Case Management: The Case of Lonnie and Dorothy
Individuals or families who need case management services do so because they have a number of problems. Like Lonnie and Dorothy, they may “get by” for a period of time. At some point, their problems escalate, multiply, or both, making it difficult to cope. It is at the end of this case, when Lonnie is beginning to experience some serious medical problems, that you enter their lives as a case manager.
Lonnie and Dorothy live in the southern part of town in a low-income area. At one time, the neighborhood was nice. This was long before Lonnie and Dorothy arrived. They have two grown sons, John and Leroy, who occasionally come by to visit, and a grown daughter they never talk to. Lonnie, 62, works at a nursing home as a janitor. Dorothy, 60, does not work due to health problems, though she has worked as a personal nurse at some time in the past. They have been married for thirty-nine years but do not get along very well. They bicker constantly, and Dorothy has talked of times when Lonnie would lock her in the house due to jealousy while he was at work. Now, they basically coexist together without much substantial interaction.
Lonnie’s job is rough on him—he works seven-day shifts and then has three days off. He drives forty-five minutes to work in his 1985 pickup, on which he is still making payments. He spends all day on his feet and is exhausted when he gets home. For years, Lonnie was the head janitor at a truck stop and enjoyed the job. Unfortunately, he was laid off due to cutbacks and has been trying to find a job with better pay. He has found that his age has kept him from getting better work. He has been working at the nursing home since. He has talked of finding better work, but because he and Dorothy live from paycheck to paycheck, they cannot afford for him to take any kind of pay cut, even temporarily. Lonnie spends most of his spare time in front of the television.
This is hard on Dorothy. Due to heart problems, she is on disability and rarely gets away from the house, often spending days alone in the house. This causes her to be lonely and to have a limited view of the world—the “other side of town” is like another world to her. If she does get away, it is only to go to the grocery store or the pharmacy. She also has a tendency to be paranoid. For instance, if her disability check does not come on the exact day it did the previous month, she spends the afternoon on the phone talking to the disability office and the post office, positive someone has “made a mistake” or has “taken her check.” In some ways this is understandable, since Lonnie and Dorothy need the check to pay their bills. Dorothy’s check pays the rent and what little spending money she gets, while Lonnie’s covers the car payment, food, utilities, and medical bills. They spend every penny each month, leaving nothing for savings. Last month, Lonnie started to have medical problems himself and has had to go the doctor more frequently than usual.
- List the needs that Lonnie and Dorothy have. Then prioritize them.
- Identify the necessary case management roles and purposes for each of the three most important needs Lonnie and Dorothy have.
- The three methods of delivering case management you read about in Chapter 3 provide a structure for the case manager’s roles, responsibilities, and length of involvement with a client. Review the methods.
Which one would be most effective with Lonnie and Dorothy’s situation? Why?
Book: for chapter 3 question (#3)
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