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!")

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.

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. 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? 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. 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.