the reassessment - school of social work

Chapter 8

TheReassessment

Reassessment completes the cycle envisagedin the Family Assessment and Change Pro-cess, in that it measures the effect of theclient’s, family’s, and social worker’s actionsagainst the client’s initial circumstances, and,depending on the results, reinitiates the pro-cess of identifying and prioritizing items forchange, specifying goals, developing andimplementing the family plan, and monitoringthe client’s change or response (based on AModel for Excellence, p. 42).

When you reach this stage in the process,you are likely very knowledgeable about theclient, the family, and their circumstances. AModel for Excellence recommends that socialworkers conduct reassessments at least annu-ally. While some aspects of monitoring some-times can be performed over the telephone, thereassessment, which replaces the quarterly re-view at least every fourth quarter, is somethingthe client and social worker do face to face. Youmay need to conduct a formal reassessmentmore frequently than annually if your client’scircumstances change radically. For example, ifyour client is hospitalized in the course of theyear, you may need to reassess to see what effectthe situation that caused the hospitalization hashad on his or her functioning. Are the servicesyou had in place still appropriate? Are there newproblems? Are there new goals to be set? Arenew interventions or services necessary? These, ofcourse, are the same questions you will be askingif the reassessment falls at the “normal” time.

The Social Work behind theRecordWhy Is It Important to Do aThorough Reassessment?We’ve just said that by the time you need toreassess your client and family you know themfairly well, so why go to all this trouble? Onereason has to do with empowerment. Both foryou and for the client, it helps to set a formal timeto take stock of the situation globally and mea-sure and take pride in your successes. One suc-cess often makes others possible, because itallows clients and families to see that theirefforts are effective and that they have somemeasure of control over their lives. Just as wesuggest that you help clients identify strengthsbefore problems, we suggest that you identifysuccesses and savor them together before youturn to new areas for change or to unfinishedbusiness—things that didn’t work out so well.

Reassessment also provides an opportunityto look at the client’s and family’s situation with“new eyes,” to identify aspects of their lives andfunctioning that might not have been apparentwhen you were first getting to know and under-stand them.

In examining both your successes and theproblems that remain, try to identify why you gotthe results you did. Apart from the practicalaspects—the intervention fit the goal, or didn’tquite—were there things in the attitude of theclient or of another involved party that helpedthings along, or conversely, that made it harderto succeed? Also, be generous in how you mea-sure success. Remember that among the pos-sible types of goals were maintenance goals. Forsome things, holding level or minimizing therate of decline are successes.

Using the Adult ServicesAnnual ReassessmentThe Adult Services Annual Reassessment has manyelements in common with the original Adult Ser-vices Functional Assessment and others more likethe Interim or Quarterly Client Review. This re-

103

104 Social Worker’s Guide

A Guide to Record Keeping in Adult Services

After the first quarterly review, Mrs.Johnson showed progress in a number ofareas. Her doctor had arranged one homevisit from an occupational therapist, andbetween that and good modeling by the in-home aide, she had learned ways to com-plete her household tasks up to her ownstandards and felt good about it. The “Sun-shine” committee of her church women’sgroup volunteered to do spring houseclean-ing once a year—windows, turning mat-tresses, cleaning rugs and slipcovers, andother tasks that were too much for her tohandle by herself. The aide was still help-ing with her hair.

To improve her financial situation, Mrs.Johnson sold her house to her son. Thefinancial advisor at Kudzu Women’s Centerhelped them find a lawyer whom they couldafford, and Mr. Johnson signed a contract topay his mother $25 every two weeks, pay formajor upkeep of the house and property, andallow her to live there for her lifetime. Aspart of the agreement, they made arrange-ments for Mrs. Johnson’s care should shebecome physically or mentally incapacitated.

She was resolving her grief issues fairlywell, but she and some of the other widowsin the support group liked the group so muchthey were thinking of continuing to meet tosupport each other in coping with such otherissues as aging and dealing with adult chil-dren. She had a regular ride to church onSunday mornings and rarely missed a ser-vice. Her social worker anticipated beingable to close the case after the second quarterlyreview. Then, about two weeks before herreview was scheduled, she slipped on a wetspot on her porch and broke her right arm.

