Advice for dealing with a client

[HILARY BECKER]

I posted this in the Greater New York Chapter a while back but I guess that’s not an active board!

I have a client in her early 80s who has no immediate family, her only relatives are in Europe. She’s listed her health care proxy as her doctor, she has a friend that is her POA and while the friend does get her account alerts, they aren’t very close from what I can tell.

I’m starting to notice her getting a little forgetful… I see her every three weeks. She does have a 24/7 aide, she goes out twice a week to an adult facility for PT and OT… I’m worried that one of two things will happen:

She’ll slowly decline and no one will notice it. OR I’ll get a call one day that she’s in the hospital. I am not equipped to take on either of those situations (none of us are in our positions I would think!) and I’m also an hour away from her.

I had a geriatric care manager come a few weeks ago, they hit it off great and although my client couldn’t afford to keep her ‘on staff’ so to speak, I figured she’d be a good resource for health issues (plus she found some activities to keep my client’s mental health going)… Fast forward to my latest visit yesterday and my client wouldn’t stop complaining about “that woman” and “who hired her” and “I don’t want her back.”
She has always been very picky about her caretakers, aides, I couldn’t even suggest her meeting a backup DMM in case I went on vacation or in an emergency.

So I guess in short, do any of you have clients that have no support system and what do you do in that case? And for those of you who say, engage another professional/care manager/etc, what do you do when they won’t? I’m sure the exact same thing would happen with another GCM.

Since writing this, what I feared came to pass, she was involved in an accident and spent an overnight in the hospital. I’ve been trying to navigate insurance claims and doctors and while some of this falls under my duties, much of it is beyond me. I’m having a personal injury attorney come talk to her but aside from that… I need advice! Are there resources that are low cost that would manage her care better? She’s gotten worse with her caretakers, cursing at them and not wanting them to help her use a hoyer lift, so she’s been confined to her bed.

Thanks for any and all advice!

[Anonymous]

Have you considered contacting Adult Protective Services in your area? I have two clients for whom I’ve been named guardian/conservator by a court because those ladies have no one and clearly are not capable of caring for themselves. APS can get involved in this kind of situation, and they have resources that DMMs don’t and can go through the courts if necessary.

[HILARY BECKER]

Barbara,

I thought about a guardianship, I don’t feel comfortable taking on that role myself though, I guess the court would have to appoint someone. I’ll look into it more for the county though, thank you for that suggestion.

[Anonymous]

I’m part of a county volunteer guardianship program that’s separate from my DMM business. I took on these two ladies years ago as a public service thing and have really enjoyed the experience. My involvement with that made me realize that anyone can, and should, call Adult Protective Services when someone like your client needs assistance.

[Karen Ethridge]

Hello Jennifer,

I had several elderly clients who had no other family members close by and/or available. When one started having significant health issues and her cognitive functioning became worse, I recommended (along with the assisted living staff) that Adult Protective Services be called in (a Dept. of Aging case manager attempted to do an assessment but the client refused). The client was civil and actually very polite with me when I did her bill paying, but she became too argumentative and uncooperative for the assisted facility to handle. They asked if I would take over guardianship and I said I would not. She ended up in a nursing facility and on Medicaid. I terminated services since her funds were needed to pay for her care. She died a couple years later and I got a call from the facility because they had no one else listed as her POA. Since that experience I always include a secondary person on my initial contract before I begin working with a new client in the event that I need to contact them if the client becomes impaired. I also found an individual in the community who will take on the guardianship for clients who have no one else. I like Barbara Green’s idea to provide this service as separate and distinct from her DMM business. Because I am also a clinical social worker, I’ve had people ask me to take on other duties in addition to my DMM work, but I specify what I will do in my initial contract which I then refer back to if needed. That helps to avoid situations where it’s beyond our scope of practice as DMMs.
Barbara Boustead
608-515-4083

[Author]

Posts