Overgrown lawn: military Veteran no longer able to maintain the yard

Abstract: Driving to her next housecall, a family physician* sees which house contains her new patients—a 1950s bungalow set among perfectly maintained rancher homes with sparkling renovations. The house has peeling paint, missing roof shingles, and a disheveled front yard. Picking her way up the broken sidewalk, she notices the curled, wavy outer layer of the plywood front door and the rubber-backed curtains, clothespinned shut, on all the front windows. Ethel eventually answers the door. She is a game, determined, upbeat 70-year-old; her clothes are not clean and are a bit ragged. She does not appear to remember the appointment. Ethel shows the doctor to her husband’s room. Bill, a 75-year-old military Veteran, lies on a single bed in a bathrobe watching television. He is wearing nasal prongs from an oxygen concentrator. Parkinson disease, osteoarthritis, and chronic obstructive pulmonary disease keep Bill nearly confined to a chair. Clearly, Ethel is the legs and Bill is the brains. Bill remembers everything, including his Korean War service. Ethel is unable to remember much of anything (for which she takes a medication that appears to have made no difference), but has no other health problems. Ethel and Bill fear that they are wearing out their family caregivers. He is interested in some “help from the government” to maintain their home, because he realizes that he and his wife are barely able to remain independent. Bill scores 6 out of 7 (moderately frail) on the Canadian Study on Health and Aging frailty scale.1 The family physician develops a treatment plan for Bill’s pain and stiffness, and consults provincial home care. She calls Veterans Affairs Canada (VAC) with Bill’s permission, and he is found to be eligible for the Veterans Independence Program (VIP).