The Suburb of Fremantle and the Johnsons Family - Case Study Example

A CASE STUDY OF A COMMUNITY IN PERTH (AUSTRALIA) CONTENTS 1.1 Introduction to the family.................................................................................pg3 1.2 Financial impact on the family..........................................................................pg4 1.3 Socio-Cultural limitations..................................................................................pg5 1.4 The availability of resources..............................................................................pg6 1.5 Recommendations............................................................................................pg8 1.6 Conclusion.........................................................................................................pg9 1.7 References........................................................................................................pg10 INTRODUCTION TO THE FAMILY In the 2006 Australian Census, 7,458 people considered Fremantle the place they most likely call home. The average person is a comfortable 41 years of age, and they have an average weekly gross income of approximately $539 per week. Fremantle folk that are planning to own homes have to pay a weekly mortgage of around $379 with the average house price in Fremantle being around $620,000. For those less fortunate to own a house the average rent in Fremantle was around $180 a week. In terms of employment, 51.52% of people in Fremantle were considered employable. Currently, the suburb of Fremantle is home to around 7,458 people, with the major industry being health care & social assistance, and a majority of workers being professionals. The Johnson’s family is a nuclear family living in south Fremantle in Australia’s west coast. Mr. and Mrs. Johnson have five children; all except one are in grade school. The family moved to South Fremantle, from Dianella in the north in October 2005 after their elder son’s (Josiah Johnson) dementia problem became critical. The Johnsons are Presbyterians in a Catholic dominated neighborhood and rarely socialize with their neighbors, preferring to stay isolation. In addition, they are conservative and prefer to raise their children in a controlled environment. Economically, they have an average weekly income of $459, mainly from their shop at 50A High street. This average income is split between rent ($150), education, healthcare and recreation. The four younger children are in grade school. The elder son, Josiah Johnson, also known as J.J., had to leave school because of his condition and now consumes much of the family’s monthly income which is mostly spent on medical services and school. A diagnosis in 2000 confirmed J.J’s condition at the tender age of 15 and since then has been growing from bad to worse. This condition made their neighbors conclude that the family had a history of mental illnesses, especially after his violent behavior towards his peers on one occasion. The government statistics place the prevalence of threatening behavior at 2% in the south metropolitan (The Western Australia Police - Annual crime statistics 2007-2008, Revised Oct 2008). Furthermore, an estimated 37% of the population received home based care which was not conducive in their former neighborhood. FINANCIAL IMPACT ON THE FAMILY With the majority of persons with dementia being cared for in the community, it has been suggested that the coping mechanisms and resources of families may be severely tested (Dunkin and Anderson-Hanley 1998; O'Shea and O'Reilly 2000). During the prolonged care period characteristic of Alzheimer's disease and other dementia conditions, caregivers face the potential for social isolation; financial drain; and physical duress (Clyburn et al. 2000). Women are particularly vulnerable; as they make up the majority of care providers (Gwyther 2000).The micro system in which the Johnsons live is characterized by negative perceptions, especially about their elder son. His condition has limited his siblings’ interactions with their peers and some of their schoolmates because some associate the mental problems of their elder brother with genetic factors. Such perceptions are also constructed by the isolationist tendencies of the Johnsons as they try to keep J.J. out of the public domain. Furthermore, the relations between the Johnsons and the school teachers is also poor as they insist on keeping their son “locked” from the public, partly due to their financial capability and partly to prevent him from causing harm to the general public. The constrained budget of $309 in addition to most of their neighbors shying away from any significant association makes the expansion of their business locally quite difficult. Dementia poses considerable medical, social, and economic concerns as it impacts individuals, families, and health-care systems throughout the world (National Institute on Aging and National Institutes of Health 1999; O'Shea and O'Reilly 2000). Not surprisingly, increasing attention and resources have been directed toward the medical aspects of dementia—with the goal of better understanding the various causes, treatments, and possible cures for the diseases that produce dementia's debilitating symptoms. The cultural experiences of the population of Fremantle with regards to living standards compared to other states with developed healthcare systems that can cope with such conditions better, creates further strain and financial drain at the family level as it makes the family rely only upon their financial means, which is limited and strained to the limit. The chrono-system that the Johnsons live in has necessitated a radical adjustment to the situation the family found it self in. Furthermore, even though the financial resources of the family were diverted to care giving for J.J., they finally adjusted to the prevailing circumstances although Mr. Johnson’s experiences at his business makes it difficult for him to adjust to his new environment since they moved to south Fremantle. This has further delayed the children’s integration process in their new social setting. The financial position of the family has militated against accessing some of the basic services that the system offers hence worsening their hardships. SOCIAL AND CULTURAL LIMITATIONS The Bronfenbrenner’s Ecological systems theory, when applied to the family in this socio-cultural setting illustrates the limiting factors as far as seeking the best care for their son is concerned. To begin with, the social stratum that you find the family is limiting due to the financial stability, though the neighborhood is considered to be living comfortably. In Australia in 2008, around 37% of dementia sufferers received no formal care (Access economics 2009). With changes in society leading to a de-institutionalisation of people with disorders family caregivers often feeling expected and compelled to take on informal care responsibilities regardless of cost (Moyle, Edwards & Clinton, 2002; Sorensen, Duberstein, Gill & Pinquart, 2006 & Bloch et al, 1994). The Johnsons family has had direct experience with such a trend since it has been their desire to give love to their son who was once a very active responsible child who would help around when not in school. A combination of guilt and responsibility has therefore been aggravated by the culture of home