Case Study 7.1: The Case of Mrs. Jones

Ms. Smith is the office nurse at a primary care clinic. 75-year-old Mrs. Jones is a relatively new African-American patient at the clinic, which serves a population of primarily minority and/or low-income persons. A large proportion of the patients are also elderly. Mrs. Jones, who was widowed 10 years ago, recently suffered a small cerebral vascular accident (CVA) as a result of poorly managed hypertension. Ms. Smith suspects that one reason that her hypertension is poorly controlled is that Mrs. Jones does not always fill her prescription, and her prior health care providers are not aware of this.

Mrs. Jones is living on a fixed income and she has told Ms. Smith that her budget does not always permit her to pay her rent and to buy her food for the month. She admits to being "too proud" to ask for assistance. On further questioning Ms. Smith discovers that for some weeks prior to her CVA Mrs. Jones had been stretching out her anti-hypertensive drugs by only taking half of the prescribed dose. Currently Mrs. Jones is doing well, has only mild residual right-arm weakness, and is being cared for by her son and daughter-in-law. Mrs. Jones confides in Ms. Smith that she would like to move back into her own apartment as she feels she is a burden to her daughter-in-law Sherry who has two-year-old twins and a five-year-old. She says Sherry sometimes gets short-tempered and "yells" at her, although "mostly she is very kind". Her son works long hours and is not around much to help Sherry. Mrs. Jones wants the clinic personnel to permit her to return to her own home.