Narratives of Gerontologists: Blurred Lines
Katrina Polk, MPA, Ph.D. Candidate
Karen O. Cobble, LSWA
All too often, professionals working with the aging in place population are presented with "a call to action" that demands an immediate choice of service implementation--formal or informal. As we, applied gerontologists, continue to provide direct services to “vulnerable seniors”, professional ethical boundary dilemmas will be a constant reality and relevant topic for "Professional Helping". We struggle with moral obligation versus professional procedural responsibility. Many times, these two approaches present blurred lines for any human service “sensitive” worker. The incorporated narratives, “Katrina’s Work Grandma” and “Karen’s Caring through the Ages” illustrate potential gray areas for professionals while serving and caring for older adult consumers.
Keyword: aging in place; boundaries; caregiving; elderly; ethical; older adult; professional helping; service provisions; vulnerable seniors
Katrina’s Work Grandma
In this new role, as the Assistant Director for Aging and Disability’s Day Health Programs, I would come across many consumers, 18 and over, with various severe disabilities and chronic conditions. We had approximately 32 persons daily and seven staff members--enough staff to comply with state and county ratio regulations. However, our program was always short staffed at least twice a week, allowing me to put my 20 years of practical service experience to work. I had been supervising for a number of years in an office setting, awaiting the opportunity to feed, bathe, and provide companionship to vulnerable populations. I would be itching to come to someone aide. And, I got that chance; especially since a particular staff member would always take off. With this new job, I had many direct service hours.
When it was time to be of services, I was friendly and willingly available to assist all—no matter the condition. But, I must say, my work grandma was special. She was older African American Woman in her late 80s early 90s from the South. Work grandma was kind and generous. She often would speak of her sister who ran off to New York and was found a few years later murdered in an alley. Her eyes were old and full of wisdom. Proud, she was! Unfortunately, her eyes also showed health deterioration. Work grandma was battling with multiple health conditions and Dementia. As her conditions started to worsen, secretly, so did I. We were very much so connected in spirit and mind.
As time passed, her supportive needs increased and more resources were required to care for my work grandma. Her Instrumental Activities of Daily Living (IADL) functions had failed, and now, the Activities of Daily Living (ADL) were quickly slipping away. Her demands extended from living with freedom and mobility within an independent senior community residence to having a halftime home health aide and meals on wheels deliveries. Work grandma was high risk for possible assistant living placement. Because of her decline, I had to enroll her in the center’s bathing program. That sadden me. I went from assisting her in the shower to fully bathing her. I realized that I was reliving my past. Work grandma had taken the place of my deceased great-great grandma, who I had cared for until death. I was now bathing her, feeding her, and redirecting her exit seeking behaviors almost daily.
Our typical day had gone from delightful conversation, beautiful litany of stories, and light hearted banter over coffee and toast to three repeated statements by her: “Hello what’s your name?”; “I had surgery on my belly”; and, “I don’t know why they killed my sister and left her for dead in that alley…” I would tear up every time. Work grandma decline had a tremendous effect on me. I was depressed during the day seeing her but not knowing who she had become; and, on the weekend, I suffered from anxiety not knowing her status. Was she eating, taking her meds, or keeping up her hygiene? Darn Dementia! County policies and procedures outlined ethical boundaries that prohibited me from check-in on my work grandma. I would have to wait until Monday morning.
It had gotten to the place, the first thing on Monday—it never failed, staff would call me… “Hey Katt! Come get your grandma… she won’t take off her coat.” Or, after lunch, someone would shout out…”Katt… your grandma is at the center door trying to leave… Please come get her!” The request did not stop there; the cab company that provided door-to-door transportation for her called the center on a late evening. He wanted to notify us that after walking the consumer to the door, she left out the building as he pulled off. He saw my work grandma in his rear view mirror. I freaked out… Policy required me to call Adult Protective Services (APS). But, I did not make the call. I did not know all of the facts. I had told myself that I would go see what the deal was, and then, I would call. I was practicing deceptive intelligence! I knew I would not call APS on my work grandma. I went there to rescue her. So, a co-worker and I jumped in my car and sped through the streets to her complex, and we saw her coming out of the adjacent assistant living facility’s cafeteria. As I approached her, the manager of the cafeteria made his way down the path too. He asked did I know her in which I quickly responded, “yes”. He then blurted out… she cannot eat here anymore. She is not a resident in this facility… Yet, another issue for me. What will my work grandma eat at night and over the weekend?
