Hard Work and Heartbreak : The Daunting Task of Social Workers Who Aid the Aged

The voice on the phone was frantic.

The in-home caregiver was trying in vain to cope with an 84-year-old woman who alternately laughed insanely or screamed in pain. The elderly woman--call her Martha--was suffering from dementia. She refused medicine and food, she was shedding weight, she was incontinent and had bedsores. Martha cursed in response to pleas that she go to the hospital.

The caregiver had been especially conscientious in a hard, often thankless job that pays only the minimum wage. And now she seemed about to unravel.

At the other end of the phone, social worker Glenda Stovall was soothing and understanding. But beneath the calm, professional manner, Stovall was worried. Martha might be dying--and Stovall wasn’t sure what to do about it.

Stovall is a crisis intervention social worker for Los Angeles County, and this was but one of more than 25 tough cases in her active file.

Her caseload also included a gaunt elderly woman living alone in a filthy apartment strung with spider webs and cluttered with rotting food. The woman was demented and covered with lice, but was unable to obtain medical care because she had no private insurance and was blocked from getting public assistance by a paperwork snarl.

There was also the case of an elderly couple whose mentally handicapped daughter was suspected of physically abusing them. And then there was the 90-year-old man whose neighbor had been robbing him of his savings and had gotten himself written into the elderly man’s will.

*

Stovall, who works out of Pasadena, is one of 50 such social workers employed by the county Department of Community and Senior Services. Each handles 250 cases per year. These Adult Protective Services workers, who have offices throughout the county, are often overwhelmed, but paid little. Their job is to cope with situations involving dementia and unhealthy living conditions among older people, as well as problems such as abuse experienced by vulnerable people over the age of 18.

The majority of clients are elderly, but some are younger people who are handicapped or retarded. The cases are almost always difficult, and frequently, they are heartbreaking.

“We cannot always help these people,” said Stovall. “Sometimes, there’s nothing we can do.”

Martha’s might be such a case, she feared.

Stovall’s cases come to her from concerned neighbors who call the elder abuse hotline and from other social service agencies. Or she might be called by an in-home caregiver hired by the county or by relatives of an elderly person.

As Stovall soothed Martha’s caregiver over the phone, a home health care nurse arrived at the elderly woman’s house to check on her at the social worker’s request.

With Stovall still on the phone, the nurse and the home caregiver were somehow able to persuade Martha to go to the hospital. The next hurdle, said Stovall, would be to get the hospital--Kaiser Permanente Medical Center on Sunset Boulevard--to admit the woman against her will if she changed her mind, as she probably would once she arrived at the facility.

In the case of uncooperative but seriously ill patients such as Martha, doctors and hospital officials frequently are unwilling to seek involuntary commitments, according to Stovall.

“It has to get to the point where people are literally living in their own feces,” she said.

Martha appeared to be getting close to that.

“If she wants to die, that’s her right,” said Stovall, “but she has to die clean--that’s our responsibility.”

In the meantime, there were other cases to deal with.

*

Stovall routinely works alone, but on this day she was joined by fellow social worker Lori Barraza, who has a similar caseload. Their jobs require a bachelor’s degree, and both majored in social work. Stovall also has a master’s in counseling and Barraza will soon receive one. Their salary: $33,780 a year.

The women are good friends. They have worked in other social service jobs for two decades, they each went back to college in middle-age and they have similar reasons for pursuing the demanding, stressful work.

“To have to go out of this world filthy and not eating, and living in ugly circumstances, is just not right,” Stovall said of her elderly clients. “To be able to help them out of that, makes me feel better--that I’ve done a little something, anyway.”

Stovall and Barraza climbed into an Isuzu Rodeo and swept onto the Foothill Freeway heading toward Los Angeles. Barraza was at the wheel of her van as Stovall used a cellular phone to alert hospital personnel that Martha was on the way.

“She is going to say she doesn’t want to stay, but that’s because of the dementia,” Stovall told a hospital worker. “She cannot go home.”

In the meantime, Barraza had pulled off the freeway and parked on a side street near a rundown apartment house where another client lives.

Inside, Catherine--the names of clients have been changed for reasons of confidentiality--stood on a filthy rug in the living room. The 86-year-old woman was skeletal, her hair hung lank and dirt was caked in the lines of her face. Catherine’s eyes were wide and vacant as she smiled at the social workers.

There was garbage on the kitchen floor, the sink was caked with filth, the stove top was rusty and unused. In the refrigerator were old, partially eaten TV dinners brought by Meals on Wheels. Kitchen shelves were dense with spider webs, studded with dead roaches.

Stovall had been here before, but Catherine didn’t recognize her.

When had Catherine last seen a doctor, asked Stovall.

“I don’t go to doctors,” Catherine replied pleasantly.

And that, Stovall said as she left, must change.

“I’d like to get her hospitalized,” said Stovall as she got back into the van. “I think she has the potential to improve. I would like to put her in board and care.”

Catherine is a foreign national living permanently in the U.S. She is eligible for Medi-Cal and aid through Social Security, but the woman’s ex-husband had possession of vital information and paperwork and was uncooperative.

Her case had been referred to Stovall months ago and she thought she had resolved it by locating the necessary paperwork, but Catherine had somehow fallen through the cracks in the social services system until a senior center called about her condition.

Barraza had by now pulled to the curb in front of a well-kept apartment building to check on one of her own clients.

