Friday, September 25, 2009

Crossroads of Liability and Volunteerism

She was an elderly, shrunken, somewhat deranged, poverty-ridden lady living alone in subsidized apartment housing. A victim of self-inflicted poor life choices, she was dependent on public assistance for subsistence.

She was accustomed to a life style of acceptance in her small town's social circles. Even after three marriages, one failed and twice widowed, she continued to enjoy a circle of friends from her many years working with her husband(s) as entrepreneurs, and later when widowed, for local businesses.

She had no children; only distant young descendents of her generation living 500+ miles away. Her cantankerous attitude and acid tongue alienated her from them and others who atempted to be helpful.

Like many widows, her income became a free-fall in widowhood. Income drastically reduced, she did not realize the life-style to which she was accustomed no longer had financial resources to substantiate continuing.

Belatedly, she downsized her living quarters from manors and multiple homes, to modest housing, to manufactured housing. Finally selling her last home, she applied and qualified for public housing for the aged.

Like many persons on public assistance, she did not adjust gracefully, demanding white-gloved service and maximum care.

Expecting individualized personalization of services for which she qualified, she verbally criticized the Senior Meals on Wheels volunteers who prepared menus, lecturing them about inclusion of spinach for Coumadin (warfarin)-dosed clients. There are only two type meals provided in the area: regular and diabetic.

She ranted at the physicians who accepted her Medicaid assistance.

Routinely, she threatened lawsuits against physicians, hospitals, health care providers, living arrangements and agencies providing taxpayer provided services she received. The threats never materialized.

She periodically fell behind on bills, but railed at providers as not having sent her monthly statements. It became such a habit, she called "wolf" too often. Utility shut-offs became common. She lost her TV cable service, and her phone was often shut-off. Finally, her only contact outside of her apartment was a small radio and land-line telephone with portable handset.

Occasionally, old friends would invite her for lunch, but many days were spent in isolation, no phone calls and no human contact. I have seen persons living in isolation sink into dementia, solely from lack of human contact.

Her very old vehicle was not reliable, nor should she drive. Her driving was erratic and she made U-turns on congested highways. The local police were generous in simply issuing her warnings and not tickets which would have gone unpaid. She did not have a current license tag.

At this point in her life she contacted our local TeleCare service for our daily phone call.[See A Simple, Single Phone Call ] We added her to our client list.

We carefully explained our program and its limitations to her; basically all we provided was a single phone call per day, 365 days per year. But as with other free services for which she qualified and received, she pushed the envelope at every opportunity.

She needed bread, a ride to the doctor, a can of soup. If we kindly refused and re-explained our service, she usually found someone to provide the service. Our next call would be the "rub it your nose, I found somebody" type conversation.

We provided her with the name of charitable organizations devoted to rides and shopping, etc. Interestingly, she had used them and did not like the attitude of their volunteers.

We had arrived at the crossroads of liability and volunteerism. This is not unique. Large organizations are able to afford some measure of liability insurance, but not our little group of 12.

Several meetings of volunteers were devoted to how to handle these requests. We are a loosely organized group of 10-15 volunteers devoting approximately one hour a day for one phone call. We chat with clients , some briefly, some longer.

At times this lady could be really funny, even when she repeated, repeated and repeated the same old stories. We listened. One volunteer kept a list of how many times he heard the same story.

The three organizers, of which I am one, finally told the volunteers they were welcome to do errands or other services if they wished, as long as it was clear it was personally provided, and not in the name of TeleCare.

In the interest of the volunteers and other clients who depended on us, we felt we could not jeopardize our service with even the remote possibility of a lawsuit. Neither our small organization that operates on less than $2000/year, nor any single volunteer had the wherewithal to survive litigation.

Further, our state's Good Samaritan Law did not cover taxi-like service, only stopping to render aid, primarily vehicular accidents.

This lady threaten lawsuits for dust in the HVAC ducts of her apartment, the inefficiency of the physical therapy department at the hospital just because one of her two knee and hip replacements weren't as she expected, and on and on.

