Ray is a 28-year-old married man. He and his wife, Tonya, moved from an urban center to a rural town in southern Georgia because the corporate staff of the restaurant

CASE STUDY 17.1: CHALLENGES WITH ACCESS TO HEALTH SERVICES IN RURAL AMERICA

Ray is a 28-year-old married man. He and his wife, Tonya, moved from an urban center to a rural town in southern Georgia because the corporate staff of the restaurant that Ray manages promoted him. He was asked to open a new restaurant in a smaller community, about 100 miles east of the city, without access to comprehensive healthcare facilities. Tonya is pregnant and now travels 50 miles to the nearest obstetrician for prenatal care visits. Her pregnancy is considered high-risk due to a history of high blood pressure controlled by a special diet, exercise, medications, and a sleep plan. Ray is very supportive of her prescribed routine, and Tonya is following the health plan. Unfortunately, just 3 months after their move, the COVID-19 pandemic forced all restaurants in the area to close, leaving Ray unemployed. With tight finances and numerous obligations, the couple worries about keeping their health insurance, purchasing medications and the food items needed for Tonya’s diet, and paying for gas and car repairs required for travel to healthcare facilities for prenatal care. They must also pay for the new home that they purchased in their recently acquired community. Ray is overwhelmed with worry and has begun to complain about feelings of anxiety, difficulty sleeping, and brief bouts of depression. He says that his highest priority is the overall health of his wife and unborn child. In just a few days, their life, once stable and relatively well planned, became a “nightmare” for both of them. Ray goes on to say that because they’re a new family in the community, finding assistance will be complex, and they will have to “start from scratch” when it comes to seeking aid for healthcare, housing, and social support. Ray has begun to search for employment, which has not yet produced any positive outcomes. He admits that frightening thoughts enter his head, but will not comment further.

Case Study Questions

1. When you’ve constructed a plan of care for this family and identified priorities based on a family-centered approach, what steps would you take to ensure that Ray and Tanya agree with the program and work with a social worker and other health professionals to address their needs?

2. Are there immediate issues that need attention? What are the long-term problems that should be discussed at this time?

3. Is there a need to discuss with them the COVID-19 virus and its implications for Tonya’s and Ray’s safety as determined by the CDC guidelines?

4. Identify Ray’s and Tonya’s physical, mental/emotional, and social/interpersonal needs and delineate their priorities with documented, evidence-based practices.

5. Would the needs of Tonya’s and Ray’s unborn infant be a component of the comprehensive plan (including its birth delivery at a nearby health facility)? If yes, describe that component. If not, provide a rationale for not including the infant’s health concerns in the plan.

6. Could telehealth be used to support this couple? Could you determine whether there are barriers to the use of telehealth for them? What concerns might emerge?

7. How will the family pay for health services? What about services for the unborn infant?

8. What are your next steps? What community resources and supports would you suggest for this couple? How long do you think they will need assistance before their level of overall stability is restored to its original, pre-crisis state?

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