As the average life expectancy of Americans continues to increase, it presents a challenge of an explosion in population of the elderly aged 65 and over (Valdez & Arce, 2000). Such is the predicament of the patient in the case (whom shall be called John in this case), who hails from the Hispanic community which has contributed to the diversity of senior population. John is 85 years old and has been married since he was 25 years of age. They hail from the Hispanic community and their first and second languages are Latino and English respectively. John who lives in Los Angeles is neither religious nor an atheist, has never been convicted, and lived with his wife for 60 years until her death. The patient has no record of mental issues though he is a light drinker. Johns drinking increased after his wife passing, and it coincided with deterioration in health and decrease in financial support as the wife was a major financial contributor through donations from well-wishers. John has no known close family or relative and they never had children in their marriage. The patient has no medical insurance and benefits from the Medicare initiative, but give that he retired from his role as a janitor at the age of 55 years, he exhausted his saving many years back and has been living through support initiative. John lives alone and confesses to going through difficult times since his wife’s death.
Assessment Approach
There is a significant increase in the cultural pluralism of the US society that has raised the need among clinicians to examine the role of cultural factors on psychiatric illness, in addition to presentation of symptoms and help-seeking behavior. Clinical encounter in the case is defined by the need for accurate diagnosis across cultural barriers to facilitate formulation of treatment or care programs that are beneficial to the patient of client. The Cultural Formulation Model is identified as the most suitable systematic approach for eliciting and evaluating cultural information, given that English is the second language to John, and they may not be able to understand the complex nature of the discussion during the session. According to Lewis-Fernández and Díaz (2002), Cultural Formulation Model expands on the DSM-IV guidelines that are used to ensure accurate diagnosis and treatment across cultures. Fernández and Díaz (2002) elaborate that Cultural Formulation Model comprises of five key elements: “assessing cultural identity, cultural explanations of the illness, cultural factors related to the psychosocial environment and levels of functioning, cultural elements of the clinician-patient relationship, and the overall impact of culture on diagnosis and care” (p. 272). The components are crucial for inclusive participation of John in aiding the process of diagnosis.
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Recommendations and Interventions
Support programs exist for ensuring equity among Americans including the elderly. However, comprehensive assessment is needed to ensure that only eligible elders are enrolled to such programs. The family and financial history of John leads to their categorizations and the most in need for health benefits in Medicaid and financial support. It important that John be considered for placement in an elderly care home because besides the physical and financial challenges that come with age, John also shows signs of depression and is developing alcohol dependence, situations that need to be managed closely as can only be dome where John can be monitored around the clock. A study by Zisook and Shuchter (1991) established that 73% of widows and widowers met the criteria for depression as per the DSM manual at different stages in the first year of losing their spouse, and the prevalence was substantially high compared to depression rates in groups where all couples are alive.
Resource Attainment Plan
There are a number of places where John can access relevant help they need at their age and include homes for the elderly where assisted living is available. They include:
Sierra Bonita Board & Care; Los Angeles, CA; +1 323-658-8722
Vermont Senior Housing; Los Angeles, CA; +1 323-334-3901
Belmont Village Senior Living Westwood; Los Angeles, CA; +1 310-475-7501
It is important for John to liaise with representatives of federal government agencies including the U.S. Department of Housing and Urban Development (Robert C. Weaver Federal Building, 451 7th Street SW, Washington, D.C.) and the U.S. Department of Health and Human Services (Hubert H. Humphrey Building Washington, D.C., U.S.), charged with administration of assistance to recipients through special programs to facilitate being enlisted into special care programs.
Client Strengths that can Aid the Plan
John situation is aided by the fact that he is among the few Latinos who are knowledgeable about Medicare programs by the government and have taken advantage of it, hence they are able to cover their grief counselling expenses. In addition, the accuracy of the diagnosis justifies their inclusion into a list of clients prioritized for care and support programs for the elderly. Having no source of livelihood and the heightened need for assisted living increases John’s chances of getting the best help.
Potential Barriers
However, John’ situation is complicated by the absence of any known family member or relative who can contribute towards their care and support. This is likely to be a problem right from the onset because it proves difficult to understand the condition of the client due to cultural challenges and language barrier despite the use of Cultural Formulation model. In addition, John’s presentation with depression and alcoholism increases the need for specialized care which may require enlistment into special programs where consent of the next of kin may be needed. Navigating these challenges requires inclusion into a treatment program that is closely monitored for all symptoms presented. An appointed representative who is not part of the care team must be sought to take part in decision making and issue consent where it is needed.
Discussion of Impacts of Religion and Culture on Recommendations
Though John is not influenced by any religious leanings, their potential for recovery may be impaired by cultural barriers. Communication irregularities are a norm where instructions are issued in English to clients whom this is their second language. In addition, racial inequalities have led to misguided evidence where members of the Hispanic community are considered to have high prevalence rated of depression. Such racial and culturally biased perceptions have the potential to limit John’s chances of getting the care and support they need. In addition, Latinos are not aware of the special programs available to recipients facing the predicament similar to John’s a situation that limits their access to relevant support programs and other benefits offered by the federal government.
Conclusion
John is no condition to recover optimally if they are left on their own even if the emotional and financial support provided to them. However, enlistment into a care home for the elderly solves this problem because they will be under the care and attention of qualified professionals at all times, which may speed the outcome of interventions. It is important to take into consideration the possibility of a support group that allows John to be people off similar problems; it also allows for creation of a day program where the group can visit others of similar age state to share and discuss their experiences or just have a social time. It is also possible to explore the possibility of having a trained caregiver to administer the necessary tasks and only visit the clinic for therapy sessions. This implies getting a temporary place for John, which should also include a companion for them besides the caregiver.
References
Lewis-Fernández, R., & Díaz, N. (2002). The cultural formulation: a method for assessing cultural factors affecting the clinical encounter. Psychiatric Quarterly , 73 (4), 271-295.
Valdez, R. O. B., & Arce, C. (2000). A profile of Hispanic elders . Cutting Edge Communications, Incorporated.
Zisook, S., & Shuchter, S. R. (1991). Depression through the first year after the death of a spouse. The American journal of psychiatry , 148 (10), 1346.
