Consider this scenario, Case Study #1 there are many studied at case conferences...a man and dog in the desert. He keeps up a monologue, which requires little response, as he moves frequently from present to past.
Grateful for the attention --both man and dog are happy to see you. You feed the dog the doggie treats you always bring. You've taught this happy-go-lucky beast to 'sit', and sit he does, on command, anxious for the dog biscuit you've brought. That done, greetings and skeletal social niceities concluded, the man turns to go back and sit on the couch. As he does so, you notice that his long johns have a spot of feces on it. The room reeks of cigarette smoke, and other smells best left unnamed. The house is now insulated with the 3' of snow that fell, yet the plastic over the windows cannot keep out the cold chill I feel in my heart.
There is evidence of alcohol, and either dementia or delirium, it is hard to say which. The conversation remains befuddled, although you sense from both man and dog that they are as desperate for conversation as
The poverty, filth, and clutter scramble for dominance in the place he calls home. His sibling can no longer talk sense to him. The man's mother and brother, seen in tears leaving the house, with it's air leaks, stained carpets, garbage piled high, have been unable to have him sign the papers for a transfer to an Alternate Level of Care, which he desperately needs.
CCAC continues to send a nurse, if the path is shovelled. The local church pays for snow clearing on the driveway. His doctor unable to attend him, recently gone by ambulance to hospital himself. A doctor in Toronto continues to refill his prescription. We know not how.
He has debts that have sent him in to the bowels of depression and addictions: beer, cigarettes. He is in hospital, dehydrated, has had two total blood transfusions. They are still doing tests to determine the cause of his dehydration, poor blood counts, diarrhea.