Occupational Profile of Ms. D

Las Vegas Adult Day Center

Amanda Barr

Summer 2010

OCCT 651

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OCCUPATIONAL HISTORY & EXPERIENCES

Ms. D is currently a day resident at the Las Vegas Adult Day Center in North Vegas and

her attendance at the day center is funded by a grant from the state of Nevada. She attends the

center on Tuesday, Wednesday and Friday and finds the site to be welcoming and enjoyable. She

does not receive any formal therapy services outside of the day center. Her current medical

conditions are listed as epilepsy, cataracts, hypoglycemia, Gastroesophageal reflux disease

(GERD) and COPD. She has weekly allergy checkups with a med clinic due to her extreme

allergies as she states and complications in her immune system due to multiple bouts of

pneumonia over the last 2 years. The client sees a primary care physician every 3 months and

feels that she is aware of her health problems and is thankful for her family for helping her with

her welfare.

The client was born in 1960 in Provo, Utah and moved to Las Vegas with her family at

age 3. Her family consisted of her father, mother and 3 siblings; 1 brother, 2 sisters. She is the 3rd

oldest of 4 children. The client was diagnosed in infancy with Spinal Meningitis diagnosis and

further nervous system issues precluded into her early development through age 9 when she

states her seizures began. She was classified as epileptic and was noted as having grand mal

seizures at least once a day. She was unable to recall the seizure from her childhood but her

ability to know was based on her observation of wetting herself during an incident. The client

stated that she was a quiet child and was chubby because she didn’t like sports and tended to play

in the house by herself. The client states that she has never had a driver’s license due to the

prevalence of the grand mal seizures that would occur as much as twice a day.

The client mentioned openly that she misses her parents. She stated that her mother

passed away at the age of 56 from secondary complications stemming from her battle with

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alcoholism and her father left this earth suddenly from a Heart Attack at age 72. She ended this

sentence with the comment that “I live my life very conscious of my health and this thanks to my

parents”.

PATTERNS OF DAILY LIVING

The client did not state much when it came to her daily routine since it does vary as she

says based on what is happening with her sister and if she is feeling up to attending the Day

center. She did note that gets up every day at 6AM and does a morning stretching routine that

says helps keep her loose and ready for her day. She also washes her O2 mask in her bathroom

sink every morning before breakfast and lets is dry during the day in her bathroom. She lets

Cinderella, her poodle out in the backyard at 7AM for 30 minutes to do her business and get

some energy out. She eats her breakfast when she hears someone in the kitchen. She tends to not

have a set eating schedule and does eat a lot of snacks like crackers and cheese or carrots. She

will watch about an hour of TV at night before she takes shower. She prefers to take a warm

shower to help her sleep.

AREAS OF OCCUPATION & INTERESTS

ADL

Based on discussion with the client and a review of her chart she is independent in her

bathing, bowel and bladder management, toileting, dressing, eating, feeding, functional mobility

and personal hygiene/grooming. It is unknown if the client is sexual active and limited

relationship with the client this therapist did not employ questions regarding this area.

Specifically noted by the client was that she maintains her personal devices of O2 mask for

sleeping and related equipment each day but does need some assistance in locating her glasses

when she loses them in the house.

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IADL

The client currently has lived with her older sister and brother in law for the past 15 years

after giving birth to her twin girls. Her sister became the primary guardianship of her daughters

and the client is supportive in decisions that her sister makes regarding their welfare. She cares

for her 10 year old miniature poodle, Cinderella with morning and evening play, feeding and

cleaning up after her and a bath about twice a month. She stated that she is able to communicate

with her family through a cell phone she carries and is able to us public bus transportation to and

from the Day center since it’s about a 30 minute bus ride.

She assists her sister with errands like going to the grocery store or Wal-Mart by helping

carry bags, assist in locating items and pay for her personal items like movies, beauty products

and her clothing. She is highly aware of her safety as she crosses streets after an accident on her

bike in the past where she was hit by a car at a corner near her home. The client does not take

part in regular organized religious practices but does state she is spiritual. She is independent in

her health management and maintenance as she notes she does like to be active around the house

by “being useful” in chores like doing her laundry and cleaning whatever her sister asks her too.

