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Case Study: How We Help Professionals

Client Summary

Erica is a 57-year-old single woman, living alone, with Schizoaffective Disorder, and diabetes. Erica’s Trustee worries she might be vulnerable in a mental health emergency or that she could become a victim of undue influence. Eric doesn’t have a close family member to support her.

 

Problem

Erica lived with her older sister in a three-bedroom townhouse until her sister passed away two years before IKOR became involved. Erica’s parents had established a trust for her ongoing care prior to their deaths. The trustee is concerned about how to best support Erica around her mental health and medical concerns. Erica has mental health services through a behavioral health system that supports her at home. She also had a home aid from a home care agency. Erica did not have a Durable Power of Attorney or anyone to act as her Medical Power of Attorney. The Trustee feels that Erica is a vulnerable adult, so they recommended that IKOR support Erica in these roles. Erica has a bachelor’s degree from a local university; she is well-traveled, kind, and very aware of her psychiatric symptoms. She is able to make decisions for herself but she needs someone to support her in navigating complicated systems of care and routine life. 

Outcome

On the surface, when IKOR steps in to act as a Durable and Medical Power of Attorney, it appears Erica is functioning well. The IKOR RN Advocate and Erica create a few goals as a result of the IKOR assessment process. 
As the IKOR team became better acquainted with Erica, we realized more concerns were brewing beneath the surface.
• Erica’s in-home caregiver would call us regularly to say that she would not let her into the house to support her.
• The cleaning lady was calling to report that she was finding psychiatric medications in the couch cushions.
• Erica was saying that she hears voices, and the voices are degrading to her.
• The neighbors in the townhouse complex were reporting that they would hear abusive yelling (not by Erica) when the in-home caregiver and the cleaning lady were at home. Erica did report that the cleaning lady didn’t like her and that she called her lazy. She reported that the woman who came to clean would make her do the cleaning, and the cleaning lady would watch tv instead of cleaning. Erica also reports that the cleaning lady would share her life problems, asking to borrow money that she did not repay. 
• Erica’s diabetes and weight had become more of a concern. The caregiver wanted to take Erica out to eat and shopping on every visit. Erica would pay for all of their outings. The IKOR RN Advocate was concerned that if Erica doesn’t change her diet, she is going to become insulin-dependent and need to go into a personal care home. Our team felt that a personal care home was not an ideal placement for Erica. In a personal care home, Erica would be much younger than the other residents. It was Erica’s, and her parents wish for her to remain in the townhouse as long as possible. IKOR and the Trustee have monthly conferences about Erica’s care, and everyone agrees that it’s in her best interest for Erica to stay in the townhouse.  IKOR finds a nutritionist to work with Erica on her diet and begins to help Erica to set healthy boundaries with her care providers.
• The IKOR RN is attending Erica’s medical appointments and finds that Erica’s Primary Care Doctor was not working in collaboration with the Physician’s Assistant, who was leading in Erica’s psychiatric treatment. It’s not ideal when mental health and medical health are not working together. Eventually, the IKOR RN Advocate uncovers a concern with Erica’s Behavioral Health program and addresses it, advocating for Erica to have a Psychiatrist support her at home instead of a Physician’s Assistant. 

As with most cases, it takes time for us to develop a trusting relationship with Erica.

• Erica was protective of her in-home care providers because the caregivers were her link to getting out into the community to purchase what she needs. Erica does not want to let the cleaning lady go at first because she is sensitive to the cleaning lady’s need for a job. Over time with support from IKOR, telling her that she doesn’t have to accept poor treatment, Erica eventually admitted that both care providers used abusive language with her and that the cleaning lady wasn’t behaving appropriately.

Erica eventually opens up and recognizes how the care she has isn’t working as it should be. The IKOR team works collaboratively with Erica to determine what great support would look like for Erica and eventually together with the Trustee they create a customized solution based on Erica’s needs. The care plan includes resolving issues related to Erica’s need to participate in recreational activities, psychiatric concerns, financial awareness, and addressing appropriate eating habits. The IKOR RN works to get Erica’s medical and psychiatric team working together. The IKOR team eventually creates the Life Enhancement Specialist Position hiring an appropriate recreational and life skills team member with mental health experience, instead of a home care provider who is trained in the personal care needs of seniors.

Disclaimer: This case study is a combination of several clients IKOR has supported and does not include the exact details of how we have helped clients like Erica. If you would like to understand more specific information about how IKOR has supported the care of clients like Erica, please call our office to schedule a no-cost consultation.

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