The social worker rescheduled the re-

view as soon as possible on learning aboutthe broken arm. Because Mrs. Johnson isright-handed and the arthritis is worse inher left hand and arm, she was now im-paired in all ADLs except toileting. Sheneeded more in-home aide services thanshe had been getting. Mrs. Gooch was notable to work enough additional hours onthe schedule that was needed, so a new in-home aide was assigned. Mrs. Johnsonreally missed Mrs. Gooch and had troubleadjusting to Ms. DeShields, who wasyounger and had fewer of the same inter-ests. The social worker helped Mrs. Johnsonunderstand that she had other friends andthat the aide was doing her job adequately.Mrs. Johnson’s attitude remained goodthrough this event. She saw it as a tempo-rary setback that others had dealt with. “Itcould happen to anyone.”

Nothing very eventful happened afterthis. Mrs. Johnson had another visit fromthe occupational therapist and got someadvice and devices to help her dress andbathe herself, and she very slowly resumedmost of her personal care and a little bit ofthe housework. By the third review the armhad not finished healing. Dr. Shepard con-firmed that this was a little slow but nothingto worry about in a woman of Mrs.Johnson’s age. The doctor also reportedthat Mrs. J. was doing a “fair” job ofkeeping her blood pressure under control.She continued to show progress in ADLsover the third quarter, and made progresson goals to take her blood pressure medi-cine daily, and to follow her food plan atleast 25 days each month.

Mrs. Johnson’s Story Continues:What Happened after the First Quarter

Reassessment

Chapter 8 105

flects two philosophies of reassessment—a focuson documenting change (that is, what’s the differ-ence between the client’s status now and what itwas before, and what has happened to produce thischange?) and a focus on “looking at the client andfamily situation with new eyes” (for example, whatdoes the bigger picure look like now?). Socialworkers will differ in the emphasis they give thesetwo pieces, but most will agree that some elementsof both should be included. Before we look at thedetails, you might examine the summary of whathas happened to Mrs. Johnson since the first quar-terly review. The completed Reassessment toolreflecting these changes is at the end of thechapter.

SocialThe first two spaces of this domain reflect thetwo purposes of reassessment. The first providesspace for you to record the client’s and family’sperceptions of social functioning, which is con-sistent with the “looking with new eyes” phi-losophy of reassessment.The second allows youto document changes in the client’s householdand network of family and friends—who’s new,who’s still there, who’s gone—and changes inthe dynamics of those relationships. If there hasbeen a change in the emergency contact, youwould update that information on the Face Sheet.

The example shows that Mrs. Johnson’ssocial contacts have increased. She is attendingchurch regularly and is involved with a group offriends. She is less dependent on her family foremotional support.

EnvironmentIn the assessment, you documented how well theclient fit in his or her environment. Here againyou can reflect a new picture of the client’soverall situation, as well as specific smallchanges. As in every domain, you have space torecord the client’s and family’s current percep-tions of the client’s environment. Checklists fortype of residence, location, head of household,and conditions in the home are similar to those inthe assessment so that you can document the

current picture and the small changes in a famil-iar format. The section concludes with a space todocument how environmental changes have af-fected the client and family over the period sincethe last assessment or reassessment.

Mrs. Johnson is doing better in her environ-ment than before. She keeps the house to her ownstandards, and she is able to use the resources inthe community more frequently. Her son is firmlyenlisted in helping her keep the place up becausehe now has a stake in it.

Mental/Emotional AssessmentAgain we begin with a place to record theclient’s and family’s current perceptions ofmental/emotional health. Space is provided tolist any mental health assessment instrumentsused since the assessment or last reassessmentand to record any hospitalizations or treat-ments in the past year. The next space allowsyou to record the impact of changes in mentaland emotional health on the lives of client andfamily. This question may be especially im-portant for clients with severe disabilitieswhose families care for them, since it is herethat you might note signs of “caregiver burn-out.” The grid that follows allows you torecord diagnoses and symptoms that have con-tinued since the assessment or to make note ofany new problems, to provide the source ofthat information, and to make any additionalcomments.

For Mrs. J. we find the interesting situationthat her mental health symptoms are exactlythat, symptoms of returning emotional well-being. The comments make it clear that herappetite has improved, and her activity levelreflects improvement as well.

