You are a new nurse case manager at a home health agency that provides in-home support services to adults with disabilities. You’re excited about your role and eager to meet some of the clients served by the agency. You’ve worked with many individuals with cognitive impairments as well as physical disabilities in both the hospital and clinic setting, and are confident that your clinical skills are up-to-date. During your job interview, you told the agency director that you’ll need time to familiarize yourself with community resources and options. The director has arranged for you to spend the first week of orientation with Nancy, the nurse case manager who is leaving to go back to graduate school.

After you and Nancy drive across town to the apartment complex that houses several of your adult clients with Down syndrome, she introduces you to Marguerite, Leonard, Esperanza, Lejon, and Esther. Jotting notes rapidly in the files you’ve brought along, you note the issues that each adult discusses with you and Nancy:

Taking a deep breath as you and Nancy drive away at the end of the morning, you ply her with questions and try to sort out the priorities of the adults in your caseload.