CASE $4$

Advance Directives

The assistance of Patrick Claudius, MD$,$ in developing this case is gratefully acknowledged.

An $18-$year$-$old male patient was admitted to Greenfields Nursing Home, South Carolina, from another skilled nursing facility located in North Carolina. The patient was moved to South Carolina because he qualified for Medicaid in that state. The resident stayed at Greenfields for $12$ years until his death at the age of $30.$

The resident had sustained a serious head injury in an auto accident at the age of $15.$ As a result of this injury, he became comatose. He remained in a persistent vegetative state and had a G$-$tube for enteral feeding. However, the resident$$s overall condition was stable. He received maintenance rehabilitation for severe contractures in hands, arms, and feet. The resident also received regular sensory stimulation.

The resident had fevers off and on in the range of $100\backslash$deg F $(37\mathrm{.}8\backslash$deg C$)$ to $102\backslash$deg F $(38\mathrm{.}9\backslash$deg C$).$ His fevers were most likely to be secondary in nature because most other causes, such as infections, were ruled out. The nursing staff were able to control the fevers using ice packs and alternate administration of Tylenol and Motrin. At times, however, the resident would have episodes of urinary tract infection. He was also hospitalized with recurrent aspiration pneumonia. He began running fevers as high as $106\backslash$deg F $(41\backslash$deg C$).$ Sputum and urine cultures showed the presence of methicillin$-$resistant Staphylococcus aureus $($MRSA$)$ infection. At times, severe infection required hospitalization in the intensive care unit. Intermittently, the patient had to be placed on a ventilator.

Shortly after the auto accident, the resident$$s mother had abandoned him. The mother is the one who was responsible for the accident that resulted in his severe head trauma; she was driving the vehicle in a state of intoxication. The resident had no family contact whatsoever. The court appointed the Department of Social Services as the resident$$s legal guardian. The Department of Social Services, however, was uninvolved in his care and did not give any directives regarding continuity of treatment. The resident eventually died of natural causes.

Assignment

What role$($s$)$ would be appropriate for the facility$$s social worker in the life of this resident?

What role should the activity department play in the life of this resident?