It was Friday afternoon and participants were preparing to go home. I was in my office window watching our folks getting into cabs with the assistance of the staff. I was overwhelmed with anxiety. Time was ticking, and I hadn’t heard from county personnel about a food security plan for my work grandma. I made desperate calls to all the managers who have program oversight for these types of situations, but I did not receive a definitive response. I was worried. So, I thought to myself… “Okay, Katrina where’s that sound judgment and prudent decision-making that people have come to depend on.” I got it!!! I rushed to the programming floor and sought out my dependable comrade. I believe every manager needs a Ms. Blue. She was older—and approaching the threshold of aging-in-place herself. Her knowledge, skills and abilities were on point, and she was always willing to learn and do more. She was a true caregiver. Ms. Blue…MS. BLUE… BLUE! I called. As always, she appeared out of nowhere. “Yes Katt” she responded. “I got a plan for my grandma,” I said. Ms. Blue replied, “I took care of it.” Hmmm… I was scared to ask her what she had done. I knew technically, if Ms. Blue had not followed the county's policy and procedures, I would be required to discipline her. Darn it! At that moment, I realized that I had put my staff member, my fellow public servant crusader, and soon to be my best friend, into a vulnerable and compromised ethical position on the job. What kind of manager does this? I had added frustration to my emotional imbalance.
Later that day, I went to Ms. Blue and said, “I feel bad for incorporating you into my trouble." She rolled her eyes at me and responded with a sigh… “I’ve been doing this type of work for over 30 years; so, you don’t need to impress yourself with thinking you are the only one that cares around here.” I chuckled. That day, I discovered that the entire staff was helping participants with all kinds of potentially ethical boundary issues. On our way home from work on public transportation, I asked Ms. Blue “what did you do for work grandma?” She said, “I do not know what you are talking about”… with a grin on her face. I replied, “you know what I am talking about.” She responded, "My job is to assist our consumers with supportive services and programs, and so, I did my job. I also wrote a progress note and updated her Medicaid binder. I am not going to lose my good government job when I am getting ready to retire.” For the first time in months, I had a sense of peace concerning my work grandma. I learned that if Ms. Blue had observed my struggles with moral obligation and ethical professional responsibility. She supported my work grandma and me by thoroughly and properly disposition the issue according to county’s procedures.
Over the weekend, I was exposed. I re-realized that policies and procedures are implemented to safeguard all parties, and once breached people are at-risk of exposure to potential misfortune. It was obvious that I needed a refresher course--professional ethical boundaries for human service employees. During that weekend, I also was able to get some rest and complete schoolwork without much guilt.
On Monday, I arrived early to check my voicemail—praying that no one called about my work grandma. At that moment, I started to feel guilty that I attempted to be selfish by limiting my thoughts concerning her. "Great, no calls!" I said. Moving forward, I proceeded with my administrative tasks for the day. First thing, I researched all participants’ information, inclusive of progress notes and supporting documentation. Ms. Blue was right... she had crossed all “Ts” and dotted all “Is”. Second thing, I observed activity levels of participants and staff. That’s when I discovered, no work grandma today? I jumped up and started walking around frantically; Ms. Blue saw me from afar. She rushed over to inform me that my work grandma was in the hospital. Instantly, I began to cry. My confidence dropped, and I felt like a failure. Somehow, I related the worsening of her health condition to my non-availability and inability to provide care. I was devastated. In reality, my work grandma's health condition was critical, and there was nothing anybody could have done for her. Ms. Blue and I consoled each other. I would never see my work grandma again, but I knew that “we” made a difference in her life in the short time she participated in the county’s program.
You can do the right thing or the best thing. Remember, the right thing is always the best thing but the best thing is not always the right thing.
Karen’s Caregiving through the Ages
Working in the social worker field for over 30 years, it is difficult for me to pinpoint a particular caregiving experience because I have cared and nurtured for infants to older adults. However, I can draw from one special client who I became her surrogate daughter. This narrative speaks specifically about caring for an older adult.
Mrs. J. Brown was a client that lived in Hedin House apartment, which was the residential building where our offices were located. She had relocated there after the lost her spouse. As most seniors of state, she did not want to go into a nursing home, and so, she remained in the living independently the community. Mrs. J told the people she could live by herself. Reflecting back some years, I remembered her when she lived at 208 Massachusetts Avenue S.E. when it was a senior building. Mr. and Mrs. J lived there. She and her spouse was such a cute couple. She was a dutiful subservient wife. She walked proudly behind him and did whatever he asked her.
Years had passed from my last encountered with Mrs. J, so I wasn’t sure if she was the same person I had seen many years prior. She was introduced to me and through our office during a period of recertification for housing. She was very agitated and out of sorts because she did not understand what was being explained to her. It was after she calmed down and we had a conversation about not getting worked up and raising her blood pressure that she quietly whispered that she could not read or write. Her spouse had done everything for them in the past. They had been married since she was a young girl down south. He moved her here when and took a job and they had been in Washington DC ever since. I was so astonished by this revelation, I had to get up and leave the room to keep her from seeing me become emotional.
After collecting my feelings, I went back into the room and at that point, I made a decision that I had to help Mrs. J because if not she would be taken advantage of. I inquired about her former residence confirming that she was indeed the same person that I had met a few years ago. As time went on, she gained my trust and began to confide in me that in the early mornings, “she was going to meet a lady who took her to Columbia and Baltimore on alternate days to work for the white people”. I was furious because she was very frail and bowlegged and could hardly walk without her stick. Literally, a tree branch not a cane. I became more furious when she told me she made $200 a month and that it was paid in cash.
