Managing multiple diagnoses is challenging for families when there are complex symptoms that can be present. These symptoms can alter slightly throughout the day or they can have significant impact in how they present immediately interfering with everything that is happening. The ability to communicate such subtle changes through to such large issues can be extremely challenging for all involved in managing chronic conditions. An important issue to take into account when managing health care for any individual is their level of control over their own body. As an OT: who chooses the type of clothing? yet who lets a caregiver know when it doesn’t fit right anymore? who choose the weight of the actual material of the clothing? yet who is the one who earns the money and needs to balance material type vs branding vs height loss ratio for the type of material? yet who are the ones in the playground who measure the value of the brand of pair of shoes? so – who chooses the type of clothing? Our environment alters the time of day that we have available for us to manage showering and bathing but what happens when we are involved with carers working within our homes. And, what happens when there are multiple and ever changing carers working within our homes? Staff turn over rates can be a high issue with individuals privacy especially with management of personal care. How many people are in each individuals life? what ‘role’ do they have? And, what role do they ‘take’ as part of that relationship with the individual? Whose home is it? What does that mean about who decides the rules? The individual may not live alone? They may live with an entire group of people, each with different levels of responsibilities and abilities and routines.