“Renata explained that her mom had stopped wanting to bathe or socialize or go to the doctor, and that it was very difficult to see her that way. That was my opportunity to ask Renata about her feelings. As soon as I did she broke down in tears.”
Maria, 86, was referred to Partners in Care by her health insurer, Health Net, who was concerned that she had not visited her doctor or received any medical care in over twelve months. She was visited by Sandy Pena, MSW, a social worker with Partners in Care. Sandy often works not just with a referred patient but with their caregivers too. “I have a Major in Psychology, but I was drawn to social work because it allowed me to take a more holistic approach – to see a person’s circumstances and work with the whole family. Oftentimes, people don’t have the tools they need to help themselves – they don’t know what’s available in the community or how to start the process.”
“Renata was quite resistant to speaking with me when I first reached out to her mom,” says Sandy, referring to Maria’s daughter. “She said that she’d had phone calls from lots of people, but that no one was doing anything. I explained that I wanted to meet her mom at her home, which no one had done previously, to make sure that her needs were met and to see if we could set up any services that might help Maria and Renata.”
Reluctantly, Renata agreed to the home visit. When Sandy arrived Renata was very quiet. Sandy spoke with Maria and quickly established that Maria had significant but undiagnosed cognitive impairment. “Renata explained that her mom had stopped wanting to bathe or socialize or go to the doctor, and that it was very difficult to see her that way. That was my opportunity to ask Renata about her feelings. As soon as I did she broke down in tears.”
Like many people caring for loved ones, Renata, who is herself 66 years old, had been struggling with the demands of caring for her mom’s needs alone, with little to no support from other family members. Studies consistently report higher levels of depressive symptoms and mental health problems among caregivers, with 30 to 40% of people caring for loved ones with dementia reporting depression and emotional stress.
“Renata didn’t have a lot of knowledge about her mom’s condition,” says Sandy. “That was a big contributor to her stress because she didn’t know what to expect or how to manage her mom’s behavior. She felt very overwhelmed, particularly because she had no idea about the range of resources and services that were available to help her.”
The most immediate issue was to get Maria to a doctor. “I explored the relationship roles between Renata and her mom. Renata was not comfortable telling Maria what to do and deferred to her mother’s wishes, even though Maria is no longer able to effectively make decisions for herself” explains Sandy. “I coached Renata to try a different approach, and helped her to see that taking a parental role with her mom was not disrespectful but a kindness.” Sandy then contacted Maria’s doctor to make an appointment and made sure that Renata was prepared to take her mom.
Sandy also referred Renata to an organization that provides legal services for older adults, to enable her to obtain the right to make decisions for her mom now that Maria was no longer able to do so for herself. Sandy also recommended that Maria attend a Community-Based Adult Service (CBAS) Center, which provide a range of services and therapeutic activities, including personal care, a meal and transportation to and from Maria’s home. Crucially, it would also give Renata some much needed respite from her caregiving responsibilities. “Because Renata was struggling with her mom’s increasingly erratic behavior, I gave her information about how to contact Alzheimer’s Greater Los Angeles, which has lots of resources to help Renata get a handle on her mom’s cognitive issues. She was resistant at first, saying that she didn’t have the time to check out the resources, but during the visit she changed her mind and allowed me to give her a cognitive impairment notebook that explains the type of behaviors to expect.”
Sandy also did a home safety assessment. “I noticed that there were no grab bars or other safety equipment in the bathroom, so following the home visit I contacted Maria’s health plan to see if those items could be obtained through her coverage to help minimize Maria’s risk of falling.” She also liaised with the case manager to make an appointment for Maria to see a specialist so that she could get a medical diagnosis for her cognitive impairment. And she added Maria to the waitlist for the Multi-Purpose Senior Services Program (MSSP), which provides a range of long-term services and supports necessary for independent living, helping seniors to age in place rather than face unnecessary and costly nursing home placement.
Renata, meanwhile, buoyed by Sandy’s coaching, was finally able to get her mom to see her doctor and update her prescriptions for hypertension and high cholesterol. “I spoke with Renata after the appointment and she was excited to tell me that after a year of being entirely housebound, Maria had gone to a family gathering. Everyone was thrilled to see her!”