It then became my mission to change her life. I started taking her grocery shopping buying her food, articles of clothing, linen for her bed. Whatever I could do to make her life a little easier I did. She always kidded about eating pork chops. “ I do not eat no poke chop my doctor say don't eat that eat turkey bacon.” She would then laugh and say, "Ms. Karen I fooling with you.” We got her bank account issues straighten, her Medicaid corrected, applied for food stamps, and even made a prepaid burial arrangement through Fort Lincoln Cemetery. In which, she committed to a burial contract that she paid monthly. Everything would be done at Fort Lincoln and she would have her final rest at Harmony near her spouse. This information became part of the case record because she had no family. We met with Mr. Celeste and took care of everything to coordinate the burial at Harmony. According to Mrs. J, all of her family died except for her and she always wondered why God was keeping her here by herself. I got her a phone in her apartment so that I could check on her. She would say me, "I don't have no friends but you and two people in the building.” In an emergency, she didn’t know who to call. I gave her my cell number and the number of my office. It took an act of God not to give her my home number or take her home with me. I stuck to bringing her meals from the house.
Mrs. J had told me that before she died she wanted to learn how to read and write her name. She was tired of putting an X for her name. At that time, DC Office on Aging (DCOA) had literacy programs. I arranged for her to go to Delta Towers. I showed her how to ride the bus and she went faithfully. She would also let me know that she studied her lesson and how she did. Mrs. J was very determined to complete this process, so we got her a senior bus pass and every chance I got I would take her, making sure that she had enough money. Her only income was SSI and Food Stamps.
To further assist with Mrs. J's educational attainment, I gathered every preschool toy in my house that could help her. I gathered all types of flash cards numbers, letters, and math. I gave her some beginner books as well. She was really tickled with the See n Say and another preschool toy that I had given her. Mrs. J would come to my office some evening and we would work on her letters composition to spell her name. I made up some worksheets for her and drew dotted letters and numbers for her to trace. The joy was when she finally learned how to print and read one of the books I provided. I started her on how to write cursive letters and connect them. She was learning cursive just to sign her name. She was truly happy the first time she printed and wrote her name in cursive.
In 2005 when I transferred to Ward 8 in SE, she called all the time and we would get together to go grocery shopping and attend her doctor appointments at DC General. It was during this transition, I realized that the newly assigned social worker probably would not do what I have done, or care as much as I demonstrated. I tried to separate from Mrs. J and her case on my own, but it was hard to accomplish. Our separation came when I was called on the carpet for doing too much for this client. The new social worker protested my efforts and decided to organize Mrs. J's case differently. At that moment, I understood that possibly, I blurred lines between social work ethics and my own moral convictions.
This case had slapped me in the face and reminded me that no matter how much I care, I should never get personally involved. Of course, Mrs. J didn’t understand my potential error but accepted it. We kept in contact for a while; however, our calls eventually died off. Last year client became ill and was placed in a nursing home.
Notes on Narrative Methodology
Narrative inquiry was an appropriate approach for this qualitative presentation. According to Spector-Mersel, (2010), narrative research is relevant to creating an understandable viewpoint of society, and how individuals psychologically maneuver and perform within it. More precisely, narrative inquiry is a phenomenon and method, and it investigates how people experience society (Connelly & Clandinin, 1990). Also, narrative inquiry is more than a narrative; it is a story, which analytical studies and acknowledge that self-reflecting individuals find refuge and value in other people's stories (Duff & Bell, 2002). It creates "meaning to what can seem as meaningless situation” (Gilbert, 2002, p. 224).
Narratives from applied gerontologists who render aging services, in low-income communities—inclusive of subsidized housing, to aging in place seniors, explains the complexity of adherence to service provisions, ethical boundaries, and moral beliefs. For human service providers that are spiritual, the Bible holds us accountable for rendering assistance to the weak, infirm, and poor people in the world. And, if we are federal, state, or local public service employees, overarching policies and procedures and bureaucracy require us to do more with less, which might not meet aging in place’s demands. As experts in the field of aging, within today’s society, which process should come first?
Connelly, F. M., & Clandinin, D. J. (1990). Stories of Experience and Narrative Inquiry. Educational Researcher, 19(5), 2–14. doi:10.3102/0013189X019005002
Duff, P. A., & Bell, J. S. (2002). Narrative research in TESOL: Narrative inquiry: More than just telling stories. TESOL Quarterly, 36(2), 207–213. Retrieved from http://onlinelibrary.wiley.com/doi/10.2307/3588331/abstract
Spector-Mersel, G. (2010). Narrative research: Time for a paradigm. Narrative Inquiry. doi:10.1075/ni.20.1.10spe