She spoke of her mental schedule that she performs on the days she is not in the Day Center that

involves cleaning her bedroom, her bathroom and vacuuming and dusting the house. She noted

that she is not able to go into the kitchen other than for the microwave use since she is not

allowed to cook due to her safety risk.

She relies on her sister, the twin girls or her nephew for meal preparation and the clean

up. Her sister takes care of her finances, medical appointments and medication refills. Ms. D

does state she needs some sort of reminders about her medication management and this is an area

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that her sister gets upset at her about cause she ends up having a medical problem when she

doesn’t keep on her schedule.

Rest/Sleep

The client has had poor sleeping habits over the last year and notes that she was waking

up in sleep. She attended a sleep study and found out she has sleep apnea and she is currently

using a O2 regular and face mask when she sleeps and since employing this regime her sleep

tends to be restful. She sleeps best after a shower and she applies hand lotion before bed that

smells like “heaven”. She sleeps for 8-9 hours nightly with occasional waking up usually from

being cold. She uses an alarm clock and it is set for 6AM so she can see her daughters off to

school at 6:30AM.

Education

The client is educated through High school and stated that she had difficult learning and

was placed in special education for all classes but Math. Her poor grades in subjects of English

and history are what made her discouraged in High school. Although she spoke highly of her

math courses that she attended as a regular student with her peers and felt she was capable of

learning so much better when it came to numbers.

Work

Currently the client is retired says she isn’t able to work due to her disability. Her past

work experience has been with her parents or friends businesses from age 18 to her late 20’s. She

held a job with Desert Thrift Store for 3 years in the retail sales environment prior to the birth of

her twin girls back in the mid 1990’s. After twins birth, she collected cans on her bike; typically

about 1,000 cans a day due to her so called “connections” with a few local businesses. She

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performed this for 6 days a week, for roughly 6-7 hours for 2 years. She said she was in the best

shape of her life riding her bike and had very few seizures during this time.

Leisure

The client stated that she likes spending time with word puzzles, gossip magazines like

People and Us weekly. She is an avid card player and highly enjoys poker, Lucky 7’s and

learning anything related to card games. She states that she adores movies of all genres, except

horror and she rents a movie a week with her sister when they go to the grocery store.

Play

Ms. D states that she loves to sing and she is fond of ABBA and the Pointer Sisters. She

has done Karaoke once and feels that the day Center should try doing Karaoke to get people

involved. She plays bingo every afternoon when she attends the day care center, as well as has

her own deck of cards for the Lucky 7’s games. The client feels that she has developed some

good friends at the center because of the card competition which makes her more motivated learn

new card games like Texas Hold’em.

Social participation

Ms. D engages in conversations with familiar people at the Adult Day Care Center and

she is highly motivated to participate in any games such as the Lucky 7’s, Texas Hold’em or

Dominos. She pursues activities in groups like the art therapy and the music therapy sessions but

does not tend to initiate conversation unless spoken to first.

CLIENT FACTORS - VALUES AND NEEDS, BELIEFS

The client used to be religiously affiliated with The Church of Jesus Christ of Later Day

Saints until the early 1980’s when her family decided to leave after the church extradited her

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mother due to her mother’s battle with alcoholism. The family decision was to not continue

attending church or other affiliated branches due to lack of compassion and assistance to help her

mother overcome her illness. She states that her family was pretty close up until her mother

passed away and most of her siblings live in neighboring states other than Utah. Her beliefs as

she states are her own and she feels she can continue to maintain her spirituality without

organized religion. She values her immediate family very much and is very proud of her twin

girls as they are growing into strong and independent women thanks to her sister and her brother

and law.

CLIENT’S PROBLEMS & CONCERNS

PERFORMING OCCUPATIONS & DAILY LIFE ACTIVITIES

Due to some argument that her sister and her have had recently regarding not following

through with her medicine schedule or the lack of initiative to do things around the house, the

client has said she wants to be more organized and put more effort into maintaining her own life.

