Case Story 1: Stan and Viola

Stan and Viola are both in their early 80’s, have been married for almost 55 years. They were born and raised in the community in which they live, Birchtown, NS. The town is small, around 200 people, but has most amenities including a few small stores. The closest town is Shelburne, about 15 minutes away.

They live in a one and half story home on half an acre, which has been their home since having children. With Stan’s pension, they live comfortably. However, there is not much left over for extras or an emergency, such as an extended time away from home. Stan and Viola’s two children, Diane (50) and George (48), live in Halifax two and a half hours away. Diane and her husband have three teenage children and George and his partner have one child. Viola speaks to her daughter regularly. She also has lifelong friends from their church community and local library, which she sees on a regular basis. Stan used to go out for coffee a couple of times a week with a group of retired men but hasn’t attended in a while. One of the men contacts Stan about once a month to see how he is doing.

Health Journey Narrative

Stan: Quiet man, who worked for a shipbuilding company in neighbouring town for 45 years and retired at 65. Enjoys woodworking and yard work. Stays active by going for walks and yardwork. Spends a lot of time in his shop on woodworking projects.

Developed diabetes in his 40’s. Managed with diet and exercise until recently. Now on Metformin. He has also started to experience decline in his eyesight and has stopped driving. He has recently started worrying about his memory, and is starting to struggle with his mental health and increased isolation.

Viola: Healthy, active and social. Stayed at home with their two children. Volunteered at school, the library and their church. Worked part-time at the library after the children graduated and left home. She quit working at the age of 60.

She has mild arthritis and has the occasional migraine. She had two children and one miscarriage.

She enjoys retired life with Stan. They do yard work and go for walks together. She also remains active in their local church, but involvement has been declining due to Stan’s increased needs. She would love to see her grandchildren more often.

Presenting Experience:

Stan – Recently was released from a one-week hospital stay due to an ankle fracture after a fall and is now has a walking cast on for 4 more weeks. He is very frustrated with his lack of mobility and inability to do yard work. Since his hospital stay, he has noticed it increasingly difficult to follow conversations and remember things such as taking his medication.

His primary health concerns are managing his diabetes and his memory. He is also experiencing declining eyesight.

Viola – Is in health, has arthritis (takes ibuprofen when needed) and the occasional migraine. She is Stan’s primary ( only) caregiver. Increasingly tired due to his higher care needs. Viola would love to keep going for daily walks as this helps ward off arthritis pain. Starting to think about looking for help but doesn’t know how Stan would respond.

Viola is active in their local church but involvement has been declining as she is needed at home. Recently she has taken on all their household duties inside and out because of Stan’s lack of mobility. She is not overly concerned about her health but does worry about how she will manage when Stan’s needs increase.

Intersectional Identity:

• Stan and Viola have lived in Birchtown their whole lives and are deeply rooted in their community and African Nova Scotian heritage.
• They are middle-class and are able to live comfortably, but a limited pension and increasing food prices have made their budget tighter. This concerns Viola, who does not want to choose between their medications and eating healthy.
• While they do have a primary care provider, they do not go regularly. Other than footcare, they are not aware of any additional available resources for diabetes or for people with memory impairment.

Supportive Relationships:

• Engaged Health Care Professionals:
  • Primary care provider (Nurse Practitioner) is in Shelburne 15 minutes away. Has been their care provider for just over 5 years. While the NP follows their medical needs well, there is very little relationship and understanding of social needs.

• Support Networks:

• • Diane and George, their children who live 2 hours away, come with their families to visit on major holidays and in the summer. They have both offered support but have busy lives themselves and children to care for.
  • Viola talks to daughter weekly and updates on health but does not go into detail as she doesn’t want to be a burden or create extra stress for her family.
  • Church members frequently check in with Viola, especially if she hasn’t been in contact for a while. They do not know that Stan has been having memory problems.
  • Stan’s friend occasionally drops by for coffee. Viola is considering asking him to come more often (biweekly) to help with the yard work. She is unsure how Stan would react to asking for help.
  • Viola is thinking more help would be great, however is unsure of where to find it and if Stan will accept it. Their area has a few home care agencies but they sometimes have problems finding enough staff.

• Barriers and Facilitators to Relational Care:

• • Stan wants to remain as independent as possible for as long as possible. He views any help as intrusive and does not want to be a burden. He does not want people to know that he has memory problems and has made that very clear to his family.
  • Viola would love to continue to spend time with her friends but finds it difficult to leave Stan at home alone especially with his mobility being limited by the walking cast. She worries about his increasing isolation and decreasing mental health. Stan’s recent hospital stay was very stressful on both of them.

Patient’s Voice and Perspective:

“I have always been able to do things myself. I would like to keep it that way.” Stan

“Stan is very independent and does not want people to know about his memory loss. I am trying my best to be supportive, but am finding that taking care of both of us is getting more difficult. I would like to ask for more help, but how can I?” Viola

“Mom and dad have always been very self-sufficient. I think that they are doing quite well and we help out when we can. But life with three teenagers gets busy…” Diane (daughter)