Case Study

Mrs. Shahin Lotfi is an 80-year old widower who lives alone in a bungalow right outside the city. She is a retired housekeeper, who keeps active and particularly loves her garden. Both her children, Riaz and Negin, live within the city and come to visit her usually once a week. They regularly call their mom to check-in with her and make sure her kitchen and house are stocked and clean. However, over the last few months, Riaz and Negin have noted that Mrs. Lotfi doesn’t want to garden, her food in the refrigerator is untouched and moulded. She also seems more confused when they speak with her on the phone. For example, she doesn’t remember what month it is and often mixes up the names of her grandchildren.

Mrs. Lotfi had a fall at home 2 years ago and since then has been using a 4-wheel walker. Negin has asked her mother many times to live with her, so she can help support her better. However, Mrs. Lotfi does not like being in the city and does not want to leave her home and states “I’m not living behind my beautiful memories of my husband and raising my two children”. Since her fall, Mrs. Lotfi has a personal support worker (PSW) who comes into her home to help her shower and make her meals for 2 hours per day, but Riaz and Negin both agree that their mother needs more support because she is not able to take care of herself anymore.

Riaz takes his mother for a check-up to their family doctor as they are concerned, she might be developing dementia. Mrs. Lotfi is referred to a gerontologist, but Mrs. Lotfi herself is not concerned about her safety and insists on living at home alone. During Mrs. Lotfi’s appointment at Senior’s Wellness Clinic 3 months later, her mini-mental state examination (MMSE) score is 21, and the gerontologist recommends starting her on Aricept (Donepezil) as he suspects that Mrs. Lotfi might have Alzheimer’s Dementia. He also recommends that Riaz and Negin consider alternative living arrangements for their mother. He cautions that her illness will progress, and she is going to require more support and supervision in the future. At this point in time, Mrs. Lotfi needs assistance with her meals, personal care, and medication management (for comorbidities).

Mrs. Lotfi and her family are assigned a case manager, coordinated by their family doctor, to discuss home care options and the possibility of long-term care (LTC). Mrs. Lotfi’s husband had passed away from a heart attack many years ago; therefore, Mrs. Lotfi, Negin, nor Riaz are familiar with the home care options. They have a family care conference with you as the case manager. Negin and Riaz are shocked to learn about the cost of home care, as they were under the impression that LTC was covered within OHIP.

As the case manager, you tell Negin and Riaz to look into assisted living and long-term care options while considering Mrs. Lotfi’s wishes.Mrs. Lotfi does not want to move into the city and still does not want to leave her bungalow. Due to the long waitlist of 1-2 years for LTC, you adviseNegin and Riaz to add Mrs. Lotfi’s name on the list.

Riaz is particularly worried about the cost of LTC or assisted living and asks you about retirement living.  After some research, Negin informs her brother that the retirement homes have the personal care and nursing staff that can meet Mrs. Lotfi’s current medical needs. They need to plan for when their mother’s health will deteriorate, and she is going to require more help with her activities of daily living, personal care, medications, feeding and mobility.

Negin and Riaz are now concerned about financing their mother’s needs for LTC. Riaz suggests selling Mrs. Lotfi’s bungalow and using her old age security, as Mrs. Lotfi does not have a government pension. Negin is hesitating to sell the bungalow at this point as she knows how much it means to her mother.