There is a somewhat depressing but highly accurate article in the New Yorker this week about how easy it is for the elderly to lose their rights through a court appointed guardian. It sums up the stress and distress of the last job I had as a case manager for a guardianship agency. How stressful was that job? Well, let’s just say that I work now with people with severe mental illness, some of whom have murdered other people and it’s much less stressful than working as a guardian.

You would think that helping people is a great job. Well, most of the people I worked with were not asking for help so I was more of a meddler than a helper and no one likes a meddler.

I dealt with people with various forms of dementia, substance abuse, lots of mental illness, hoarders, intellectual disabilities and more than a few dysfunctional families.  I got to ask fun questions like, “Do you want to die in a hospital or at home…” as if it mattered, none of our clients ever died at home, too expensive.

That’s not to say that I didn’t work very hard. On any given day, I would have court in the morning, do a noon visit to an ICU unit, make an important end of life decision with a few phone calls to different doctors, attend an annual Medicaid meeting on behalf of a client and end up buying and delivering groceries to a client living in a boarding house. That was a fairly typical day.

We like to believe that hard work means good work but we would be wrong. One of the very saddest part of that job was that  although I did work really hard, often taking several phone calls after hours and being on call 24 hours sometimes even when on vacation, I can’t say with certainty that I always made the best decisions for the individuals I was entrusted to care for. Good, person centered decision making takes time, thought and good information none of which my job provided.

Agencies exist to help stop abusive guardianship laws  but I’m not confident that they are going to be able to enact real, meaningful change. There are so many outside forces at play here, like the under regulated Assisted Living Communities all over the place that change big bucks to house elders and the hospitals doctors who sometimes hire lawyers to appoint a guardian for a patient who doesn’t comprehend their treatment enough to consent. I saw a few very sad cases where a person was appointed a Guardian because they were not cooperating with the hospital social workers who needed to apply for Medicaid for the individual.

I saw a lot of missed communication between individuals who needed help and those trying to help. So many social service agencies are overworked and so severely understaffed that their workers aren’t going to take more time than necessary explaining the processes and requirements of a Medicaid application or a social security hearing.  And while I empathize with the workers I really sympathize with their clients more, I mean they ask for bank statements…it’s a little affronting. Taking the extra five minutes to explain why Medicaid needs to know your whole financial profile would really calm some nerves, but you know, nerve calming isn’t the job of a case manager…stay in your lane and all that crap.

Another big issue effecting social service is that we don’t tolerate weirdness anymore.

Everyone is so undone with paranoia that the slightest odd behavior is criminal. I had a former client who really liked being homeless. She could panhandle enough money to eat, she could smoke anytime and anywhere she wanted to and people stayed out of her way. When she lived in a group home, they regulated her every move, demanded that she shower every day and regulated her smoking. But I couldn’t be angry with the group home because Medicaid wants to know what staff is doing with the consumer (that’s literally what medicaid called recipients) every 15 minutes. I would hate for anyone to know what I’m doing every 15 minutes and believe me, you would hate to know what I’m doing every 15 minutes, too.

I know panhandling is illegal but it’s no worse than my bank changing me $1.50 to use my debit card at a grocery store. Get a grip, people.

Since when can we not occasionally stink a little? I would rather smell some God given foot stink than a mountain of Axe body spray any day. And I find it pretty sad that some facilities absolutely demanded showering but never mandated tooth brushing (but that’s a personal peeve of mine).

I’m glad that the New Yorker article is bringing some of the main issues of Guardianship up for the intelligentsia to mull over.  There are much larger questions here concerning more than just “old people getting their shit taken away”.  There are questions about what is worthwhile to a person rather than just what is worthwhile for a person. I hope this is the beginning of that conversation and I hope the right people are listening.