Lisa is a 75-year-old widow whose daughter died early this year. She has developed a pattern of binge drinking. Barraza had been unable to reach the woman by phone, and her concern mounted as she repeatedly pounded on the door and called the woman’s name to no avail.

When Lisa finally answered the door, the pleasant, soft-spoken woman was not drunk, but acknowledged that she had fallen into depression.

“I don’t know why lately I’ve been feeling like this,” she said. “I don’t even want to get dressed or go anywhere.”

Normally, Lisa makes sojourns to a nearby market just to get out of the house despite grotesquely swollen and painful ankles.

But lately, the depression had kept her inside.

“I don’t even clean the house or anything,” she said. “I just lay around and sleep and watch TV. Sometimes I don’t eat at all. I just drink coffee.”

Even so, Lisa was planning a trip to see a granddaughter in another state.

*

Barraza asked permission to look around the apartment that was cluttered and over-furnished, but nonetheless clean. There were knickknacks and family snapshots everywhere. When Barraza returned to the living room, she asked Lisa if she had ever thought about harming herself. Lisa denied any such notions.

But back in the car, Barraza was even more worried than she had been before the visit. In Lisa’s bedroom, the social worker had found brochures from the Hemlock Society, a group that provides information on suicide.

Part of Stovall’s job is doing what amounts to preliminary detective work into complaints that elderly people are being swindled.

That afternoon in the office, Stovall phoned a man she termed a “perp”--short for perpetrator. A senior citizens center had called to say that 90-year-old Carl had been fleeced by a neighbor. Another social services agency had been able to put the man’s financial affairs in the hands of an old and trusted friend, but Stovall would now look into the alleged crime.

In a lengthy phone conversation, Stovall persistently but gently questioned the suspected perp. The man said that he had begun running errands and doing chores for Carl when the elderly man could no longer take care of himself.

One thing led to another, he said, and Carl began signing checks for his neighbor to cover various expenses. Stovall had already determined that $10,000 had been drained from the elderly man’s bank account over a short period, leaving a balance of $50,000.

The suspected perp readily admitted to Stovall that he used $1,500 of Carl’s money to get a lawyer to write a will leaving all the old man’s money to him.

By the time she hung up, Stovall was convinced that the helpful neighbor had indeed helped himself to the vulnerable elder’s savings.

Finally, before she left the office on that Friday evening, Stovall was assured by a Kaiser intern that Martha would be admitted to the hospital or placed in a convalescent home for the weekend.

*

Often, crisis intervention workers are able to solve a problem and close a case. Sometimes they are not. Some cases come back again and again, perhaps never to be resolved.

Here are some updates on the crisis situations Stovall and Barraza handled on that recent Friday:

In the case of Carl and the helpful neighbor, Stovall turned her findings over to police, who opened a criminal investigation.

In Lisa’s case, Barraza phoned the out-of-state granddaughter, who was so concerned that she arranged for the elderly woman to come and live with her.

In Catherine’s case, Stovall used information supplied by the Canadian Embassy to obtain an emergency Medi-Cal card for the elderly woman. Catherine was hospitalized and Stovall hopes to have her admitted to a board and care home.

“She is going to be fine,” predicted Stovall. “She’s going to be taken care of.”

And then there is the case of Martha.

Stovall thought Martha was safely in the hospital for the weekend, but she learned the following Monday that the woman had been sent home and had spent two to three days alone and without food.

A Kaiser official said that Martha’s medical information is confidential, but went on to say that involuntary admissions must be made with care.

“We cannot force a patient who has the capacity to make decisions to take any treatment or to be transferred to a facility against their will,” said Kit Neimeyer, area public affairs director for Kaiser. “This particular case is very complex,” she added.

*

In the days that followed, Stovall was able, with the help of the in-home caregiver and a hospital social worker, to persuade Martha to admit herself to Kaiser.

While she was there, the elder abuse hotline received a call from a hospital employee who was concerned that Martha would be discharged.

The information from the employee, who asked to remain anonymous, was relayed to Stovall:

“Client is unable to care for self. Requires skilled nursing, but refuses to stay. Client is extremely frail. Doesn’t take medication. Has a history of dementia. Was admitted to Kaiser for skin infection and malnutrition. . . . Suffered a fractured hip in early ’94. Has a history of bleeding ulcer. Subject to fainting episodes . . . “

Martha stayed in the hospital a week and was again discharged to her home.

When Stovall went to Martha’s home to check on her, the frail old woman came to the door and, barely able to stand, greeted the social worker with hostility.

“I don’t want to see you,” she said in a surprisingly strong voice. “Mind your own business.”

“I’ll leave you alone for now,” said Stovall.

“It better be forever,” said Martha.

But Stovall won’t stay away forever. She was able to locate Martha’s attorney and a daughter in another city who did not know of her mother’s grave condition. She was also able to locate a substantial bank account that Martha had misplaced.

The daughter, the lawyer and the faithful, long-suffering caregiver are doing what they can to aid Martha, but she remains belligerent.

“We’re right back to square one,” said Stovall, “but we do have people involved and I think they will get her into a board and care.” In the meantime, Martha’s daughter and caregiver have found that the elderly woman will cooperate to some extent if they make a certain threat.

“Martha hates me so much,” said Stovall, “that all they have to do is mention that Glenda Stovall is going to come over. They even got her to bathe.”