Martha and David have been caring for their daughter Joan who has Down’s syndrome since her birth 33 years ago.

They are now both in their 70s and David has increasingly failing health and Martha finds caring for both Joan and David very stressful and tiring. Joan has a number of health problems and suffers from epilepsy, which is controlled mostly by medication.

Martha has been considering putting Joan into residential care as she is aware that soon that decision may need to be made. David is adamant that Joan will not go into care while he is still alive and Joan wants to stay with her parents. The situation is getting very strained as there have been a number of big arguments, and Martha is showing signs of stress. Joan gets upset every time the subject is mentioned and David is becoming increasingly stubborn and refuses to discuss it. A support worker comes in 3 times a week to help Joan have a bath and has told her manager about the arguments she has overheard.

1. If you were the manager, what advice would you give her about how to try and help the family find a solution to this problem?
2. What options do the family have for additional support for Joan, and what reassurance could you give the family about residential care if they do decide to go down this path