You are a social worker at an adult day care center. At times, your clients end up with broken hips, diseases such as diabetes, obesity, dementia-type disorders, and some physical disabilities. When they are injured, you may be asked to help find them an appropriate structured setting after they are discharged, sometimes coordinating with a hospital social worker. Some of the elders are placed in nursing homes.

After he fell and broke his arm, you began working with Eduardo, who also has diabetes and brittle bones. Eduardo has exhausted his savings and barely exists on his Social Security at home. All his family members are dead or they live too far away to care for Eduardo. You want to be sure he is placed in the best facility, as Eduardo is a sweet and dear man with whom you have developed a good relationship.

Because nursing homes vary in their level of care and conditions for their residents, and Medicaid only pays for the bare minimum of care at a nursing home, you are concerned about Eduardo’s placement. In your experience, impoverished patients sometimes end up at inferior homes, and you are concerned about the ethics and justice of this situation. Thus, you’d like to make some changes.

A couple of colleagues agree with you, but your boss isn’t very interested in your concerns. Administrators of the adult day care center where you work and hospital administration tend to view nursing home facilities as none of their concern. And, while licensing requirements must be met for all nursing homes in all states, these requirements only apply to the bare minimum of standards.

1. Who is the macro client or system in this vignette and why?

2. Who could be part of the action system and why?

3. Who or what could be your target system and why?

4. Identify and discuss how you would apply one of the following perspectives to this situation: the ecological, social systems, or social structural. Which one would seem to be the most helpful and why?