Case IV: Chapter 3: Multiple Dilemmas

Chapter 3: Multiple Dilemmas

Dudley was still laughing when Ray drove through the gate at La Vida Aureo.   He had really enjoyed seeing his friends after such a long absence. Their discussions were always lively and stimulating and he realized how much he missed the companionship. He had promised them that he would find a way to get together more often even though they had chided him about living in an “Old Folks’ Home”. Dudley had only hinted about his role as La Vida Aureo’s resident Handyman and, despite Ray’s persistent questioning, mentioned nothing about also becoming the House Detective. But, he knew Ray’s curiosity was aroused and that he would talk to Frank Garcia at his earliest convenience. Dudley was not too surprised to find Isabella in the lobby when he entered the main building. “Her project must be more important that I realized earlier, he thought to himself. I guess I’d better let her tell me what’s on her mind.”

“Let’s go to my office, said Isabella without bothering to say Hello.”

Dudley followed Isabella into her office and she closed the door before sitting down at her desk. “I’ve been going over the monthly expenses for La Vida Aureo and identified some rather disturbing trends.”

Still in a buoyant mood, Dudley said something he quickly regretted. ”So, all those years studying to get your MBA paid off?”

“Look, Doc, this is serious.”

“Sorry. Please continue.”

“Remember, one of the main reasons Señora Jaramillo hired me was precisely because of my analytical skills. Too many non-profit organizations fail or are constantly struggling because a well-meaning Executive Director doesn’t “mind the store”. Too many EDs are afraid of the numbers or think that financial management is a “dirty business” and should not be part of a non-profit organization. One of my MBA professors often reminded us that if an organization, even a non-profit, doesn’t consistently achieve a profit margin, they will be unable to achieve their Mission, no matter how noble. In fact, there was a sign over his desk that said “No Margin, No Mission”. Initially, I thought that was a pretty cold-hearted view, but I now realize the value of that perspective.”

“It appears, from my analysis, that we are spending an increasing amount of money each month on durable medical supplies, everything from diapers and bedsheets to oxygen tanks and some diabetes-related supplies. So far, it has been mostly small stuff, but it adds up and the total keeps increasing. Some of these items are charged directly to individual residents, but some are part of our General Supplies. Regardless, we need to get a handle on this and I could use your help because the financial data are not timely enough. By the time everything gets posted in our financial system and I receive the necessary expense reports, another month has gone by. If I am to take any type of corrective action, I can’t wait that long.”

“I’m sorry for trying to be clever. Of course you have my total support. What can I do to help?”

“I’m not sure, but I was thinking that perhaps you could construct some sort of supply cabinet that made it easier to see, or count the amount of each item we had on hand at any time. Right now, all our supplies are kept in one main Store Room and lots of people have access to it. I don’t want to keep everything locked up; that would send the wrong message to our Staff. So, I was thinking that some sort of cabinet or shelving that was calibrated would allow the Shift Supervisors to take inventory more often by just looking at the shelves and provide me with up-to-date information.”

“Do you suspect that someone is actually stealing supplies?

“I don’t know and I obviously don’t want to accuse someone without considerable proof. It troubles me deeply to think that one of our staff would consider stealing. Unfortunately, there aren’t too many other plausible explanations. I am growing increasingly anxious and want to resolve this matter before one of our Residents complains that they are being over-charged for supplies. Regardless, it is not good for business”.

“I think I understand what you want and let me give some thought to how that would look. I have some preliminary ideas, but want to make some sketches for you to look at before I start building anything.”

“I appreciate it, Doc, and I’m confident that you share my sense of urgency and concern.”

“Certainly, Isabella, you have my total support.”

A few days later, Dudley showed Isabella some sketches for a modular shelving system that could be installed easily in the main Store Room. There was a basic module for each major type of supply and, within each module there was a calibrated marking resembling a tape measure to indicate the quantity present. “I’ve used thin pieces of wood to further separate the nodules so that each “pigeon hole” will only hold a few items. That way, a Supervisor can quickly take a rough inventory by simply looking at the shelving units.”

“This looks great, Doc. I knew I could count on you. How soon can you get started installing these, at least for the specific items that we use the most of and seem to be most troubling to me, like diapers?”

“I’ll have a “diaper module” installed by the end of the week, if that’s OK. You’ll need to talk to the Supervisors about their new responsibility and I’ll explain how the system works and prepare some sort of log sheet for their use.”

The basic concept of La Vida Aureo was to provide a continuum of care with apartments and casitas for totally independent living through stages with increasing support to full-time staff support for residents who could no longer care for themselves.   All levels of Assisted Living were housed in the main building, separated into floors and wings. The design of the physical structure incorporated significant flexibility so that the respective space allotted for each level of care could be modified as the composition of La Vida Areo’s resident population changed over time. The sections designated for assisted living and the memory care units were highly self-sufficient with their own utilities, laundry and some food preparation capabilities. This design element provided a higher level of security for the residents as well as more timely support.

Martina Trujillo had worked as a housekeeper at La Vida Aureo for over two years in the Assisted Living Section. Recently, she was also working additional hours in the Memory Care Section to earn extra money. She always found the work interesting as she observed the variation in mental acuity of the residents in these parts of the complex. Some in the Assisted Living Section had full metal capability, but needed some assistance with basic physical activities. Others were physically fit, but had varying degrees of deteriorating mental capacity. And, these conditions could change on a daily basis with some Residents; one day they were perfectly alert and pleasant and withdrawn or sullen the next. All of these conditions and variations were more pronounced in the Memory Care Section. Her observations were important to Martina as they gave her perspective on her own parents. She was painfully aware that both her father and mother seemed to be declining a little bit each time she visited them.

