Case Study 10.1: Margaret Davis Stays at Home
As a social worker working with this family, discuss how you would negotiate between autonomy, self-determination, and competent practice.
How does living in a rural area affect these negotiations?
What might be some of your concerns and reasoning processes?
Case Study 10.1
Margaret Davis Stays at Home
Margaret Davis has lived in her small, rural community in southern West
Virginia for all of her 85 years. It is in this Appalachian mountain town that
she married her grade-school sweetheart, packed his pail for long shifts in
the mine, and raised their four children. It has been more than 30 years since
she answered the door to receive the news that her husband had perished in
an accident at the mine. She remains in that same house by herself, with her
daughter living in a trailer on the same property and one of her sons living
just down the road. Her other son recently moved to Cleveland to find work,
and her other daughter lives in the same town but has been estranged from
the family for several years.
Mrs. Davis has hypertension and was recently diagnosed with type 2
diabetes. The nurse from the home health agency is assisting her and her
daughter with learning to give insulin injections. It is the nurse who asks for
a social work consult for Mrs. Davis. The nurse and Mrs. Davis’s daughter
are concerned that she is becoming increasingly forgetful with her
medications and often neglects her insulin regime. They also suspect that she
is experiencing some incontinence, because her living room couch and carpet
smell of urine. Mrs. Davis and her daughter Judy greet the social worker at
her home. They have been baking this morning and offer a slice of peanut
butter pie. Judy excuses herself to go to her trailer to make a phone call. The
social worker asks Mrs. Davis about how her insulin regime has been going
and if she feels that she could keep up with the injections. She responds that
she has learned to give herself the shots and “feels pretty fair.” The social
worker conveys the concern that she may be missing some of the injections
and other medications as well. To this she replies, “Oh, don’t worry about
me, I’m fine.” The social worker proceeds to ask the sensitive question as to
whether she has been having trouble with her bladder or getting to the
bathroom. This causes Mrs. Davis to become very quiet. Looking up at the
social worker she shares that witches have been visiting her house late at
night and have been urinating in her living room. The witches are very
“devious,” but because she is a very religious person, she does not feel that
they will harm her.
Judy returns to the home and joins her mother and the social worker. Judy
voices her concern about her mother’s safety, noting the problems with
medications and with general forgetfulness. Judy is able to prepare meals,
dispense the medications, and give insulin injections in the morning because
she works evenings at a factory. Judy’s daughter, Tiffany, has been staying
overnight in the home but complains of her grandmother’s wandering and
confusion late at night. As a result, she is often exhausted during her day
shifts at a nursing home in the next county and in caring for her small
children. When asked about Mrs. Davis’s son’s involvement in her care,
Judy responds, “He works and is in the Guard some weekends. He handles
Mom’s money mostly, and his wife, well, she has her own problems.” Judy
also reported that her mother has Medicare, but she was not sure if that
would be sufficient to pay for all her mother’s care long-term. Judy is also
worried because her old car has been giving her problems lately, and the
repairs are becoming expensive. She concludes by stating, “We promised
Mom that she would never go to a home . . . we take care of our own.”