She has said she wants to be able to make food for herself even if it’s just a microwave entire or

putting something together from the refrigerator. She also feels that she depends on sister too

much and doesn’t want to be a burden. She wants to be engaged in scheduling her medical

appointments and helping her sister with more than just house cleaning like maybe sprucing up

the front yard with some plants. Also her lack of contact with her twins makes her feel

depressed since her sister is more of the mother figure for her girls. She would like to at least

spend time with them either socially or in some sort of leisure activity so she can have a place in

their lives even if she not as parental guardian.

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CLIENT’S PRIORITIES FOR RECOVERY/PARTICIPATION IN OCCUPATIONS

The client states that she thrives off of being around people as she says she is people

watcher and likes to be around a small group of like minded people. She feels that somehow she

wants to support her girls in achieving their dreams. Her life is enjoyable but she does say she

has a lot of down time and would like be more engaged within her family. She wants to have

independence and be more active which may mean making adjustments to her current

environment like going to the Adult Day Center only a two times a week.

CURRENT PERFORMANCE LEVELS/PERFORMANCE SKILLS

Sensory Perceptual

The client has noted that she is aware of a time frame that a seizure will occur; usually it

related to her diet and muscle weakness from Hypoglycemia and eating something every 3 hours

helps both the symptoms of hypoglycemia and her epilepsy. She has some increased joint

stiffness in her fingers and wrist during card playing and has not be diagnosed with any type of

arthritis. The client voiced that she is sensitive to certain skin care products especially on her

face and she relayed that she face is tender for in the mornings from her O2 mask pushing

putting pressure on her nasal and cheek areas during the night. The client notes that she has had

some morning stiffness in her neck and jaw from the fixed position while using the O2 mask.

Motor/Praxis

Miss D has the ability to control and plan her motor patterns but has some noted

problems with fine motor actions like during painting during art therapy. She has to be very slow

and precise in her ability to control her movements. She does have gross motor skills and gait

within normal limits and is highly capable of being mobile and independent is response to

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objects or obstacles in her pathway. This therapist noted some coordination issues when

observing her participation in the 20 minute exercise routine, as the client is not able to

coordinate upper extremity crossing or complex steps that require multiple joint use like flexion

of shoulders and crossing the arms or turning the hands in unison.

Emotional Regulation

Ms. D voiced that her family has stated to her that she is highly emotional and Mary, one

of her daughters, has told her she flies out of control when under pressure or stress. She does

admit that her moods are variable based on her experiences and level of interest. She agreed that

her emotions are connected to her pain or irritations from health. During the observation time the

client was initially irritable in the morning hours and became engaged in conversations, group

activities lifted her mood as it would any other person.

Cognition

The client showed some increased time to collect thoughts and respond to questions when

this therapist was engaging the client. She tends to mull over past experiences that are more than

a year and her response time was between 1-2 minutes based on the complexity of conversation.

Although Ms. D does know addition and can add multiple number in her head and respond fast

than the therapist. She is able to recall and recount game related facts or instructions in a fluid

manner to new game attendees and her verbal responses are easy understood. Her processing

speed is affected by large group of people as she becomes more inhibited in a group of more than

4 people.

Communication/Social

Ms. D is within normal limits regarding social exchange and interactions as her ability to

articulate based on subject in her interest makes her more apt to engage in a conversation. She

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also helps others and is willing to initiate assistance when someone needs help. She can maintain

a conversation for about 10 minutes. She shows genuine interest in others, actively observes

people’s conversations and interjects with comments around familiar peers.

PERFORMANCE PATTERNS

Habits & Routines

Her day begins with standard hygiene and grooming activities morning and knows her

pills, has ritual of seeing off her girls at the bus stop before class, does her breathing and stretch

exercises in the morning before breakfast and washes her O2 mask in the morning after brushing

her teeth.

Roles

The client tends to herself and no longer has parental guardianship of her two 15 year old

twin daughters. Her Past roles included mother and wife which ceased when she was 25 years

old.

Rituals

The client did not state any information that pertained to this area.

