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Avoid the Hustle

Multigenerational Family Dynamics: Case Study

Category: case study

Mom brought Grandma, a 75 year old African-American, into the doctor’s office, because Grandma has been experiencing increasing pain in her legs and hands over the last year. She was diagnosed with arthritis about 5 years ago, but has been reluctant to go back to the doctor for ongoing treatment. Grandma is caring for both her husband and her mother (Great-grandma), who also lives with them. Grandma’s husband (Grandpa, 80 years old) suffered a severe heart attack a year ago. Although he is still able to do many things for himself, he is becoming more disoriented and confused cognitively.

Great-grandma, 95 years old, moved in with Grandma and Grandpa over ten years ago. Increasingly frail, she needs Grandma, as her primary caregiver, to help with most of her Activities of Daily Living (ADLs). The doctor referred Grandma and Mom to talk with the social worker after prescribing her pain medicine for Grandma’s arthritis.

Mom, 53 years old, convinced Grandma to see the doctor after numerous tense discussions about Grandma needing help to manage her pain. Now Mom is voicing the opinion that Grandma cannot continue to care for Great-grandma in the home. Mom comes over to help Grandma with her caretaking responsibilities at least twice a week. But lately, Mom has needed to give more time, since Grandma is not able to meet the needs of both Great-grandma and Grandpa. Mom feels guilty that she’s not able to help as much as Grandma wants her to. However, Mom has just gone back to school to get a nursing degree, and works nights as a nursing aide in the hospital. Mom thinks Great-grandma needs to move to a skilled nursing facility, because no one in the family is able to provide for all her needs. Grandma is highly resistant to moving her mother to any kind of long-term care facility. Mom doesn’t like the idea either, but she does not know of any other option.

Mom’s son, 20 years old, is in college nearby, but is very busy and comes around only about once a month to help his mom. Mom’s brother, age 55, lives in another state and does not seem to understand or care about the difficulties that Mom is facing in trying to meet the needs of her parents’ and Great-grandma. The family is stressed, overwhelmed, near the breaking point and does not know how to resolve the issues facing them.

The social worker learns more about the family and as he listens, he draws the following genogram:

If you were the social worker assigned to work with Mom and Grandma, how would you proceed to assess the family’s needs?

This is an individual assignment. Please disregard the group assignment.

• What does the genogram tell you about this family?
• Who would you define to be the primary client? (A primary client is the one who is going to be the most affected)(located in an unsafe situation) The secondary client? (the one that his/her needs are not being met) How do their needs differ? What emotional issues are they experiencing?
• Psychodynamic Perspective (Provide how would you apply each perspective in this specific case)
• Family Systems Perspective
• Family Life Cycle Perspective
• Feminist Perspective
• Family Stress & Coping
• Family Resilience Perspective

Your work is to develop a strategy how they would help the family understand their current situation by educating them on the perspectives assigned. In other words, An example would be using the Humanistic Perspective. I would outline my approach to the different issues faced by the family members. Great Grandma needs more care and according to family, they can no longer care for her at home. Second, educate on the humanistic perspective – (dignity & worth), all have a value and each person is unique. Choices are made for the desire to maintain a positive experience with others, maintain personal meaning, and be true to self to reduce anxiety. Could this be jeopardized by keeping great grandma at home? I would ask them how? Is she being treated with less worth & dignity if placed in a nursing facility? Can stress interfere with mood and behavior? As they begin to verbalize how, they are provided the opportunity to voice and this helps them make the connection of their feelings and her worth as well as we discuss how stress can interfere with quality of relationships.