Case Study: Mr. Samuel Grayson's Healthcare and Discharge Planning

This case study presents Mr. Samuel Grayson, an 88-year-old man admitted to Mona Vale Hospital following a stroke and diagnosed with type-2 diabetes, overlaid on obesity. The case details his extensive medical history, including Alzheimer's disease, hypertension, high cholesterol, and osteoarthritis, and the medications he is prescribed. The case study delves into his social history, living situation with his daughter and son, and the challenges in providing care due to his declining health and functional abilities. The assignment explores the attempts to trial the least restrictive options, including home modifications and family training, and the conflicts that arose between the healthcare team, Mr. Grayson, and his family regarding his discharge destination. The healthcare team recommended the appointment of a Public Advocate as Mr. Samuel’s guardian due to the family's disagreement. References to relevant literature are provided.

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Background
Mr Samuel Grayson is an 88-year-old man who has been admitted to the Mona vale
hospital by his only daughter Beryl Grayson (40 years old) and son Victor Grayson (36-year-old)
when they found him lying in front of the balcony on the first floor of their home during the
early morning at 8:00 AM sharp. Beryl and Victor thought that he was there the whole previous
night. After admission, it was seen that Mr Samuel had a stroke last night, and as a result, he lost
all his energy and fell on the floor being unconscious. A diagnosis of type-2 diabetes was also
made, which is overlaid on a pre-existing diagnosis of obesity.
Social history
Mr Samuel Grayson has been staying in his home at Mona Vale NSW, for the last 30
years. He has lived alone since his wife Mrs Cherry Grayson, died seven years due to heart
attack. Earlier they had a family of four people, and now only the three people Samuel and his
daughter and son live together. Before Mona Vale, Samuel and his family used to stay in
Campbell town with Samuel’s and Cherry’s mother and father. But after the death of both of
their families, Samuel and Cherry along with their children shifted to Mona Vale. Earlier Beryl
used to live separately far away due to her job, though, since the past eight months she has been
living with her father because she lost her job and was preparing for a new job.
Medical history
The medical records of Samuel showed that he has a complex medical history with signs
of several kinds of mental and physical health issues. In the year 2013, Samuel was diagnosed

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with type-2 diabetes, high cholesterol and hypertension. Along with that, he also had
osteoarthritis in the joints (Palazzo, Nguyen, Lefevre-Colau, Rannou & Poiraudeau, 2016). He
also has a history of Alzheimer’s disease (Alzheimer's Association, 2016). Earlier doctor’s
suggested insulin and metformin for treating type-2 diabetes (Aroda et al., 2016); atorvastatin
and lovastatin for treating high cholesterol (Karlson, Wiklund, Palmer, Nicholls, Lundman &
Barter, 2016); bumetanide and acebutolol for treating hypertension (Laurent, 2017). Along with
all these medicines, Samuel was also prescribed with acetaminophen, Cymbalta and some
painkillers for treating his condition of osteoarthritis (Enteshari et al., 2019). Since it is known
that Alzheimer’s disease can cause dementia and since it cannot be completely cured and that is
why the doctors have prescribed him with Aricept and Namenda (both of which are FDA
approved drugs) to treat his symptoms of Alzheimer’s disease (Howard t al., 2015).
Currently, he needs at least two or three individuals to help him to get into and out of bed
and one individual who will help in managing the work linked to post-toilet hygiene. Due to his
osteoarthritis problem, he has to stroll but for an only short amount of a distance with the help of
a four-wheel frame and will need one individual who will supervise him while he walks. He
profits from encouraging himself to use the walker frame and also require someone’s assistance
for making and arranging the food and to set him up to eat and drink daily and to manage her
medication routine. In order to manage insulin intake regularly, Samuel needs one individual to
help him.
The healthcare team stated that Mr Samuel Grayson’s ability for health betterment has
improved in the last ten days. They suggest that it would be best for his best interest to be relived
to a residential care facility because he requires a constant need for a maximum of two
individuals to deliver help with the main activities of daily routine. Mr Samuel is adamant that he

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wants to return home to live with Beryl and Victor whom he states can look after him. Beryl has
a history of chronic back pain, has required three-time admissions to hospital over the past two
years and recently the last one was in this year and stated she wants to be able to care for her
father at home. She states that she is unwilling to agree with the additional facilities as her father
would not want them. Victor is worried about Beryl since she has not been feeling well enough
and mentions that recently it was the third time admission to the hospital in few months, believes
it is now time for their father to enter residential care. Victor is very much opposed of
discharging his father back to home since alone Beryl is in no condition of taking care of Samuel
and Victor would not be able to take care of their father since he has to leave for work every day.
Recent risks
Due to osteoarthritis, Mr Samuel has a high chance of falling from high places. Also, due
to his condition especially stroke, his right side of the body has become weakened, and due to
Alzheimer he has lost the ability to do daily living tasks on his own and cannot make decisions
on his own. It has also complained that Samuel does recognize people whom he has met before.
He now requires individuals to assist him in doing his daily living tasks, and he lacks knowledge
regarding his health conditions. Mr Samuel is also at danger of further substantial functional
weakening which may aggravate Beryl’s back pain.
Attempts to trial the least restrictive options
In order to cure Samuel, the healthcare professionals decided to have a meeting among
Samuel and his family along with other senior staff of the multi-disciplinary team to decide on
what has to be done. In the first meeting, it was seen that all the members agreed on giving Beryl

