All names and identities have been changed to protect the client’s confidentiality

Client (John Snr) referred to Great Lakes Manning Community Options in 2002 by Mid Western Brain Injury Rehabilitation when he and his wife relocated to the Great Lakes area.

John Snr. was assessed in May of that same year

Stroke in 2000 Meningitis – resulted in Acquired Brain Injury Visual Impairment Cognitive Impairment Limited use of hands - needs assistance with eating, dressing etc Depression Aged 52 at time of referral Client is Maltese

John Snr. is cared for by his wife (Judy) for all his care. He is completely unable to assist in many of his tasks of daily living. Judy was not coping with the situation. Judy is also the carer of their eldest grandson who has ADHD.

Judy has a history of alcoholism

Judy provided all levels of care for the John Snr. including –

most personal care including all aspects of toileting

Feeding at every mealSupport getting in and out of bedUnable to leave alone due to fear of choking Client relied on wife for all aspects of his life

and would make requests continually.Carer reached breaking point.

At the initial home assessment the client and carer needs identified the following -

Assistance with Personal CareAssistance with Domestic including some meal preparationAssistance with equipment needs (PADP)RespiteFinancial managementSupport for caring for grandson

Referral to Home Care for domestic and personal care

Referral to Meals on Wheels ( clients then declined this service)

Referral to Carer Respite Centre ( never accessed)Referral to Neighbour Aid for shopping supportVitalcall Contact with school for grandsonInformation on ADHD including support groups

2004 –Son and family move to area – 3 children

youngest with cerebral palsyJudy leaves the clientJohn Snr. unable to care for himself – son and

family unable to assist with any of the careJohn Snr. Refuses to be placed in aged care facilityGrandson returns to his family

Home Care – reassessed to –Personal care morning and nightly 7 days per week, also

included meal preparation, Domestic assistance - 2 hours weekly

Meals on Wheels – 7 days per weekNeighbour Aid to provide weekly shoppingVitalcall installed (this had been refused earlier)Transfer of Power of Attorney to his sisterAssistance with changing accounts for electricity and rent

from joint namesArranged for accounts to be deducted from Centrelink

paymentOT assessment for equipment to increase independenceArranged for wife’s possessions to be transported to herAssistance with establishment of account at Bilo for

shoppingOrganised solicitor for client to change beneficiaries of

superfund and will

John Snr. independence increased and he was able to remain at home.

Meals on Wheels was cancelled and Home Care prepared simple meals a couple of times per week.

Client was able to heat these in the microwaveSon’s partner ( moved in with John Snr. in 2007

but didn’t provide any care or assistance. Suspicion of drug use and abuse of John Snr’s medication. John Snr. asked her to leave early 2008, wife returned for a short time but also moved out again

Equipment was purchased (after OT report) which enhanced client’s quality of life

In 2006 John Snr. needed to move from his residence as it was being sold. He was able to negotiate with the local real estates and organise for viewings of other properties. Assisted with organising a Neighbour Aid volunteer to assist with some of the inspections

Community Options assisted with the move and transfer of services.

Client’s situation is stable with services in place and the client is discharged from Community Options in September 2008.

Son (James) and his family moved to the area late 2004. Referred youngest child who has cerebral palsy to Community Options in 2006

2 other children - both with possible intellectual or learning difficulties

Son likes to be living near his father

37 year old carer of 3 children – receives Family Assistance and Carers

allowancevolatile relationship with his partnerLow literacy skillspoor memory lack of insightpossible intellectual disability lacks initiative and organisational skills lacks ability to manage the household eg: untidy house, take

away meals, no or little money limited parenting skills – reluctant to instil discipline – children

often don’t attend school, allowed to wander streets at night Developed a friendship with the owner of the tip and sometimes

helps out in return for a few dollars or collectables eg: cars or parts

Unstable – recent hospitalisation in Mental Health unit – past history of mental health issues

lack of insight lacks parenting skills and decision making lacks understanding of sensible dress (for her and the children),

healthy meals and appropriate living conditions history of violent outbursts in public which have resulted in the

police being called and placement in rehabilitation and mental health units

not trust worthy – will tell you what she thinks you want to hear and will also play once service against another

history of drug abuse, especially amphetamines to assist with depression – prescribed by psychiatrist but abuses the usage which results in unstable behaviour

currently situation is stable and relationship reasonably peaceful as she is serving a 12 month good behaviour bond.

moved out last year, returned and lived with the father – in –law. (previous client discussed) has since returned to the family home

Eldest (David) is 15 and recently left school, has poor literacy and numeracy skills, is not interested in returning to school as he has to travel 30 klms. on a bus to get there.He felt he was an outsider and unable to fit in and started mixing with the wrong crowd.

Middle child ( Julia) is 12 and will complete primary school this year, in trouble often, out of control behaviour – local school has referred her to special school which is 45 minutes away and will create problems in attendance, has also been the centre of allegations of sexual misconduct in the family.

Youngest (John jnr – our client) is 9. John has cerebral palsy, is able to walk with the aid of splints, has been referred to the Spastic Centre, receives regular Botox injections, regular positive support from the school.

All children appear to have a positive relationship with each other and the parents

Level of ability, skills and understanding of the family members

level of education of the parents and the ability to be positive role models to the children

Children have little external social stimulation and interaction

Geographic isolation Very few friends Referred to DADHC in 2007 –no or little support.

Transferred to different DADHC office and only the eldest child has been activated with no outcomes as yet.

Close family unit that depend on each other, even when volatile, extended family unit and supportive close relationship from

grandfather

Referrals to Home Care to assist and support with cleaning of the house, particularly when the partner was not living there.

Assistance to address overdue rent to try and avoid eviction Relocation after eviction Referral to Family Support Services for parenting skills and support – no outcome due to

rural isolation and reluctance of the parents to participate. Purchase of fridge Referral to Holiday Coast Respite – youngest client has package but due to rural isolation

and lack of organisation skills of the family little of the package has been utilised. Enrolment in Vacation Care – very positive outcome and accessed some of the Holiday

Coast dollars to provide a one-one-one worker. Referral to Leisure and Respite Options for social activities for all of the children Family Assistance Funding application – purchase of tricycle for youngest Assistance for James to obtain free tax help Assistance with repairs and organising registration of family vehicle. This allows family

to attend medical appointments and shopping Use of a planner to allow James some structure of when appointments and activities for

the children are happening. Community Options assists with updating this through the Home Care workers

Regular meetings with the school and the services involved to ensure consistent approach by all workers involved ( parents are included in this meetings. The father will often attend if he is picked up and taken)

Whilst this family will continue to function with or without our support, the service will continue to assist by providing the Carers with information to make informed decisions to improve the quality of life for themselves and their children. This was demonstrated to us in the last school holidays when the two youngest children attended vacation care and benefitted from participating. The strong network and support from the school, services and regular case conferences involving the parents has been very positive.

The whole family unit has been maintained. Further support to transition the children through the school system, address equipment needs and regular specialist visits will hopefully enhance the quality of life for this family.

There is still many issues and areas that need to be discussed with the family. Community Options will continue to provide support, case management and information to try and address some of the issues that this family face, particularly around the ongoing care of John jnr. And his changing needs as he gets older.

These clients often raises many challenges for the case manager due to the isolation, limited services available family history and their limited skills but also provides opportunities to investigate and trial innovative ideas for this family. We recently organised services for vacation care as per the previous school holidays but unfortunately the days before the start of the holidays the family have become uncontactable.