Our anxiety was fueled by a case where an accident occurred, and the family of the client, who was severely injured, sued the driver providing the service.

We had this lady as a client a few years. She looked forward to our annual luncheons and never missed one. She never failed to thank us for calling. It was evident she received very few phone calls.

Over the years her mental and physical health became so compromised, we wondered about all the physicians' visits she mentioned.

Her personal habits became repugnant; her apartment was unfit for human habitation (read total incontinence with no cognizance of fact, soiled clothes and furniture, I think you get the picture. ]

The Senior Meals on Wheels drivers, hated to enter the apartment, its odor left them gagging. Adjacent apartment dwellers claimed the odor permeated their units through walls and ductwork.

Yet she continued to combat forces trying to help her.

Sadly, her health became such she could not live alone. Our service found her unresponsive, but conscious, on a Sunday. The apartment manager called the ambulance and sent her to the hospital. Subsequently, she was committed to a nursing facility by the state advocacy service.

At this writing her apartment is locked and sealed. We suspect HAZMAT specialists will be required to sanitize the quarters, before needed renovation can be started.

This is a sad story. No one could find a mutual acceptable solution. The lady would not designate a medical power of attorney. It is never pleasant invoke the state advocacy unit for a court ordered solution. But an impasse is impassable.

[This story is a composite of clients, including a male; it illustrates the dilemma of elderly living alone far from relatives, without advanced directives, or designated power of attorneys, and the stress absorbed by friends, churches, volunteers, healthcare personnel or others trying to provide compassionate care.]


jinksy said...

What a warning not to be cantankerous!

Arkansas Patti said...

Very powerful and painful story. Bless you for working with people that it are often, difficult and disagreeable to work with. The decline of a person aging is terribly sad.
That bleak future lurks for too many.
I do hope there are enough of the good people you deal with to balance out the difficult.
Bless you.

NitWit1 said...

Jinksy and AR Patti: the most painful part of this story:
1.the self reflection I see in my own aging.
2. the desperation of the elderly to avoid the diminishing options of care because of financial restraints or simply rapid decline in health.

one lady with obvious decline of mental accuity had the cunning knack of turning a question asked her about herself into a question about the inquirer. It was amazing in and of itself as it would fool you into believing what you suspected was wrong, might be wrong with yourself!

Carol @ TheWritersPorch said...

How sad! I have been envolved with the elderly all my life and have seen things that make me think dying before reaching this age can be a blessing.

Amber Star said...

As I have told everyone who would is so difficult to care for our elderly parents. Actually my husband's parents. They are generally compliant...he more so than she, but mainly she gets argumentative about leaving their home for assisted living. I know...I wouldn't want it either, but the time has come when they can't continue to try to manage on their own. They simply cannot do it anymore.

Pat - Arkansas said...

A sad, but all too true tale, one that I sometimes see in my own community. My elder daughter is trying to assist a woman whose house is, literally, falling down around her and who adamantly refuses to be moved. She is a hoarder, especially of trash. Daughter, like the Meals on Wheels folks, hates to enter the residence. Daughter will probably find her dead, surrounded by God-only-knows what one of these days.

Thanks for sharing the story. You put this composite together seamlessly.

Sniffles and Smiles said...

Yes, it is very difficult for everyone involved to work through advanced age...It is so hard for a once independent person to let go of their autonomy...their dignity. And so hard for those who wish to help to do so while at the same time preserving the other's self-esteem. There is no easy way through such rough passages. It is heartbreaking. Thank you for writing this. It is powerful, and thought provoking as well as disturbing. ~Janine XO

Lorna said...

both my parents worked at Telecare in their community, and I was always so proud of them for it. It's a difficult and draining task, and I really admire you for your willingness to accept both the satisfaction and the pain that sometimes goes with it.

Anonymous said...

Your patience is wonderful. What a blessing you are to the community