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personalized care training to train her to care for Samuel after discharged. However, during the
momentum of the training process, Beryl mentioned a severe amount of pain in her back when
she tried to lift Samuel from the bed and stated she would prefer to leave her father on the bed
until he was well enough to get out with less support.
Later an occupational therapist visited Samuel in their home and recommended that they
modify the tap system to a shower system and install a commode in a safe place where chances
of slipping on the floor would be minimum and will have maximum support (Parente, Tofani,
Santis, Esposito, Santilli & Galeoto, 2017). Also, the OT mentioned them to provide food of
Samuel directly to the bedroom Mr Samuel stated he would not pay for these modifications and
Beryl stated she did not wish to go against her father’s wishes. The team encouraged Mr Samuel
to consider developing a back-up plan and explore residential care options which would offer a
ground floor for them to stay rather than staying in their old house on the first floor. Staying on
the first floor will become hectic for Samuel to daily go up and down to the ground floor using
the stairs as his home does not have an elevator or escalator. The team also delivered education
and information to Beryl and Victor regarding the progressive impact of Samuel’s co-morbidities
on his functioning.
Mr Samuel and Beryl declined to accord with and proceed with the Aged Care
Assessment process which would allow Victor to waitlist his father’s name at suitable aged care
facilities (Warburton, Cowan, Savy & MacPhee, 2015). Thus the healthcare professionals
proceeded with organizing a trial overnight visit. Unfortunately, this visit was not successful as
Beryl would have to stay at home alone taking all the responsibility of Samuel and Victor could
not stay back home as had to go for work and thus they found it very much challenging to
provide care without the use of an accessible bathroom. Mr Samuel remains adamant that he will

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remain at home. The team is continuing to work with the family to maximize Mr Samuel’s
independence, but they believe that it is unlikely this will improve.
The healthcare professionals decided to spend some time with Beryl in order to make her
understand the necessary community support services and residential care services, and thus they
helped her to explore her adjustment to the situation and delivered her with knowledge regarding
the care services. The healthcare team shared information regarding the Transition Care Program
with Beryl that would help the families to work through all the logistics. Along with that, the
team shared her with more data regarding where she would be able to get further information
regarding her doubts. The healthcare professionals seeking advice on the process and legislative
requirements from the Office of the Public Advocate’s Advice Service.
Recommendation
The healthcare team who was responsible for the care of Samuel ran out of all the options
and thus required of taking a guardianship order in order to decide on Mr Samuel’s discharge
destination and access to services. As a last resort, the healthcare team recommended the Public
Advocate to be appointed as Mr Samuel’s guardian (Martin, Rodríguez-Pinzón & Brown, 2015).
Since Victor and Beryl were not in agreement with each other’s decisions; thus, the healthcare
team believes Public Advocate is the most suitable arrangement for Samuel’s best interests. The
healthcare professionals also think that there is an impending conflict of interest as Beryl has
articulated substantial unease regarding her father’s relocation to residential care and thinks it
will have an impact on her father’s living arrangements and will also impact her father’s mental
and physical health.

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References
Alzheimer's Association. (2016). 2016 Alzheimer's disease facts and figures. Alzheimer's &
Dementia, 12(4), 459-509.
Aroda, V. R., Rosenstock, J., Wysham, C., Unger, J., Bellido, D., González-Gálvez, G., ... &
Bergenstal, R. M. (2016). Efficacy and safety of LixiLan, a titratable fixed-ratio
combination of insulin glargine plus lixisenatide in type 2 diabetes inadequately
controlled on basal insulin and metformin: the LixiLan-L randomized trial. Diabetes
care, 39(11), 1972-1980.
Enteshari-Moghaddam, A., Azami, A., Isazadehfar, K., Mohebbi, H., Habibzadeh, A., &
Jahanpanah, P. (2019). Efficacy of duloxetine and gabapentin in pain reduction in
patients with knee osteoarthritis. Clinical rheumatology, 38(10), 2873-2880.
Howard, R., McShane, R., Lindesay, J., Ritchie, C., Baldwin, A., Barber, R., ... & Jones, R.
(2015). Nursing home placement in the Donepezil and Memantine in Moderate to Severe
Alzheimer's Disease (DOMINO-AD) trial: secondary and post-hoc analyses. The Lancet
Neurology, 14(12), 1171-1181.
Karlson, B. W., Wiklund, O., Palmer, M. K., Nicholls, S. J., Lundman, P., & Barter, P. J. (2016).
Variability of low-density lipoprotein cholesterol response with different doses of
atorvastatin, rosuvastatin, and simvastatin: results from VOYAGER. European Heart
Journal–Cardiovascular Pharmacotherapy, 2(4), 212-217.
Laurent, S. (2017). Antihypertensive drugs. Pharmacological research, 124, 116-125.

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Martin, C., Rodríguez-Pinzón, D., & Brown, B. (2015). Human Rights of Older People.
Springer, Nueva York.
Palazzo, C., Nguyen, C., Lefevre-Colau, M. M., Rannou, F., & Poiraudeau, S. (2016). Risk
factors and burden of osteoarthritis. Annals of physical and rehabilitation
medicine, 59(3), 134-138.
Parente, M., Tofani, M., De Santis, R., Esposito, G., Santilli, V., & Galeoto, G. (2017). The role
of the occupational therapist in disaster areas: systematic review. Occupational therapy
international, 2017.
Warburton, J., Cowan, S., Savy, P., & MacPhee, F. (2015). Toward the development of a more
integrated aged care assessment process for rural older Australians: practitioners’
perspectives. Journal of gerontological social work, 58(5), 503-520.