Case Story 2: Mr. & Mrs. Bishop

Mr. Patrick Bishop is 87 and was born in Conception Bay South (CBS), NL. He met Gloria, who was also from CBS, when she was 15 and he was 18. They have 2 sons and 2 daughters together; Donald (62), Kirk (59), Prudence (57) and Rose (55). The oldest son, Donald, is currently living in Newfoundland, and the rest are in Nova Scotia. Patrick worked in retail until he retired at 60 years old. He and Mrs. Bishop then moved to Nova Scotia to live with his daughter and son-in-law. They currently live in Halifax Regional Municipality. Due to various circumstances, his granddaughter and great-grandsons moved into the same house. He has an extended family in Newfoundland and friends whom they met every summer when they went camping in their camper van.

Gloria is his primary caregiver. His daughter (Rose) and son-in-law look after him when they are not working; however, the one they put in charge of making the care decisions for Patrick is their their eldest son – Donald – who lives in Newfoundland. These past 3 years, Patrick and Gloria have become estranged from the other two children, whom they see only a couple times a year after a falling out about Patrick’s care decisions. Kirk and Prudence believe that Patrick needs to be admitted to long-term care, but Gloria refuses to agree to her husband moving into a home. Kirk and Prudence also believe that Gloria has developed signs of dementia and thus may not be able to make decisions or provide care for Patrick. Donald and Rose disagreed with this and try to honour Mrs. Bishop’s wishes. Other than to visit Patrick’s health care team, they have not been out for more than a year. They spend time with Rose, her husband, their granddaughter and great grandsons the most. Sometimes, Gloria looks after the great-grandsons for a couple of hours.

Patrick and Gloria live in the basement suite of a house. They have a door and five steps to the backyard. They have their own kitchen, small living room/dining area, one bedroom and a bath. Rose and the family live on the main floor; their bedrooms are on the second floor, and her daughter shares a room with her two sons.

Health Journey Narrative:

• Patrick was diagnosed with dementia three years ago, and his condition has been deteriorating significantly. He is often not aware of the time. He remembers his wife, but on some evenings, he forgets who she is and keeps asking for her.
• He has mobility issues and has been using a walker for a while.
• He was hospitalized several times due to pneumonia and low sodium. The last time he was hospitalized, he stayed in the hospital for 2 weeks. Gloria visited every day to help with his daily care and keep him entertained. The hospital staff helped him walk around every day with his walker.
• He has hearing impairment and wears hearing aids.

Presenting Experience:

• Patrick’s condition is progressing.
• Four months ago, Gloria was ready to get help from Continuing Care, but she refused to think about him moving to a long-term care facility.
• They had a case coordinator come to their home to assess their situation and decided Patrick needed home care. However, the waitlist was long, and when the case coordinator contacted them again to let them know that they got one, Gloria hesitated and decided that she felt more comfortable having Rose and Chris look after her husband.

Characteristics:

• Patrick Bishop and his family are white and from Newfoundland.
• He is retired and has a very modest retirement savings. Since Gloria never worked, she does not have a pension, this is the only income they have aside from Old Age Security.
• Rose and her husband were laid off and now are working casual hours as evening office cleaners. They pay the household expenses and sometimes groceries for their grandsons (Patrick and Gloria’s great-grandchildren).

Health Care Relationships:

• Engaged Health Care Professionals:

• • Family doctor: Patrick has a family doctor and gets regular check-ups when needs a referral. The doctor assesses Patrick when he is unwell and has been his family doctor for years.
  • Geriatric Medicine Team: He goes to see the geriatrician every year to assess his condition and whether he needs different medication.
  • Case coordinator: a case coordinator from NSHA came to assess Patrick’s condition and determine his eligibility for assisted home care. The coordinator came with what Rose described as “piles of paperwork.”
  • Despite his mobility issue, Patrick never seen any other healthcare practitioners (e.g., physiotherapist, etc.) and has never been referred to one.
  • Patrick’s hearing aids are about 10 years old and he’s not had his hearing reassessed in many years.

• Support Networks:

• • Rose and her family are the main support network.
  • Donald and his wife visit every three months. They are responsible for all administrative work and planning. They were also the ones who figured out and bought any devices that might help with Patrick’s day-to-day activities and did home improvement to help him move around the house.
  • They have close-knit families and friends in Newfoundland but rarely see them since Patrick’s condition progressed.
  • Prudence, Kirk, and their children have not visited them for more than two years.. Kirk and Prudence call every couple of months.

• Barriers and Facilitators to Relational Care:

• • Gloria feels reluctant and uncomfortable to have professionals helping her at her house.
  • With their modest saving, they cannot afford private care.
  • Although they are told that Patrick’s case is managed by the geriatric team, he rarely sees his geriatrician and their family doctor. Patrick has never been referred to an occupational therapist or physiotherapist for his condition.

Patient’s Voice and Perspective:

• Patrick to Gloria: “I just want to be with Gloria (Mrs. Bishop). Where is Gloria? Let me see her!”
• Gloria: “I am not going to have people hover in my house every day. This place is tiny; where are they going to stay? How am I going to cook in my kitchen and watch the TV?”
• Rose and her husband: “We lost our daytime job, and now we are taking office cleaning gigs. It works better since we can stay with Mom and Dad in the daytime and work in the evening while Chris (their daughter) looks after Dad. It’s tiring; Kirk and Prudence complain a lot, but they have not visited us for two years.”
• Donald: “I know Dad and Mom need assisted care and that we should put his name on the long-term care waitlist. But, if Mom doesn’t want it…. She made the call, and I will listen to her.”
• Kirk: “I think Mom is losing her marbles too. She needs to also get a check-up because I think she has dementia.”