. This was because the nature of her cancer prevented her continuing with blood-thinning medication due to the risk of haemorrhage. Gertie expressed the wish to stay at home and while the option of a care home was discussed, it was not what she wanted. Annie supported this decision and moved into Gertie’s small flat to care for her.

For this case consider –

• Collaborative Care Planning
• Shared Decision Making

Case Study 2

Fionn.

Fionn is a thirty-year-old service user, admitted into the hospital due to a motorcycle accident.

He is admitted into Oswestry Orthopaedic Hospital which is a specialized hospital for a collar bone surgery. He sustained a fractured collar bone, third degree burns to his left thigh and some severe injuries on his body. His health condition requires him to remain admitted to the hospital for nearly five months.  He required a daily care routine and the surgery to be performed on him in the next few days. Fionn has discussed his health condition with his personal nurse, medical staff, and care assistants in the hospital.

His healthcare team will need to coordinate and come down to a conclusion to ensure that his personal care needs are met.  His personal care package included his personal hygiene needs and his personal interests, which are watching motorcycle racing, as well as reading books and listening to music.

Fionn is single, and works with the railway network, he has his elderly mother living nearby. She has a spare bedroom but can only provide limited care, she herself has a care package from social services due to her limited mobility and COPD.

For this case consider:

• Collaborative Care Planning
• Shared Decision Making
• Supported Self Care Management
• Social Prescribing
• Health coaching/Motivational Interviewing

Case Study 3

Amaya.

Amaya is 45, has a diagnosis of mixed dementia and has limited communication with others. She can only ever used one word – “rain”.  She severely lacks confidence to socialise with others, within the care home setting, and appears to be very frustrated and anxious.

Staff at the home where Amaya lives, in Peckham, do not seem to understand the importance of activities to engage with people living with conditions like Amaya’s, in particular music.  They do not have confidence to deliver these activities. Therefore, they cannot identify correct ways to communicate with Amaya.  The staff also do not have an in-depth understanding of Amaya’s dementia, and no knowledge about her interests, history or likes and dislikes.  Amaya has no family visiting at present.

For this case consider:

• Social Prescribing
• Better Conversations
• Health coaching/Motivational Interviewing

Case study 4

Lekha is 25 years old, she is a teacher by profession and recently qualified in primary school education. Sadly, she has been unable to gain employment and is struggling with the impact of this, as there is no jobs in Warrington.

Financially, she has now ran out of her savings, and is close to being evicted from her home. She has developed binge eating disorder, to a severe level. She is now classed as obese and is struggling to leave the house due to her mental health (agoraphobia).

She has no family in the UK, she has expressed an interest in meeting people but, is worried about them judging her.

Lekha has reported that she had recently quit smoking ‘cold turkey’ and had successfully maintained abstinence for four months. She reported quitting smoking following the death of her mother, because she died of cancer. She quit smoking without any professional help and without the use of any nicotine replacements or medications to assist with the smoking cessation.

For this case consider:

• Collaborative Care Planning
• Shared Decision Making
• Supported Self Care Management
• Social Prescribing
• Better Conversations
• Health coaching/Motivational Interviewing