Practice Resources: Newly Injured Spinal Cord Patient: A Case Study
Robin Dannevik, MSW
Mr. Chavez* fell down a flight of stairs in his home last year. The accident left him quadriplegic. He spent the next several months in rehabilitation centers and nursing homes before coming to the Spinal Cord Injury unit at the Edward Hines Veterans Affairs Medical Center for further acute rehabilitation. Mr. Chavez is 70 years old, a veteran, and a retired high school guidance counselor. His wife is an 85-year-old retired biologist. It is a second marriage for both and they have had a loving relationship for over 30 years. They each have adult children from previous marriages who live in other parts of the country. Until the accident, they were enjoying their retirement, spending their savings on travel.
The Hines SCI staff believes it unlikely that Mr. Chavez will ever walk again. Mrs. Chavez is having great difficulty accepting her husband’s condition and believes that if he keeps getting physical rehabilitation, he will improve. Mr. Chavez worked hard in rehab but made few gains. After several months of rehab at Hines, staff prepared Mr. and Mrs. Chavez for his discharge home. In a discharge planning meeting, they were told quite frankly that he sustained an injury that, short of a miracle, would not allow him to walk again. Staff also discussed the level of care Mr. Chavez would need to remain healthy at home.
After discharge, Mr. Chavez became part of the Hines SCI Home Care Program where he could be followed by an interdisciplinary team. In preparation for discharge, the Chavez home was evaluated by the SCI Home Care program. Recommendations for making the home wheelchair accessible were made and needed equipment was ordered and delivered.
Tellingly, Mrs. Chavez missed appointments with the Hines physical therapists for training on a manual lift, yet she often cornered the physician and social worker wanting to discuss future physical rehabilitation as the key to her husband’s full recovery. Meanwhile, Mr. Chavez regularly saw the psychologist on the rehab unit and was coming to terms with his disability. Generally, he had a positive attitude and was grateful for the years he had before the accident. At times, however, he expressed frustration with his wife’s difficulty in accepting his condition.
Once discharged home, Mr. Chavez would need two hours of care in the morning to get him out of bed, groomed, and dressed and another two hours of assistance in the evening to prepare him for bed. As the social work intern assigned to Mr. Chavez, I provided his wife with a list of caregiver agencies as well as Americans with Disabilities Act specifications for ramp construction. I spent time with Mrs. Chavez at the hospital and on the phone listening to her concerns and providing resources. She was very anxious about her husband’s return home because she would not be able to provide much of his care due to her arthritis. By the time Mr. Chavez was ready for discharge, she had put in place a good caregiving system.
Mr. Chavez’s transition home was not smooth. He was coming to Hines twice a week for physical rehabilitation and when I asked him how it was at home he said, “Psychologically it is better, but operationally it is worse.” He described feeling trapped in their living room because the split-level, ranch style home had steps leading into all adjoining rooms; there were a few bowel accidents in the night; there were problems operating the lift; Mrs. Chavez’s anxiety level had skyrocketed. She was not sleeping and had become depressed. It was suggested that they increase the caregiver’s hours from four to eight hours per day in order to alleviate some of her stress. Mrs. Chavez asked for a list of nursing homes in the area, which I provided for her. Within two weeks of returning home, Mr. Chavez was once again in a nursing home.
A month after entering the nursing home, Mr. Chavez was admitted to the Hines SCI unit, this time for a medical procedure. We asked him if he would be interested in being added to the waiting list for the Hines Spinal Cord Residential Care Facility, which houses approximately 30 veterans with spinal cord injuries. Mr. Chavez liked the idea and so did Mrs. Chavez. I escorted Mrs. Chavez on a tour of the facility and she was very happy with what she saw. Mr. Chavez would have twenty-four hour care, access to the physical rehab unit, socialization with his peers, and would be able to move about the vast Hines campus. Mrs. Chavez says she misses living with her husband and becomes lonely at times but said she was totally overwhelmed with his care. Mr. Chavez is now living in a nursing home waiting for admission to the Residential Care Facility.
Clinical Impressions:
In an instant, Mr. Chavez was rendered quadriplegic. This is how it happens for most: a fall, a diving accident, an automobile accident, or a gun-shot wound––an accident that forever alters an individual’s life and a family’s life. No one can ever be prepared for something like this and social workers and psychologists have a very important role to play in adjusting to the injury. They provide therapeutic counseling, psycho-educational training, case management, community resource information, and assistance in navigating Social Security and other health benefits.
Spinal cord injury social workers and psychologists help individuals and their families adjust to a devastating physical and emotional experience. If we cannot emotionally connect with the person, or if we feel judgmental about their shortcomings and weaknesses, we will not be able to provide the best care. Having empathy for Mr. and Mrs. Chavez made working with them easier.
There were times, however, when my patience wore thin and I would discuss my frustrations with a colleague and get some clinical advice. As we go about what is, at times, the emotionally difficult task of helping others, the value of consultation and support from our mentors and our peers cannot be overstated.
* The names and some details of the case have been changed.
Robin Dannevik is a recent graduate of Loyola University’s school of social work. Her master’s degree field placement was at Hines V.A. Hospital where she was a social work intern for eight months on the spinal cord injury unit.