Case Story 4: Irene

Description of patient’s characteristics and situation:

• Name/Age/Gender Identity: Irene Walsh/74/woman
• Life Story & Cultural Background: Irene was born and raised in Sackville, NS. Growing up she lived with her parents and younger brother. She is white, from predominately Irish and English ancestry, and is Catholic.
• Significant Relationships: Irene was very close with her mother until her death 5 years ago. After her mother’s death, she moved to a group home where she currently lives.

Health Journey Narrative:

• Irene is on the Autism Spectrum and has intellectual disability. She has a complex health situation that includes diabetes, anxiety, high blood pressure, and epilepsy. She has obesity and has low levels of activity.
• Her intellectual disability manifests as challenges with interpersonal skills, social judgment and awareness of other’s thoughts and feelings. She has challenges taking care of herself, managing money and protecting her safety. Irene likes routines and will resist changes or being in situations that make her uncomfortable.
• Irene requires extensive support to manage her daily activities.
• Two years ago, she had a bowel obstruction and was admitted to hospital for a bowel resection. It was found that she had bowel cancer, and a mass was removed during surgery.
• Irene lives in a group home for people with developmental and intellectual disabilities. She moved to the home after her primary caregiver, her mother, died 5 years ago. Before then, she and her mother had a routine that included meals, outings and going to church. At times, Irene was violent with her mother. It was very difficult for Irene when her mother died, and adjusting to all the changes that resulted in the loss.
• When Irene has healthcare appointments, she takes Access-a-Bus and one of the group home workers accompanies her.

Presenting Experience:

Irene’s daily concerns revolve around buying the food she likes to eat and buying other items that she wants. Given her circumstances, these concerns are often challenges. For example, she likes to eat licorice, but it is not available at the group home where she lives. While Irene is eligible for old age security, most of the money goes to toward running the group home where she lives. She has a small stipend to buy incidental items, it’s $100 per month. Once she receives her monthly stipend, she spends it in a few days. Her long-term diabetes indicators suggest her diabetes is not well controlled (her last A1C level was 8). Historically, Irene participated in many religious activities such as attending mass, saying the rosary, and praying. She has several religious artifacts in her room. Participating as she would like in her religious activities can be difficult, largely because of living in a shared space.

Intersectional Identity:

• She is a white woman with autism and an intellectual disability who is from lower socioeconomic background. She has little control of her own situation and is dependent on others for her needs to be met.

Supportive Relationships:

Engaged Health Care Professionals: Irene has a family doctor whom she’s known for about 25 years. There is a social worker associated with her group home that she sees when needed, an average every two months.

Support Networks: Irene’s brother has little to do with her. He lives in a community near by but has not seen her in several years. Her next of kin and power of attorney is a family friend who also has very little interaction with her. The group home workers and other residents are her major social interactions. She often has conflict with other residents and resists much of the supported offered to her by staff. She had one friend at the home, Carol, who also recently died. She has no other friends either in the home or in the community.

Barriers and Facilitators to Relational Care: Due to Irene’s challenges with interpersonal skills, she is difficult to get along with. She resists help, both physically and functionally. She has few financial and social resources to draw from for support.

Patient’s Voice and Perspective:

• “They changed my doctor appointment last week. I had to cancel the bus and they wanted me to come in the next day. I can’t get the bus with a day’s notice” Irene
• “It’s hard to get her to take a bath. It’s always a struggle” group home worker
• “She’s got all these statues in our room and it’s creepy. She’s always praying and I can’t be in the room.” Resident of the group home
• “I wish my brother would come and give me some money. He’s got lots of money. I don’t know why he can’t give me some.” Irene

Media Attributions:

Image 1: Map Data (c) 2024 Google. Halifax, Nova Scotia. https://www.google.ca/maps/@44.7023973,-63.560722,11z?entry=ttu&g_ep=EgoyMDI0MDkxOC4xIKXMDSoASAFQAw%3D%3D

Image 2: Rosary Beads [public domain]