1. family and parenting
2. children

ACFI & Clinical Competency Test
Case Study
Mr Seymour Waise was admitted to your aged care facility 13 months ago following his wife Nomore
Waise being hospitalised and sustaining a fractured right radius. Nomore had been Seymour’s
primary carer for the past two years since he was diagnosed with dementia.
Nomore has been struggling to care for her husband for the past six months prior to admission, as he
is vague, unable to initiate or complete any multi task process without some physical support,
requires guidance and prompts just prior to every task. Hence she had been assisting her husband
with his hygiene, dressing, grooming activities, meals and general household activities.
Seymour’s diagnosis: Alzheimer’s Dementia, Osteoarthritis of lower back R hip and L knee, CCF and
type 2 Diabetes non-insulin dependent.
The pre- admission information states he has had multiple falls at home in the past six months
resulting in soft tissue damage and one concussion.
ACCR stated Seymour has had short-term memory loss for many months and this has been getting
worse. His recall of recent information is very poor and a fab test indicated 12/18, SMMSE score was
14/30.
He also has been incontinent of urine and is having difficulty locating the toilet at home. When
Seymour is taken into unfamiliar surroundings he becomes very confused, often calling out “I want
to go home” “get me out of here”.
Staff submitted his initial ACFI claim as a LLN.
On discussion with staff, they state he hasn’t changed much since admission. They have shared
Seymour is very confused, only able to complete very simple tasks, requires physical and verbal and
non verbal assistance with most ADLs but because he becomes easily annoyed and is agitated they
leave him alone saying he seems OK.
Comments from care staff are statements like he doesn’t like us doing anything for him so they don’t
help him very much. Occasionally they pick up his pad that he has deposited in the lounge room pot
plant and often he is found with multiple layers of clothes on and in the wrong order.
No care evaluation has been completed, just a review update on his care plan which hasn’t changed
from admission. If they try and help him, he shouts at them to go away and they generally leave him
to his own devices.
You notice on the previous behaviour claims he has a B for Q8 and nothing else in behaviours.
Current medication:
•
Paracetamol 2 prn (rarely used)
•
Aricept mane
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Lasix 80mg mane
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Metformin mane
ACFI & Clinical Competency Test
•
Oxazepam 15- 30mg nocte Prn
•
Resperidone 2mg daily
Emotional and Functional Picture
Nomore describes Seymour as a sad, lost, agitated sole that doesn’t cope well with lots of noise or
groups of people and she feels terrible that she can no longer care for him.
Seymour ambulates with an unsteady gait and stooped posture. He requires guided physical
assistance to get in and out of chairs, toilet and bed to ensure safety. The physio has conducted an
assessment and has found him to have a 10 second unsupported standing balance requires a four
wheel walking frame which he always forgets and has a LROM in R shoulder, back hip and knee.
He is a high falls risk.
Seymour appears to have pain in the lower back, R hip and R knee. He was very reluctant to be
examined in any depth and became very resistive and angry when the physio attempted the exam.
The Physio has conducted sensation tests which indicate he can determine hot and cold and
provided he is supervised, a hot pack would be appropriate to trial.
His skin is very dry with flaking occurring on the legs eyebrows and back.
He is frequently found scratching his legs and eyebrows causing both areas to bleed following his
scratching episodes.
Staff also have reported his groins are looking excoriated particularly his left, probably due to his
urinary incontinence. Swelling is always noted in his feet in the afternoon and evening.
His toenails are flaky and very smelly and the left toes appear to have tinea between them.
Once in bed Seymour lies on his back not initiating turning at all. Sacrum back of head and heels
appear very red when staff get him up in the morning.
He looks sad with tears often in his eyes, constantly calls for his wife. Nothing seems to cheer him up
or gives him pleasure at present.
He is a poor eater and drinker periodically locking his jaw together refusing food and fluid. Has lost
four kg in the past two months which places him below his healthy BMI range.
His interaction with others is often impaired resulting in perseveration (repetitive speaking either
one thought word or sentence) causing confusion and annoyance for those trying to converse with
him.
He becomes hostile in facial expression and stiffens his body clenching his fists, and threatening the
staff he will punch them if he they come near him, although there have been no reports of physical
aggression so far. Staff says this behaviour usually happens when they tell him he is going to be
showered.