I work as a social worker in Adult Protective Services for a local county government. This involves the investigation and case management of alleged abuse, neglect, self-neglect or exploitation of vulnerable adults. These are adults who lack the physical or mental capacity to provide for their daily needs.
I work with hoarders. I work with folks who have neglected themselves to the point that they have been sitting in their own excrement for years. I handle situations where adult children have stolen all of the life savings of their parent(s), who now cannot afford the care they need. Sometimes I work with old ladies or gentlemen with dementia who’ve just been raped or physically assaulted.
I don’t do this work out of altruism, or out of a sense of tikkun olam (acts of kindness), but rather because I have a symbiotic relationship with my clients—we learn from each other. APS work has taught me a lot of lessons about life. Here are some of the truths that I have learned:
1. All relationships matter. Toward the end of life, we often see really sick people lovingly looked after by the most unlikely of person–a neighbor, a coworker, or a student of the client from 30 years ago. At the time when they met, they did not know how important their relationship would become. Between neighborly exchanges of recipes, childcare, and neighborhood news, a friendship often blossomed that lasted a lifetime and eventually, sometimes, transcended geography. In the end, the most seemingly banal of relationships can become the most important.
2. Connecting with people is sometimes more important than fixing a problem. I came into this field wanting to help people, wanting to fix problems. Some situations are not fixable, though. So, by tapping into my own history of trauma, I realized that what really helps in the face of ugliness in our lives is really the power of connection—connecting to someone else in intimate, non-clinical, I-am-in-this-together-with-you moments. Sometimes just sitting together in silence can comfort as much as a warm embrace. I have the unique honor of being able to connect with folks when they are most vulnerable—in their space, in their home at the worst time of their lives, and that moment of sitting with them.
3. People are multidimensional. I realized, at some point, that if we can see both the good and bad in others, we can accept the multidimensionality in ourselves.
At first, I was overwhelmed by what I saw as true evil in my work—people that abuse, rape, and rob little old ladies and gents—even family members. No matter how tough the abuser’s childhood or life circumstances, I thought there was something purely evil about preying upon and hurting a person who is already vulnerable.
The lines between victim and perpetrator are not so clear in life, however. Often perpetrators were victims themselves. And often the evil-seeming folks, are, surprisingly… human. I have held the hand of a gasping-for-breath hospice patient who, as a young mother, beat her kids to within an inch of their lives. Her last two aides left when she screamed racial-laced awfulness at them, as they were changing her diapers.
When I came in to her room, she said that she was thankful I wasn’t another Jew like the facility administrator. Clearly she was unable to really see me or my name badge. In a voice humbled by lung secretions, she asked me to stay with her, and I did, holding her bony hand for hours until a sitter I arranged for showed up–because no one should die alone.
By seeing clients like this woman as multidimensional—neither all good or bad, I could start to conceptualize others, as well as myself, as multidimensional. I have done things in life I regret, I have had experiences that are stigmatizing, but I realized that I am nuanced like my clients. I could be competent, yet flawed. I could experience bouts of depression and be hospitalized, yet still be a good clinician. I could yell at my kids sometimes, but still be a good parent.
4. We are all one life circumstance away from being the people we ignore on the street. This job requires you to be humble; I realize I am not so different from my clients and could be one at any time. I am one paycheck away from being homeless, one misfired synapse away from being psychotic, one passport from being deported, one decade or two from being senile, and one or two bad decisions away from alienating the important people in my lives. It is with this knowledge that I can hold the hands of our clients and try not to be in judgment of how they got to where they are now.
5. Money not only can’t buy happiness; it often can’t even prevent a life living in squalor. Many of the clients I have worked with are wealthy folks living in large houses with plenty of financial resources. Often the houses look lovely and stately on the outside, but are a crumbling smelly mess on the inside—as is often the case of their own lives. Aging and illness are the great equalizers. Wealthy retired judges, politicians, and physicians are certainly not immune to the ravages of Alzheimer’s disease, abuse, or neglect. Living alone in a large house with money coming in is still living alone.
So APS helps me realize that money does not always equate wealth. And I fret slightly less as we look at our unpaid mortgage bills and cutoff notices for utilities. Because, as I look at my beautiful family and am able to go to work, I realize how rich I really am.
6. It is important to get your legal and healthcare ducks in a row. We see so many incapacitated adults that have never set up a Power of Attorney or a Living Will, and it is not clear how they would have wanted their lives and assets to be handled.
One of the hard truths I’ve witnessed is that chest compressions on an old, frail person is a violent act—(s)he usually ends up with broken ribs and/or a broken sternum—and usually doesn’t save the person—or if they are saved, they do not recover from the injuries from CPR. And without paperwork, CPR will usually be performed.
Often, when no paperwork exists, adult children squabble over how things should be handled, and their own agendas get in the way of the client obtaining appropriate care, or loved ones feel guilty for whatever decisions they make on behalf of their friend or relative, because they do not know what that person would have wanted. Everyone should have, in writing, a living will, indicating end-of-life preferences (most importantly regarding intubation and resuscitation) and an assignment of a healthcare and a financial Power of Attorney.
So APS, like all of life, it turns out, is awful and wonderful. I think I am a better parent and a better human because of the work I do.