based care that is very evident in this community. The other limiting factor of the Johnsons is the fact that they are of Presbyterian faith in a predominantly Catholic neighborhood. This further limits their patterns of interactions and creates an artificial barrier defined by religion and the cultural implications of their son’s mental condition. The negative social and cultural factors have made adjustment to the new environment and access to the locally available resources difficult in most respects. THE AVAILABILITY OF RESOURCES The major industry in Fremantle is health care & social assistance, and a majority of workers are professionals. With the development and expansion of programs including support groups, respite care, adult day care, and a growing number of specialized care facilities, assistance for families is increasingly available throughout Australia. Use of such assistance, however, varies widely depending upon availability, cost, quality, and simply knowing that these resources exist. Family expectations and guilt can also play a role in their use, as do cultural attitudes about both dementia and care giving obligations (Ikels 1998; Yamamoto-Mitani et al. 2000). The predicaments of the Johnsons and their twenty five year old son has been defined by their patterns of interactions, financial status and the stigma related to mental problems. As a result, the availability of these resources has not done much in alleviating their suffering or providing the much needed care for their son. In addition to the medical and care giving aspects of dementia, new interest is being directed toward the social needs of persons with dementia in Perth and the entire country. Some advancement has focused on developing supportive environments for persons with dementia (Day, Carreon, and Stump 2000). Others have focused on behavior management (Kaplan and Hoffman 1998) and modes of effective communication and interpersonal interaction (Feil 1993; Zgola 1999). Very little attention, however, has focused on understanding the personal and emotional experiences of having dementia. One exception is Diana Friel McGowin's (1993) account of her experiences with Alzheimer's disease. Another is the call to mental health professionals for person-centered therapies for persons with dementia (Cheston and Bender 1999). These concerns, such as supportive environments, behavior management, and interpersonal interactions as well as personal and emotional experiences of dementia are currently being addressed by the local dementia care centers such as the “Society for the Arts in Dementia Care, Perth Australia” and the “Fremantle Trust”. The Fremantle Trust is a registered charity providing care and support services for older people and adults with a learning disability. Fremantle services include care homes, day care, supported living schemes and domiciliary. The utilization of these services as well as the ones available in the government infrastructure can assist the Johnsons in tackling their health situation However, the local resources do not provide the solution for the family since the decision to use outside services can pose its own challenges, and, especially in the case of moving a person with dementia into a care facility, the decision-making process is often a stressful and contentious one and the Johnsons are no different from the experiences of the affected families. Even after institutionalization, much of the family's experience of care giving burden may remain (Levesque, Ducharme, and LaChance 2000). It is therefore noteworthy that the presence of the basic services in Perth doesn’t necessarily mean the presence of a solution for the affected family. Precisely, the limiting economic terms, the constrained government expenditure with regards to the health infrastructure as well as the culture of Fremantle has led to the peculiar predicament of the Johnsons that has made them “outsiders” in the lives of even their close neighbors, Mr. John and the Jacobs. RECOMMENDATIONS Since the majority of the workers are professionals and the major industry is healthcare, the Johnsons can create an enabling environment for their son to obtain some of the healthcare services from professionals considering that 51.52% of people in Fremantle are employable (2006 Australian census). Furthermore, the family can try to offset some of the negative perception their predicaments create by interacting with their neighbors. This would also assist in breaking this stigma as more information on the disease would be provided for the benefit of enlightenment. In addition, the Johnsons, though operating their own shop can subsidize their earnings and place their son in semi-permanent care. While the implications could be negative in some cases, the utilitarian justification would be that Mrs. Johnson, a trained social worker would be able to reach out to the community with her family’s experiences, as well as earn extra income for the family instead of investing all her time at home. In as much as there are social workers in the area, the presence of a predominant health care industry is not the only factor that creates an enabling environment for the care of dementia cases. The government should therefore provide appropriate policy mechanisms to deal with some of the cases like understanding the personal and emotional experiences of having dementia. CONCLUSION The Johnsons family by local standards is an economically advantaged family. However, the medical predicament of their elder son has made their living expensive and unsustainable. Furthermore, the wider social, cultural, and economic environments have debilitated their efforts towards self sufficiency. This has led to a wide range of problems including stigmatization. The infrastructure of the health industry and the presence of social workers within the locality, though a source of relief, don’t seem to alleviate their prevailing negative circumstances. The emphasis on general healthcare provisions including preventive care would serve a great purpose in ensuring that the community and indeed the entire country are protected from such a disease. The vulnerability to teratogens is one such factor that the community needs to be protected against. REFERENCES Bronfenbrenner, Urie.‎ (1979). The Ecology of Human Development: Experiments by Nature and Design. Cambridge, MA: Harvard University Press. ISBN 0-674-22457-4 Clyburn, L.; Stones, M.; Hadjistavropoulos, T.; and Tuokko, H. (2000). "Predicting Caregiver Burden and Depression in Alzheimer's Disease." Journal of Gerontology: Social Sciences 55B (1):S2–13. Clyburn, L.; Stones, M.; Hadjistavropoulos, T.; and Tuokko, H. (2000). "Predicting Caregiver Burden and Depression in Alzheimer's Disease." Journal of Gerontology: Social Sciences 55B (1):S2–13. Dunkin, J., and Anderson-Hanley, C. (1998). "Dementia Care giving Burden: A Review of the Literature and Guidelines for Assessment and Intervention." Neurology 51(1):S53–S60. Microsoft ® Encarta ® 2009. © 1993-2008 Microsoft Corporation Moyle, W., Edwards, H. & Clinton, M. (2002).living with loss: dementia and the family caregiver. Australian Journal of Advanced Nursing. 19(3).Retrieved from http:// www.Sciencedirect.com. Nam, C. (2004).The Concept of the Family: Demographic and Genealogical Perspectives. Sociation Today. .Retrieved from http://www.Sciencedirect.com Read More