CONTEXT AND ENVIRONMENT

Cultural

She continues to maintain her Mormon upbringing and the values regarding lifestyle that

include the abstaining from alcohol and caffeine including soda. She is highly respectful of

others and will hold doors open for wheel chair bound residents at the Day Center. She

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celebrates birthdays and holidays with her family and noted that its tradition on birthdays to

make the person their favorite meal.

Personal

Ms. D is a 50 year old female, who is unemployed with a high school diploma and is the

mother of two twin girls who gave up guardianship to her maternal twins at age 25.

Physical

The client lives in a single story home with a backyard and studio/garage. She uses the

bus for transportation and lives close to a park. She owns a dog named Cinderella and likes

plants especially orchids and tropical varieties.

Social

She surrounds herself with like minded people who are residents at the day center and

feels that she wants to maintain a relationship with her family and her daughters. Her sister is her

caregiver and is the legal guardian of her two daughters; she plays an integral part in the life of

the client both in personal and physical contexts.

Temporal

Ms. D has been unemployed for 20 years and has been an active resident three times a

week at the Las Vegas Adult Day Center for the past 3 years.

Virtual

The client is not up to date with technology, as she stated that she barely knows how to

work a computer other than to turn it on and go on the internet about once a week. Other

technology experiences are with casino video poker or slot machines and occasionally watching

Hulu.com with her daughter, Mary.

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CLIENT FACTORS ANALYZED DURING ACTUAL TASK PERFORMANCE

Exercise routine

The client is able to independently and actively engage in a 20 minute exercise routine by

following verbal and visual cues. She does show some uncoordinated arm movements but puts

forth effort to participate in complex multiple step patterns by keeping rhythm to music and

showing interest in the group activity.

Card game

The client showed initiation in inviting others to play in Lucky 7’s game with her and

another resident of the Adult Day Center. She talks minimally with other players most likely due

to the competitive mindset of her fellow players. During dealing of cards she has great fine

motor control and is able to perform the coordinated shuffling of cards with no apart motor or

cognitive difficulties. She is reminded on occasion of her turn by the players as she tends to lose

track of who is in play or she becomes anxious when playing her cards.

TARGETED OUTCOMES IDENTIFIED

Through observation and conversation with the client she felt that she would like to

improve her independence in IADLs. She feels that she is capable of performing tasks related to

her health and wellness but needs a way to remember and keep her thoughts organized. She

would like to have a more active role in her both her daughter’s lives in some sort of social

format like supporting their extra-curricular tasks like attending their school marching band

events. The client also felt she needs more structured and organized schedule to avoid conflicts

with her sister and that she would like to help her sister by taking some burden off her of

regarding shopping, food preparation and her medical management.

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LIST OF IMPROVEMENTS AND JUSTIFICATIONS

1. Client and Therapist will develop a schedule and log that can be implemented for daily

chores, medication management, activities and scheduling appointments. This system will be

discussed with her sister to help reduce the workload of her sister and improve the client’s

ability to manage her life.

2. The client will participate in an activity of her two daughter’s choice that helps to forge a

relationship that the client longs to have with her daughters. The activity can be changed

based on the girl’s interests and is designed to improve the client’s sense of contribution to

their lives.

3. To improve the client’s sense of accomplishment and engage in a meaningful activity of

gardening, the client could beautify her home environment by improving the outside

landscaping. The client noted as that she loves plants and has always wanted to do something

special for her sister. The task could be broken down into steps and maintenance could be

included in her schedule.

4. The client will engage in a leading a Lucky 7’s card game by recruiting 3 peers to join her in

one session of play; best out of 7 games. The client will maintain and submit the official

record of the scores to the front office attendant for the competition. This goal was based on

the clients desire to continue to play card games with her peers and reduce the down time at

the center. The client voiced her love of being around her peers and she wanted to improve

the Lucky 7’s competition by having a larger group of participates so that there is more

competition and opportunity for play.

5. The client would benefit from an exercise regimen that incorporated coordinated movements

with gross motor activity like yoga. The program could be an addition to her morning

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stretching routine. The client would benefit from a structured exercise plan that targets her

motor planning, body awareness as this would help increase her confidence and sense of self.

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