Physical HealthThe client’s and family’s perceptions of healthstatus start this set of questions and are stillreliable indicators of how things are going. Thereis space to record changes and additions to thelist of medical providers, and you are remindedto update the face sheet as necessary. We have



provided the same grid containing diagnosesand symptoms that you used to documentsimilar information on the assessment. Youwill want to check off conditions that persistsince the assessment or any new conditionsthat may have arisen so that you portray acurrent picture of the client’s physical health.Recording a date of onset is one easy way tomark any new conditions. If the client hassymptoms that remain since the assessment,you may want to know if they have beenunchanging and whether further medical evalu-ation is necessary. Here’s a place for yourjudgment—some diseases have symptoms thatcontinue even when the disease itself is beingtreated effectively. What you are looking foris “mystery” symptoms for which you stilldon’t know a cause, or a change, whethersudden or gradual, in the client’s feeling ofwell-being.

Medications and treatments remain im-portant to document.The doctor has addedPrinivil to help Mrs. J. control her blood pres-sure. With her, as with other clients, look outfor new problems as new medications areadded. The next two questions allow you torecord whether the client is getting necessaryassistance in complying with prescriptionsand to note any unmet needs for durable medi-cal equipment.

You are probably aware of any hospitaliza-tions or outpatient treatments the client has hadin the past year. Recording them here allowsother colleagues who use this record to find thisinformation easily. In Mrs. J.’s case, cataractsmay never have appeared on her list of medicaldiagnoses, since they were identified and treatedbetween assessment and reassessment. Record-ing her outpatient treatment here preserves thisinformation for others who might need to con-sult her case record. The last question allowsyou to note the impact of changes in physicalhealth on the client and family.

ADL/IADLThis section almost speaks for itself. Because theability to perform these activities is so critical to theclient’s independence, it is important to record theclient’s current level of functioning, as well as anychanges since the assessment or last reassessment.This domain, like the others, begins with space torecord the client’s and family’s perceptions of theclient’s functioning and ends with space to docu-ment the impact of changes in ADL/IADL func-tioning on the client and family.

Although Mrs. J. still has some disabilities,she takes care of most things with a little helpfrom family and church group members. If weimagine for a moment, though, that the forget-fulness that brought her son to see you in thefirst place was the beginning of dementiarather than part of depression, by now youmight see changes in her ability to do IADLssuccessfully—she might get sidetracked in themidst of household tasks or perhaps not bemanaging her affairs as well as previously.

EconomicAs with the other domains, there is space here torecord the client’s and family’s current percep-tions of economic functioning. Sections B, C,and D are identical to those sections in theassessment. Section E allows you to documentchanges in property ownership since the assess-ment. Question F gives you space to note prob-lems and irregularities in the way money ismanaged, and question G, to report what clientsdo when expenses exceed income. As usual, thedomain concludes with space for you to recordthe impact of changes in economic functioningon clients and families over the past year.

During the year, Mrs. Johnson and her fam-ily found a way to make her more financiallysecure. We acknowledge that this is a fairly rosyoutcome for her, although a debilitating illnesscould change the picture quickly. For clients inworse straits, you may be exercising all your besttalents as case manager to help them receive the

Reassessment

Chapter 8 107

benefits to which they are entitled and to stretchtheir resources as far as possible.

Additional NotesAt the bottom of page six, after you have re-corded information on all six domains, there is aspace for additional notes. This optional space isprovided for you to write anything that you wish todocument that has not been recorded elsewhere.

Services Currently ReceivedJust as you considered the formal resources theclient was already using when you made yourassessment, list them again here. Be sure to notecases where your DSS is providing services(including yourself as counselor and/or casemanager). In the comments section you might notewhether the client is satisfied with the servicesfrom these sources, and if not, why not. Making thislist here should give you information for the newChecklist for Change, goals, and family plan thatmight come out of the reassessment.

In Mrs. Johnson’s case, she is receiving twoDSS services—in-home aide services and thecase management services of her social worker.Because Mrs. Johnson has become self-suffi-cient in these areas now, the social worker notesthat these services will be terminated at thebeginning of the next month

Progress on GoalsThis sheet duplicates the ones you’ve been usingto track the progress toward meeting goals overthe course of the year. In one sense, it is part ofthe normal monitoring that you would do at leasteach quarter. At the reassessment, though, youwill step back a bit to look at the goals globally—not only in terms of what has been happeningrecently, but also in terms of the goals you set atthe assessment (or previous reassessment). Arethere problems you deferred that should or canhave goals now?

