Introduction to the Miller Family

Sarah (40 yrs) and Joe Miller (43 yrs) are at the center of this family. [See the geneology maps (family trees) for both Sarah and Joe below.] They are a middle aged couple, married 21 years with three children. Their children are Lucy (20 yrs), Josh (17 yrs), and Abe (12 yrs). Lucy has had struggles with substance abuse, along with having been diagnosed with bipolar disorder. Josh has been sneaking away with friends and smoking pot. Abe is a good student but has started to act out recently.

Sarah's parents are Donna and Manny Maldonado. Manny is third generation Hispanic American from Mexico. Donna has long suffered from her "moods" which is mostly frustrating to Many. He says it's"brujeria" (related to witches and magic). He worries that someone puts spells on her. They both are fluent in Spanish, Donna having learned as a result of being with Manny and around his family.

Sarah is their oldest daughter followed by her brother, Mike (36) and then sister Becky (33). Becky, divorced,has one child, Elías (10 yrs old) who was recently diagnosed with Leukemia. Mike is alone, having recently suffered the loss of his companion of many years to AIDS. He is secretly also concerned that he might be HIV+.

Joe's parents are Ella and John Miller. Ella is at the center of our story as she has been trying to heal herself from breast cancer through the use of a variety of natural means. She was raised on a farm and is not very trusting of "modern medicine." Her husband, (Joe's father) John is of American Indian origin.He uses a variety of traditional methods for health and well being and as a means of banishing bad spirits from their home. Ella's mother passed away over ten years ago but her father is still alive. He is often referred to as the "shakey grandpa" by the grandchildren and great grandchildren due to the man ifestation of some symptoms of his Parkinson's disease.

Joe has a sister, Lila (45 yrs), who has diabetes and who has always struggled with her weight. She and her husband have one child, Alisha (20), who's currently in college. Joe's older brother Sam (50 yrs), was married and then divorced years ago, has one son from whom he is estranged. He is an alcoholic who hasn't been able to keep a job for years.

The family and extended family get along well for the most part though the many cultural traditions and backgrounds do clash from time to time. Manny, for example, has been known to say, "They're crazy!" when the family discusses some of the health issues that are going on and how they are being handled.At one time, for example, Ella's skin turned orange due to the amount of carrot and other juices she wasconsuming in order to get rid of her cancer.Sarah has been married to Joe long enough to know her well and when her sister Becky's son Elias wasrecently diagnosed with Leukemia, Ella was hopeful that Sarah would encourage Becky to use naturalmeans for treating him. Sarah isn't really too sure about how she feels about it.

Final Paper

To complete this assignment, read through the scenario below and address the specific questions and issues indicated. Review the "Introduction to the Miller Family" document for specific information on each member of the family.

Grandmother Ella has been dealing with cancer for years now and has tried alternative remedies and juicing.  She went into remission for some time, but now the cancer has returned and she is in the hospital.  Her husband, of American Indian descent, has his ideas about what needs to be done as Ella comes to the end of her life.  Ella has her preferences, though she is now so weak that she has given up in many ways.  The family members are each experiencing their own fears and are grieving as they face the loss that will occur as Ella's life comes to a close.  Ella prefers to die at home and has felt stressed by the discord and discomfort of family members since being hospitalized. 

You are the social worker for this case.  You meet this family in the hospital setting as they are considering whether the patient will remain there for her final days or whether hospice and palliative care will be provided for her in her home. 

For this assignment, you will:

1. Synthesize the current research that is relevant to this scenario.
2. Discuss the cultural or traditional issues that could arise at this time.  Consider how the integration of alternative and complementary medicine and beliefs, mainstream medical practices, and cultural/traditional rituals and practices might create issues and what they might include.
   • Describe how the family might react to the following possible scenarios:
     • Ella wishes to stick with alternative and complementary practices.
     • Ella is coerced into following mainstream medical advice.
     • Ella's husband insists that, as father and husband, his family traditions should be adhered to.
   • Examine the biological basis for care and describe how the choices for care might affect the other family members with respect to their individual problems, if at all.
     • Son Sam, the alcoholic
     • Daughter Lila, with diabetes
     • Grandson Josh, starting to have drug problems
     • Granddaughter Lucy, bipolar with more entrenched drug problems
     • Daughter-in-law, Sarah's stress related to her family's medical issues (nephew with leukemia, brother with HIV, and her father's perspective that they are all "crazy!")
3. Discuss the micro, mezzo, and macro influences affecting both the patient and the diverse family members in this scenario as impacted by Ella's medical condition and prognosis.
   • What are the pertinent and likely family (micro) conflicts and differences, and concerns that could be encountered? 
   • How is the neighborhood and extended family (mezzo) reacting to the situation?
   • If she returns home, what considerations need to be taken into account as part of her discharge plan? Using your local area, research and present the needed or preferred community resources (macro) that would be available to them.  Critique the ability of these community resources to adequately meet the needs of this diverse family's circumstances.
4. Discuss the relevant medical issues and the advantages and disadvantages of hospital versus home.  When discussing medical issues in this case, use appropriate medical terminology. 
5. Discuss the psychological and social issues that are present and will possibly be more pronounced at this stressful time.  How has the fact that this illness has been ongoing (chronic) impacted the family?
6. Analyze the current scenario as it pertains to diversity, as well as to cultural, psychological, and social perspectives and influences, taking into account the stories that you have been discussing throughout the course.
7. Discuss the impact of lifespan development on the perspectives of the various members of the family (i.e., their intellect, cognitive abilities, insight, and judgment) as well as their sociocultural perspectives, preferences, understandings, and positions on the situation.