Mr. Lucien Davenport is a 69-year-old patient who has been your clinic patient for the last 3 years. He is originally from New Orleans, but he and his wife relocated to Louisville where their daughter lives following loss of their home in Hurricane Katrina. You typically see him every 3 to 4 months to maintain control of his diabetes (type 2) and his hypertension, hyperlipidemia, gout, and peripheral vascular disease. In the last year, he has missed a couple of regular appointments despite rescheduling and calling him personally. When you call him to see why he did not come to clinic, you learn that his wife of 43 years died 9 months ago, and he promises to come back to clinic for his next regularly scheduled visit in a couple of months.
Before that appointment occurs, his daughter JoAnn brings Mr. Davenport to the ER for a gout flare. She also asks to speak to the social worker in private due to her concerns about Mr. Davenport’s safety at home. The ER social worker records the concerns in her notes and coordinates moving his appointment with you up to the following week to both follow-up on his gout flare and talk to him and his daughter about how things are going at home.
Social worker additional history regarding home function states:
Daughter privately reports (in hallway where she asked to speak without client, who is her Father) finding spoiled food out at home and finding stove left on for unspecified period at least once. Daughter reports that Father will not show her the checkbook or bills or give her access to the checking account shared with her Mother prior to Mother’s death, and finding collection notices piled at doorstep with uncollected mail. Daughter reports weight loss in Father and periods of confusion about year and whether Mother is still alive. Daughter reports Father is not showering or shaving as usual. Daughter also reports she took the car keys away out of fear that Father would drive and hurt himself or others. Daughter also reports that Father has a collection of guns in the house and that they are loaded. When encouraged to discuss her concerns with Father in front of Social Worker, Daughter refused, saying he would get angry and leave the ER. Social Worker advised Daughter of resources available with mental inquest warrant procedure and crisis line for Adult Protective Services if she is worried about her father’s imminent danger to self or others.
Client’s willingness to share and discuss his care with the daughter is assessed, and he refuses this permission. His level of education and financial situation were assessed. He has a 9th grade education and was employed previously as a maintenance man in the public school system in Louisiana and has been retired since relocating to Louisville. He and his wife had pensions that they lived on, and hers has been discontinued since her death 9 months prior. His pension with social security amounts to $2677 per month, and he lives in a small home that he and his wife purchased with insurance money following Katrina. Daughter lives a few miles away and is the only remaining family. His wife had a $30,000 death insurance benefit that was used to pay her funeral expenses and remaining healthcare bills after she died of pneumonia due to COVID-19 9 months ago. The couple attended the local Southern Baptist church at the wife’s preference until her death, and he has not attended since. He has not identified a financial or medical surrogate decision-maker, and has no advanced directive in place. He refuses to discuss the possibility of planning for these during today’s interview.
Client reports to Social Worker that he has been “down” since his wife died and that she “used to cook and do the bills” and he has not “felt like doing any of that.” When asked about weight loss, he says he is eating, but not as well as when his wife was alive because “she was a great cook.” When asked about the financial consequences of not paying bills, he gets angry and says “I’m not a child, I’ll get to it, they aren’t even that behind” and then says his daughter needs to “mind her own business” and that “she wants my money so she doesn’t have to wait to inherit it, she has all of this credit card debt and is about to get kicked out of her apartment.” When asked who he could call if he was in crisis and needed someone to talk to, he said “I guess not my daughter since she’ll just get you guys to come lock me up and then take all my money!”