Mrs. Johnson has met or made progress onall of her goals. However, she needs to keepworking on maintaining her diet to keep herblood pressure down, even after services arediscontinued. The only goal that she had de-ferred when she, her family, and the social workermade the original plan was her financial con-cerns. That goal had been added in the secondquarter and met by her arrangement to sell herhouse to her son. Note that under the goal abbre-viated “grief/outlook,” the social workder hadalready written in some detail about Mrs.Johnson’s progress in the mental health domain,so she simply cross-referenced that note ratherthan repeating the information needlessly.

Summary of Findings atReassessmentYou wrote a summary for the initial assessment,and many of the suggestions given in Chapter 4are relevant here. However, you do not need torepeat what you said there—the focus of thissummary is on now. You made a snapshot of theclient’s condition about a year ago; here’s theopportunity to paint a new picture of his or her

Another Example: Mr. KentMr. Kent is a client with developmentaldisabilities for whom you are payee. He hasdifficulty managing his spending money andwas coming nearly every day to ask formore. You and he set the goal that he wouldbudget his money well enough that he wouldcome to the DSS only once a week. You andhe developed strategies to accomplish this—that he would put each day’s pocket moneyin a sealed envelope at the beginning of eachweek, mark the date it could be openedacross the flap, store the envelopes in thedrawer of his bedside table with a calendar,open the envelope first thing in the morningon the right date, and check the date off whenhe opened the envelope. He is still coming tosee you twice a week, most weeks, but he isdoing better than previously. Celebrate to-gether that he is managing to meet the goal inpart.



circumstances, including the problems andstrengths that are currently most relevent.

As with the original summary, we don’toffer a set way of writing it—you will developyour own style. Here is a brief critique of theexample. The worker has reviewed the progressmade in the course of the year, noting servicesfrom the DSS and elsewhere that have been usedto meet the goals. The focus is on the changesthat have been made in Mrs. J.’s life and theeffect they have had on her functioning acrossdomains: socialization has improved her IADLs,medical care has also improved IADLs, social-ization has improved her mental outlook andseems to have reduced her forgetfulness by re-ducing her depression. The worker notes thefamily’s improved attitude—some of the burdenon them is decreased, but they feel able to helpin vital ways.

In a case that doesn’t have a happy ending atthis point, you should still celebrate the suc-cesses you and the client have had, even whileyou identify functional problems that will serveas the basis for a new Checklist for Change, goallist, and service plan (see the example on theprevious page).

Finally, note the space at the end of thereassessment for recording documentation ofeligibility for specific services and noting yournext steps.

Frequently Asked Questions

Question: Why is it necessary to take the time togo through the whole assessment again?Answer: Reassessment provides the oppor-

tunity to get a new picture of the client andfamily. The reassessment tool is not meantfor needless repetition of everything youfound in the initial assessment but to pro-vide space for the new picture of the client,which may include some elements that youdocumented the first time.

You have already captured a lot ofinformation on the client and family thatis available in the Adult Services Func-

tional Assessment. The Reassessment toolallows you several options. You maychoose to record some key informationeven if it repeats previous information, youmay write “no change,” or you may recordonly what has changed for clients andfamilies since the assessment or last reas-sessment. However, if you choose not torecord still-current information that is onthe assessment tool, you will need to looksimultaneously at both tools to see thecurrent picture of the client.

Question: Why do I need to to record clients’ andfamilies’ perceptions of all the domains all overagain?Answer: These questions allow you to note

how the client and family currently feelabout important aspects of their lives.You may also record any changes in theways clients and families view their situ-ations since the last time you assessedthese domains. Perceptions may havechanged for a variety of reasons, such assuccessful service interventions, new ill-nesses, increased or decreased functionalabilities in clients, or changes in stresslevel for families. Recording clients’ andfamilies’ perceptions can help you stayfocused on their strengths and problemsas they see them.

Key Points• The focus of the reassessment is both

to document changes since the lastassessment and to give a new pictureof the client.

• The reassessment process provides youwith the opportunity to measure yourprogress and celebrate your successes.

• The reassessment process offers youand the client a time to look with fresheyes at the client’s state of affairs, toidentify new and continuing problems,to set new goals, and to implementnew strategies to meet them.