Her twin brother, Martin, was a driver at their Uncle’s commercial laundry, Los Compadres Laundry. Los Compadres currently had the contract for laundry for La Vida Aureo’s Assisted Living and Memory Care Units. The in-house laundry facilities were for small personal items. Towels, bed linens and other heavy-duty materials that were often soiled due to “accidents” from some residents went to Los Compadres Laundry.

Martina and Martin knew just how important the jobs at La Vida Aureo were to their lives and support of their families. They understood and deeply respected the fact that they were part of La Doña Jaramillo’s commitment to providing opportunities for the community.

Recently, Martina’s visits to her parents’ home had become more frequent and now she found herself stopping almost every evening on her way home from work. One evening, she discovered that her father had soiled his clothes and seemed unaware of the situation. When Martina asked her mother about it, she began to sob and said, “I tried to mention it to him, but he just gets angry. And, I am too weak to do anything about it myself.”

Martina was able to persuade her father to get out of his soiled clothes which she put in a large plastic bag to take home with her. “Don’t worry, Mama, I will think of something.”

“This has happened before, mi hija, but he hides his dirty pants in the trash. He refuses to talk about it and he refuses to go out of the house. He just sits there all day watching TV. He won’t even go to church with me anymore, not even to the Senior Center.”

As Martina drove home, she realized that the situation would only get worse as her mother could soon be in a similar condition to her father. At the present, her mother was still mentally sharp but age had taken its toll on her physically. She knew it would become increasingly burdensome but she could not neglect her own small children. After a restless night, she took the bag of soiled clothes and linens to her brother at work and asked him if he could include these few items with a larger load. “Just this once, Martin, she pleaded. I feel so overwhelmed and Papa and Mama are getting so helpless.”

“I’ll see what I can do, but don’t say anything to Tio Sanchez; I don’t want to get on his bad side.”

Fortunately, the next day was busy at work and Martina’s was able to put her problems aside for a while. In mid-afternoon, her Supervisor asked her to come to the Memory Care Section to help with a major clean up situation. A resident had suffered a total loss of control and there were soiled clothes strewn throughout the small apartment.   When the clean up was completed and Martina was relaxing with a cup of coffee, she was suddenly overcome with the realization that this episode could have easily been her own parents, particularly her father. And, there was no housekeeping staff to deal with the situation, just her. In desperation and without much hesitation, she went to the Store Room and took as many adult diapers as she could conceal under her smock and headed for the parking lot. She placed the diapers in the trunk of her car and hurried back inside before anyone noticed her absence.

She stopped at Los Compadres on the way home and was disappointed to learn that Martin had been unable to get their parents’ laundry done. “It was crazy-busy here today, he said. I’ll try to get it taken care of tomorrow, I promise.”

Martina had intended to only stay a few minutes at her parents’ house, but found the situation much like the previous day. She was able to get her father cleaned up and, over his very strenuous objections, into a clean diaper for the evening. She put the soiled clothes into a plastic bag to drop off with Martin on her way to work in the morning. She placed all of the additional diapers in the bathroom with strict instructions to put on a clean one before going to bed.

This became a routine for Martina over the next few weeks. Her father’s condition remained about the same and his “accidents” were less frequent. She was able to provide an adequate supply of diapers by stealing a few at a time from the Store Room and hiding them in her car. One day, she also took a set of rubberized bed sheets.

Martina Trujillo remained terribly upset and plagued with a horrible sense of guilt. She knew it was a sin to steal and another to conceal her actions from everyone, her parents, her brother and even her husband. She was painfully aware that the situation with her parents would continue to deteriorate and they would soon be unable to care for themselves. There was a limit to what she could do without jeopardizing the well being of her own small children. There was nothing like La Vida Aureo in her neighborhood and, even if there were, the family simply could not afford the kind of constant care her parents would require.   Her mother never asked about the source of the diapers. Martina assumed that her mother believed Martina was purchasing them someplace, or more likely, that they were given to her at the place she worked.

When she arrived at her parents’ home one evening, a woman friend of her mother’s from church was visiting. They two women were sitting on the front porch, holding hands and both were crying softly. “Martina, her mother said, you remember Celesta Solis, my good friend from church?”

“Yes. Mama. Señora Solis, how are you? Why are you both crying?”

“We are sad because both of our husbands are sick.”

“Mama, Papa is not sick; he is just getting older. And so are both of you.”

“Yes, Martina, but we do not have those “accidents” like our men do.”

“I know, Mama, but I am taking care of that for you.”

“Bless you, my child. I do not know how I could manage without your help. I’ve been telling Celesta about all that you do for your poor Papa. “

“I wonder, Martina, said Señora Solis, if you could find it in your heart to ask for a few of those diapers for my poor Juan?”

“What do you mean?”

“Your Mama was just telling me how that fancy place where you work has so many of these that they allow you to take a few home for your poor Papa.”

Martina didn’t want to embarrass her mother in front of her friend and was trying to think of something to say when her mother said, “It is alright, Martina, I gave Celesta a few diapers from the ones we have. I knew you wouldn’t mind. You can just bring a few extra next time.”

Martina was trapped and simply nodded her head.

After this relatively innocent episode, the situation escalated. Too often, when she stopped at her parents’ house, there was another friend sitting on the porch with her mother, deep in troubled conversation. Each of these friends had been given a few diapers with the promise that there were more available whenever needed. Martina was no longer able to just hide a few diapers under her smock and began carrying a backpack to conceal her theft.

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