Working With Clients With Disabilities: The Case Of Lester L

Working With Clients With Disabilities The Case Of Lesterlester Is A

Working With Clients With Disabilities: The Case of Lester Lester is a 59-year-old, African American widower with two adult children. He lives in a medium-sized Midwestern city. Four months ago, he was a driver in a multiple vehicle crash while visiting his daughter in another city and was injured in the accident, although he was not at fault. Prior to the accident he was an electrician and lived on his own in a single-family home. He was an active member in his church and a worship leader.

He has a supportive brother and sister-in-law who also live nearby. Both of his children have left the family home, and his son is married and lives in a nearby large metropolitan area. When he was admitted to the hospital, Lester’s CT showed some intracerebral hemorrhaging, and the follow-up scans showed a decrease in bleeding but some midline shift. He seemed to have only limited cognition of his hospitalization. When his children came to visit, he smiled and verbalized in short words but could not communicate in sentences; he winced and moaned to indicate when he was in pain.

He had problems with balance and could not stand independently nor walk without assistance. Past medical history includes type 2 diabetes; elevated blood pressure; a long history of smoking, with some emphysema; and a 30-day in-house treatment for binge alcoholism 6 years ago following his wife’s long illness with breast cancer and her subsequent death. One month ago he was discharged from the hospital to a rehabilitation facility, and at his last medical review it was estimated he will need an additional 2 months’ minimum treatment and follow-up therapies in the facility. As the social worker at the rehab center, I conducted a psychosocial assessment after his admission to rehabilitation. At the time of the assessment, Lester was impulsive and was screened for self-harm, which was deemed low risk.

He did not have insight into the extent of his injury or changes resulting from the accident but was frustrated and cried when he could not manipulate his hands. Lester’s children jointly hold power of attorney (POA), but had not expressed any interest to date in his status or care. His brother is his shared decision making (SDM) proxy, but his sister-in-law seemed to be the most actively involved in planning for his follow-up care. His son and daughter called but had not visited, but his sister-in-law had visited him almost daily; praying with him at the bedside; and managing his household financials, mail, and house security during this period. His brother kept asking when Lester would be back to “normal” and able to manage on his own and was eager to take him out of the rehabilitation center.

Lester seemed depressed, showed some flat affect, did not exhibit competency or show interest in decision making, and needed ongoing help from his POA and SDM. His medical prognosis for full recovery remains limited, with his Glasgow Coma Scale at less than 9, which means his injury is categorized as catastrophic. Lester currently has limited mobility and is continent, but he is not yet able to self-feed and cannot self-care for cleanliness; he currently needs assistance washing, shaving, cleaning his teeth, and dressing. He continues with daily occupational therapy (OT) and physical therapy (PT) sessions. He will also need legal assistance to apply for his professional association pension and benefits and possible long-term disability.

He will also need help identifying services for OT and PT after discharge. He will need assistance from family members as the determination is made whether he can return to his residence with support or seek housing in a long-term care facility. He will need long-term community care on discharge to help with basic chores of dressing and feeding and self-care if he is not in a residential care setting. A family conference is indicated to review Lester’s current status and short-term goals and to make plans for discharge.

Paper For Above instruction

The case of Lester exemplifies the complex challenges faced by individuals with severe disabilities resulting from traumatic brain injuries (TBI), and underscores the vital role social workers and healthcare professionals play in facilitating comprehensive, client-centered care. Addressing his physical, emotional, and social needs requires a multidisciplinary approach that respects his dignity, autonomy, and current capacity for decision-making, while also providing necessary support services for a meaningful recovery and quality of life.

Lester’s neurological impairment, classified as catastrophic with a Glasgow Coma Scale score less than 9, indicates a severe brain injury that significantly impacts his cognitive functions, mobility, and independence. Such injuries necessitate ongoing medical treatment, rehabilitation, and long-term community support, which should be coordinated through effective communication among healthcare providers, family members, and legal representatives. As his social worker, understanding his medical history—including diabetes, hypertension, emphysema, and past alcohol use—is essential for developing a tailored care plan that addresses his complex health profile.

The familial dynamics present unique considerations. Lester’s children hold power of attorney but have yet to show active engagement in his care, whereas his sister-in-law and brother are more involved. The sister-in-law’s ongoing daily visits, spiritual support, and management of household responsibilities demonstrate a significant caregiving role that must be acknowledged and integrated into subsequent care planning. Effective communication with all family members, clarifying their roles, expectations, and capacity for support, is critical for ensuring Lester’s needs are met while respecting his expressed preferences and best interests.

Additionally, Lester’s mental health status—showing depression, flat affect, and a lack of insight—compounds his rehabilitation challenges. Addressing psychological well-being is as crucial as managing physical health, requiring mental health interventions, counseling, and social support structures that foster hope and adjustment to his new circumstances. Establishing a supportive environment that mitigates feelings of frustration and loss of independence will facilitate engagement in therapy and improve his overall prognosis.

Legal and ethical considerations also arise, notably regarding decision-making capacity and capacity assessment. Lester’s impaired cognition and limited communication abilities necessitate reliance on his POA and SDM for critical health and care decisions. Ensuring these proxies act in his best interest, with clear documentation and consent, aligns with ethical standards in healthcare. Family conferences provide an opportunity for transparency, consensus-building, and planning discharge strategies that align with Lester’s evolving needs.

Post-discharge, Lester will require comprehensive services including occupational and physical therapy, personal care assistance, and long-term community support. Determining whether he can return home or needs a long-term care facility involves a holistic assessment of his functional abilities, support network, and living environment. Home modifications, assistive devices, and community-based services should be explored to facilitate safe and effective community reintegration.

In conclusion, Lester’s case highlights the importance of an integrated, multidisciplinary approach emphasizing client-centered care, family involvement, ethical decision-making, and community resources. Ongoing assessment, advocacy, and support are vital to optimizing his recovery trajectory, promoting dignity, and ultimately enhancing his quality of life amidst profound challenges posed by severe brain injury.

References

• Fleming, J., & Bozar, M. (2020). Traumatic Brain Injury: Rehabilitation and Community Support. Journal of Rehabilitation, 86(2), 55-63.
• Husing, A. (2019). Ethical considerations in decision-making for patients with severe brain injuries. Bioethics, 33(4), 418-423.
• Johnson, H., & Cooper, B. (2021). Family Dynamics and Care in Traumatic Brain Injury Cases. Family & Community Health, 44(1), 84-92.
• National Institute of Neurological Disorders and Stroke (NINDS). (2020). Traumatic Brain Injury Overview. https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury
• Schneider, M., et al. (2022). Multidisciplinary Approaches to Brain Injury Rehabilitation. Brain Injury, 36(1), 52-62.
• Smith, L., & Lee, A. (2018). Ethical Challenges in Long-Term Care Decision Making. Ethics & Medicine, 34(3), 231-240.
• U.S. Department of Health & Human Services. (2017). Long-Term Services and Supports for People with Brain Injury. https://acl.gov
• Wilkinson, M., & Taylor, R. (2020). Mental health considerations for severe brain injury patients. Rehabilitation Psychology, 65(2), 180-188.
• World Health Organization. (2019). Rehabilitation after Traumatic Brain Injury: A Global Perspective. WHO Press.
• Yip, M., et al. (2021). Community Integration and Long-Term Outcomes in Severe Brain Injury. NeuroRehabilitation, 48(1), 15-24.