Reassessment 1DSS-6224 (8-1-94)Adult Services

C. Location

__ town/city__ rural community__ isolated

II. Environment

A. Client’s/family’s perceptions of the home and neighborhood environment

B. Type of residence facility/group home__house/mobile home __ nursing home__apartment __ family care home__boarding room __ home for the aged__homeless __ DD home__other _____________ __ rehab/treatment/acute facility

__ shelter (specify)_______________________________

D. If client lives in house, mobile home, or apartment, who is head of household?__client/client’s spouse __other family member __friend/housemate

Adult Services Annual Reassessment

Case #

ID #

Client’s name Date

I. Social

A. Client’s/family’s perception of the client’s social functioning

B. Changes in the client’s/family’s social functioning since the last assessment or reassessment (e.g.,

changes in the household composition, changes in the dynamics and quality of client’s or family’s relationships,

losses or changes in social support). Update the Face Sheet as necessary.

C. Has there been a change in the client’s preferred emergency contact person? __ No __ Yes (If yes,

update the Face Sheet.)

95-10019

18937485368

Mary Foster Johnson 2/6/96

Client says she’s “blessed with alot of sweet friends.” Son also pleased with her relationships with others.

Clt. attending church regularly now. Has made friends in Widows’ Support Group. She is less isolated andhappier with her social life. Her family is feeling less worried about her and less burdened; they are not worriedabout her safety, and she relies on them less for emotional support.

✔

Client feels even morepositive about her home. Son is more satisfied w/spending time and money to maintain it since he owns it (seeeconomic domain).

✔✔

✔

Reassessment 2 DSS-6224 (8-1-94)Adult Services

__Transportation__Trash disposal__Ventilation__Water/plumbing__Yard (or area immediately

outside of residence)__Other (describe)

__Access within home__Access, exterior__Bathing facilities__Cooking appliance__Cooling__Eating area__Electrical outlets__Fire hazards/no smoke detectors__Heating__Laundry

__Lighting__Living area__Locks/security__Pests/vermin__Refrigerator__Shopping (access)__Sleeping accommodations__Structural integrity__Telephone__Toilet

E. Inadequate, unsafe, or unhealthy conditions in client’s environment (space for comments/explanations

below if needed). If client is in a facility, record environmental issues/concerns under comments.

Comments

F. Is there anything in the home or neighborhood that poses a threat to the client’s mental or physi-cal health, safety, or ability to receive services?

G. What impact have changes in the environment in the past year had on the lives of the client/family(may include positive and negative impact)?

III. Mental/Emotional Assessment

A. Client’s/family’s perception of client’s current mental/emotional health

B. Have you used any assessment instruments to evaluate the client’s mental/cognitive status withinthe past year, or at this reassessment? __ No __ Yes (If yes, list tools, the results, and your evaluation.)

C. Has the client had hospitalization/treatment for mental/emotional problems since the last annualassessment or reassessment (include in-patient, out-patient, therapy, substance abuse recovery programs,

changes in therapist or other mental health workers)? __ No __ Yes (If yes, give setting(s), length ofstay(s) or participation, and reason(s).)

D. What impact have changes in mental/emotional health in the past year had on the lives of theclient/family (may include positive and negative impact)?

✔

No

Son is much more invested in maintaining property now that heowns it. Clt. feels more satisfied with housekeeping and secure in her home.

Client says she is generallyhappy and enjoys her friends and family. The family is pleased that she has become so much happier. They are nolonger concerned about her memory.

GDS went from 12 to 9 to 7 over first 2 quarters. Clt.’s “log” of good days and bad days (on kitchen calendar)shows an average of 5 good days a week compared to less than 1 per week when she began keeping a record.

✔

Clt. & family both say how much more they areenjoying spending time together, even if they don’t spend as much as one year ago. Mrs. J.’s new friendshipsmake it so that she doesn’t rely on family exclusively, and this seems to have made things easier.

Although Mrs.J. now has a regular ride to church, she is still dependent on her son or daughter-in-law for most transportation. Their other obligations sometimes make this a problem.

