Send Out the Clowns

Shira told me last week, a bit harshly, that I should have been saying positive things about DOROT.  In the course of this post I will, though probably not in a way she'll like.

Immediate background: a difficult 40 minutes on the phone with my father last night.  He's manic and energized about all the eldercare people who've been trooping through his apartment -- the aides, M, and the new player from Guild Net, a Medicaid contract agency, who showed up on short notice last Thursday to do the home care assessment for CASA. 

"They've got nothing," he says.  "They're not worth anything.  We should get rid of all of them.  They're all clowns."

What he'd rather do is have me replace them with the DOROT volunteers.  There are two sets of them -- Shira's sister, a medical student, who visits him once a week, and a rotating group of high school students who visit when they can. 

DOROT is an all-volunteer Jewish charity that provides home visiting and other eldercare services.  I know about them because back in the day -- about 10 or 15 years ago -- my parents were both DOROT volunteers.  This time last year, when my father's main problem was social isolation (as opposed to catastrophic cognitive collapse), it was natural for me to think of them.  I mentioned them to J, the very capable Partners social worker, who reached out to them and made arrangements.

It's clear that he gets a lot out of the time he spends with the volunteers.  Not surprising -- these are intelligent, well-educated people who treat him like a capable human being, which is more than can be said for some of the members of the formal home care establishment.  (Side note: if there are similar programs in your area, you might want to look into them.  Additional side note: if you do, you might want to do a better job of keeping in touch with them than I've done.  DOROT doesn't have a lot of staff.  And the visits tend to run smoothly.  For both of those reasons, I'm not in much contact with them and they're not in much contact with the rest the caregivers.  The good news is that DOROT functions.  The bad news is that it functions as a split-off part of the caregiving package.  This is my fault but also DOROT's.  When things run smoothly I'm apt to leave them alone -- I have enough else to look after.  On the other hand, DOROT would do me a favor if it gave me an occasional update.  My father isn't just a lonely old man, he's a lonely old man with a fatal illness, and the things they see in the course of his decline might be pertinent.  But again, this kind of reporting probably requires more personnel than they actually have).

Putting all that aside -- the immediate problem is that now (as opposed to this time last year) my father needs both the intelligent, capable DOROT volunteers and the not-always-welcome professional caregivers. Which makes it a little challenging that he's decided it's an either/or.  Of course, the main reason he's decided that, and the main reason he's exercised about firing the caregivers, has to do with my own cleverness, which is now blowing up in my face.  You'll recall that to persuade him to accept M and go on the next series of doctors' visits, I hit on the idea of telling him that we're engaged in all this activity because Dr. R has enlisted us in a project -- to help evaluate the doctors and other providers and then report back to him.  This had the value of convincing him to (for example) go see the head-and-neck surgeon and get the two-month-old bandages taken off his head.  It has the disadvantage that -- since he thinks that he and I and Dr. R are in business together -- and that all these people are working for us -- he wants to give advice and counsel.

"What you can tell Dr. R is that if he works with these [DOROT] people, he'd have something, because they're young and they're going somewhere and they have something.  Not like these clowns."

And then he starts reciting my phone number again.  Which serves as a reminder that in addition to DOROT we have to have M, not to mention the staff of people who know how to bathe him and dress him and perform the Heimlich maneuver, whether he likes it or not.

Wednesday night he wants to go over the staffing situation and help plan Dr. R's business.  I'm trying to gather strength -- could be a long night.

Meanwhile, the home care assessment...  I wasn't able to be there so M covered it.  She reports that it went on for two hours, was thorough, and that the Guild Net representative concluded that he needs 24-hour care.  Or possibly two 12-hour shifts (different and more expensive because the night aide can't sleep).  But she doesn't think he needs night coverage because she can't see a need.  How she concludes this on a first, late-morning visit is beyond me.  Fortunately M nudged E, who mentions that he's up all night and is almost constantly agitated and disoriented.  So off goes Guild Net person to file the paperwork.  Except that it turns out that the paperwork requires we work with Guild Net, which is a managed care agency and demands that we replace all the doctors.  At which point M advises that we cut them loose and tell them to send the application back to CASA, with instructions that it be forwarded to... deep breath... Partners in Care.  Because it seems -- don't ask me how this works because I don't know -- that although Partners wasn't able to accept the case, it is in fact able to staff the case as long as the case is formally held at CASA and not at Partners.

So I agree to go with Partners.  At which point the lawyer chimes in and says she can't endorse Partners because they've had many problems with them.  To which I reply -- not diplomatically -- that I know there have been problems with Partners because most of them have been mine.  And if you have another agency to recommend, please do it immediately.  Because if you don't, I'm going with Partners because M can supervise them and because, more to the point, I've got a six-day window to file the application for August 1st and if I don't, I'm going to have to carry private-pay aides through August at their going rate of eight thousand dollars a month.  So give me an alternative solution or get out of the way.

Didn't hear back from them so I'm going with Partners.  Better the devil you know...

By the way, have you noticed I haven't mentioned Zen practice recently.  I promise I will, as soon as I'm done rampaging through the landscape and blowing people up.

Clowns.

Or has somebody already mentioned that? 

Comments

[Julie]

Wow, I wonder if there is something in the air right now or perhaps a full moon coming? We also have had idiotic scenes which make me want to don my camo gear and rampage around blowing up everything in sight. It sounds like you have more than your share of clowns to deal with.
By the way, I have enjoyed that book, The Majesty of Your Loving,
and I'm thinking I should go open it again for a reminder.
Sending positive energy, be prepared.

[Shu]

There actually is a full moon coming -- should be here within a couple of days!

My poor mother seems to feel she has the short-end of the stick this week as I am working from home so that my daughter can undertake a procedure up in the northeast, and I am SO not my daughter. I don't have her energy or outgoing engaging personality and it is making things "too different" for my mother to be comfortable. I am definitely the subpar shift, although she is still being well taken care of.

It is just interesting how changes or visitors or just disruption of schedules works into their minds and comes out the other side in their behavior.

We can't do everything or be everything or do or be everywhere. We can't create the perfection -- which probably wouldn't go over well anyway. We can just do the best we can and keep tapping into the vat of love as we try to get through each day's challenge (for them AND for us!).

Admiringly,
Shu

[Alan G. Ampolsk]

Thanks to you both, and I'm going to have to start paying more attention to those lunar cycles. It definitely feels like we've been in something. A fistfight, possibly, or something along those lines.

Julie - energy received, and thanks.

Shu - it sounds from your latest posts like you're producing some good results, however it might feel to you. You're right about disruption. We've got some coming (as in, the changing of the aides) and I'm not looking forward to his reaction. On the other hand, you're right about perfection, too. And since there isn't any, I suppose we'll just deal.