✔


Diagnosis/Symptom Source*Notes (e.g., onset, severity, functional impact,

history, untreated condition, needs professional assessment)Aggressive/abusive behavior

Agitation/anxiety/panic attacks

Change in activity level (sudden/extreme)

Changes in mood (sudden/extreme)

Change in appetite

Cognitive impairment/memory impairment(specify)Developmental disability/mental retardation(specify)Hallucinations/delusions

Inappropriate affect (flat or incongruent)

Impaired judgment

Mental anguish

Mental illness (specify)

Orientation impaired: person, self, place, timePersistent sadness

Sleep disturbances

Substance abuse (specify)

Thoughts of death/suicide

Wandering

Other:

Other:

*Source Codes:C=client's statementF=family member/guardian/responsible party

M=FL-2, MD, medical/mental health professionalS=Social worker observation/judgmentO=Other collateral (specify)__________________________

IV. Physical Health

A. Client’s/family’s perceptions of client’s current health status

B. Have there been changes/additions in the client’s medical providers? __ No __ Yes (Update theFace Sheet as necessary.)

E. Mental, emotional, and cognitive problems—diseases, impairments, and symptoms

Clt. & family believe physical healthis generally good, report no new problems. Daughter-in-law has some lingering concerns about clt.’s compliancewith blood pressure diet and medications.

✔

Clt. now seeing Dr. May Shepard at Metro Family Practice (seeaddress/phone on FS)

Substantially reduced—nearly entirely gone

C/F Occasional memory probs., clt./family don’t see as problem


C. Physical health problems—diseases, impairments, and symptoms

Diagnosis/Symptom Source*Notes (e.g., onset, severity, history, functional impact,untreated condition, needs professional assessment)

Arthritis/osteoporosis/gout

Asthma/emphysema/other respiratory

Bladder/urinary problems/incontinence

Bowel problems/incontinence

Bruises

Burns

Cancer

Dental problems

Diabetes

Dizziness/falls

Eye diseases/conditions

Headaches

Hearing difficulty

Heart disease/angina

Hypertension/high blood pressure

Kidney disease/renal failure

Liver diseases

Malnourished/dehydrated

M. Sclerosis/M. Dystrophy/C. Palsy

Pain

Paraplegia/quadriplegia/spinal problems

Parkinsons disease

Rapid weight gain/loss

Seizures

Sores (specify)

Speech impairment

Shortness of breath/persistent cough

Stroke

Other:

Other:

*Source Codes:C=client's statementF=family member/guardian/responsible party

M=FL-2, M.D., other medical professionalS=Social worker observation/judgmentO=Other collateral (specify)_________________________

D. Medications (prescription and over-the-counter) and Treatments (e.g., special diet, massage):

Name Comments (dosage, compliance issues, other)

C occasional constipation, no changes

F slightly worse than last year, esp. on phone

MotrinLasix * new since last year, 40 mg. b.i.d.Prinivil *new since last year, 20 mg./day; aggravating constipation?Milk of MagnesiaMetamucilPrune juiceLow fat/low salt diet Clt. has had some difficulty changing her cooking habits and staying on diet.

Says, “I feel so good, I can’t imagine a little salt can hurt.”

vision restored since cataract surgery

Somewhat better pain management. Condition same.

M

C

M/C

Diet & meds. —some compliance problems

See arthritis

Fracture of right radius M Healed by reassessment

Dr. Shepard


Help needed? Need met?1-yes2-partial3-noADL Tasks

AmbulationBathingDressingEatingGroomingToiletingTransfer

to/from bedto/from chairinto/out of car

IADL TasksHome maintenanceHouseworkLaundryMeal preparationMoney managementShopping/errandsTelephone useTransportation use

none

som

e

tota

l Comments (e.g., who assists, equipment used, prob-lems or issues for caregivers)

E. Does the client need assistance with medication or treatment? If so, is he/she receiving theassistance needed? ___No assistance needed ___ Assistance needed, but not received

___Assistance received from _________________________________

F. Does the client have new or continuing unmet needs for durable medical equipment? __ No __ Yes

G. Has the client been hospitalized or had outpatient procedures since the last (re)assessment?

__ No __ Yes (Describe—Where? When? Why?)

H. What impact have changes in physical health in the past year had on the lives of the client/family(may include positive and negative impact)?

V. ADL/IADL

A. Client’s/family’s perceptions of the client’s ability to perform the activities of daily living (basicand instrumental)

B. Review of activities of daily living (basic and instrumental)

✔

✔

✔ Cataract surgery at Kudzu Co. Hosp. 4/3/95 left eye; 4/18/95, right eye. Clt. satisfied with results. Fractured radius set (outpatient) 8/19/95

Clt. able to keep house, read as she used to because ofcataract surgery. Pain meds. fairly effective w/arthritis. Family no longer needs to help with personal care.

Client & family pleased with her ability to do ADLs and more IADLs. Son morecomfortable w/help he provides.

✔✔✔✔✔✔✔

✔

✔✔

✔

✔

Aide helped before; now self-reliant

Aide helping show cooking for high bp

Family and friends

Friends from support group help sometimes

1

11

1

1

}Family

Son


C. What impact have changes in ADLs/IADLs in the past year had on the lives of the client/family(may include positive and negative impact)?

V. Economic

A. Client’s/family’s perception of changes in the client’s financial situation and ability to managefinances.

B. Monthly Income (from all sources)Social Security/SSIretirement/VA/RRother

C. Other resources (e.g., food stamps, subsidized

housing, property, Medicare, Medicaid)

D. Monthly Expensesrent/mortgagefood/suppliesutilitiesheatwater/sewertransportationclothes/laundryinsurance (type)medicalother

E. Any changes in house or property ownership (e.g., mortgage added/paid off, property sold or inherited)?

F. Are there any problems/irregularities in the way the client’s money is managed (by self or others)?

___ No ___Yes

G. If expenses exceed income, what does the client do to manage?

H. What impact have changes in the economic domain in the past year had on the lives of theclient/family (may include positive and negative impact)?

Additional notes (optional) This space provided for any relevant information that needs documentation and doesnot fit elsewhere on the tool.

Client more self-sufficient; family says they feel lesspressure to help, can enjoy her company more than before.

Client & family say they are managing well.

$380.00

annuity 50.00money from son 50.00TOTAL $ 480.00

$751004530

30home 0 (son pays)

40telephone 30taxes 0 (son pays)TOTAL $350

Medicare, burial plan

Son now owns the home; clt. has lifetime right to remain.

✔

N/A

Client feels more secure in the event of a financialemergency. She has saved a little money. Son is more willing to pay to keep house up.


VII. Formal Services Currently Received by ClientService Provider Comments

Adult day care

CAP (community alternatives)

Case management

Counseling

Employment services

Food Stamps

In-home aide/PCS

Legal guardian

Meals (congregate/home)

Medicaid

Mental health services

Nursing services

Payee

Public/subsidized housing

Sheltered workshops

Skilled therapies (PT, OT, ST)

Telephone alert/reassurance

Transportation

Other:___________________

Other:___________________

DSS Discontinue as of 3/1

DSS Discontinue as of 3/1

Diet for bloodpressure

Client is having fewer slips, but still“cheats” on her diet several times per week.Blood pressure has been within acceptable limitson last 2 exams.

✔

Autonomy inhousework

Client can do dishes, dust, andvacuum. Still has some trouble with laundry, butcan get some help from family members.

✔

Grief/outlook

See item III-B under mental health.

✔


Summary of Findings—including strengths and problems

Social worker’s signature/date _________________________________________/________

Supervisor’s signature/date _________________________________________/________

Documentation of eligibility for specific services:

Next step(s) (check all that apply)

___revise goals/service plan___transfer case to another unit___close case

___make referral to another agency___other ______________________________

At the reassessment meeting with Mrs. J. and her son, we discussed progress over the past year and agreed thatwe had met the goals we set about her safety at home, getting ongoing medical care and resolving her currentproblems as well as possible, helping her get over some of her grief for her husband, and getting back herabilities for self-care and housekeeping. During the year she had surgery for her cataracts and recovered from abroken arm. She has since discovered that she has moderate high blood pressure, but her new MD is helping hermanage that fairly well. The fragile financial situation has been resolved because her son is buying her houseand paying her regularly. Between the decrease in house-related expenses for her and the payments, she hassome extra money to save for emergencies and spend occasionally on treats for herself. Perhaps the best progressof all has been her ability to make some new friends, and she and her son both say that her relationship withthe family is better, perhaps because they aren’t her only outlet. She also says that going to church againregularly has been a great comfort to her.

After reviewing all of the progress, together we decided to see if we could close our work together—that DSS services are no longer necessary and she and the family can get along independently. Mrs. J. willcontinue to work on her goal of maintaining her diet. We decided to end services as of March 1, but I encour-aged Mrs. J. to call if her situation changes in the future.

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Virginia White 2/9/96Betty Jacobs 2/16/96

See DSS-5027, terminating services, and Case Closing/Transfer summary

the reassessment - school of social work

Documents