Case VI: Chapter 3: A Challenge for Isabella and Dudley

Chapter 3: A Challenge for Isabella & Dudley

A few days later, Isabella Duncan met La Doña Jaramillo for their regularly scheduled luncheon meeting. Isabella was only a bit surprised when Father Michael joined them. This will likely NOT be the usual luncheon, mused Isabella. I suspect these two have cooked something up and, I bet I’ll be the beneficiary of their scheme. Despite her apprehension, Isabella greeted Father Michael warmly. “It is always so good to see you, Father.”

Throughout lunch, the conversation was mostly superficial, focusing on minor local issues and, of course, when it would rain. As they were enjoying coffee, Señora Jaramillo said, “Isabella, Father Michael has something he would like to discuss with you.”

“Actually, Isabella, replied Father Michael, La Doña and I were discussing the Trujillo family and the progress of helping others in the Our Lady of the Valley parish. We are able to help many elderly people and that is a very good thing. Your husband’s efforts have been invaluable. But it seems as though we have greatly underestimated just how many people are in need of assistance. And, there are many more issues than we expected. It turns out that providing diapers is a very minor concern compared with some others we have discovered. People at the church and throughout the Parish and really the entire Diocese have come forward with issues that are far more complex and troubling. There are other physical problems and some people have trouble just walking around their homes. Falls and broken bones are a lot more frequent than I realized. And, the issues associated with declining mental capacity are legion. Getting lost, wandering away from home, loss of inhibitions and inappropriate behavior and many other are evidently common. I have begun reading more about Alzheimer’s disease and was shocked to learn that it can also strike people whom I would not consider old.”

“We experience many of these issues daily at La Vida Aureo,” replied Isabella. “It is a constant challenge for our entire organization. We hold frequent meetings among the staff to share what we’ve learned and continually try to develop alternative approaches to insure that our residents receive the best care possible. I am also very aware that we must remain vigilant to the needs of our staff. Dealing with some of the behaviors, particularly the residents with Alzheimer’s, can be quite stressful. It must be an on-going and ever-evolving effort.”

“As I mentioned to Father Michael, added La Doña, it would be impractical to try to accommodate everyone in facilities similar to La Vida Aureo.”

“I sincerely believe, said Father Michael, that many of our parishioners would prefer to remain in the privacy and security of their own homes. That is not to say that La Vida Aureo is not a first-class place. But, you understand what I mean. We have a moral responsibility to all of these people and it is our sacred duty to do what we can.”

It was apparent that the three of them agreed on the need and that the need was rapidly growing, both in number of people affected and in the complexity of issues. It was La Doña Jaramillo who spoke in an attempt to bring some closure to the discussion.

“Father Michael, you can rest assured that Isabella and I share your concern as well as your sense of responsibility. I’m sure you have other duties to attend to and we appreciate your taking time to share these things with us today. Isabella and I will continue to visit a while longer and we will plan to get together again in the very near future.”

Father Michael rose to leave. “Thank you for your time today and for allowing me to talk so openly about this deeply troubling issue. Isabella, it is always good to see you. Please give my best regards to your husband and thank him again for his efforts.”

Isabella Duncan had a great deal of respect for La Doña Jaramillo. Each time they talked, Isabella was impressed by La Doña’s comprehensive understand and how she seem to always grasp the most subtle points of any situation. It was this respect that had been Isabella’s main reason for accepting La Doña’s offer to become Executive Director of La Vida Aureo. It was no surprise, therefore, when the conversation took a decidedly more pragmatic tone once Father Michael left.

“The challenge for you, Isabella, La Doña began, is to find a practical means of dealing with these issues, because there will be many more, likely many more than Father Michael realizes. He may be still a bit naïve after all. He did not say it, but my belief is that many people in our community are vulnerable which complicates matters to an even greater extent. While I totally support the concept behind the Affordable Care Act to make healthcare available to a great many more people, I have some grave misgivings. The law is so complex and difficult to understand that it creates opportunities for unscrupulous persons to prey on unsuspecting people like many in our community. I fear that many people will give their personal information to these charlatans because that is what they are told is required under the law. Then, these charlatans will use that information for illegal purposes while our people remain unsuspecting victims of these crimes. No matter how much this upsets me, I realize that we are basically powerless to prevent this. It is my desire, which I know you share, to help as many people as possible, but in a straight-forward, practical way. I do not want to add to the confusion. “

“I agree with you completely, La Doña. I guess I always knew that some form of middle-man group would emerge to assist people in signing up for the benefits of the Act, but I had not given too much thought of how this very new and complex system could be so easily abused. People would willingly give their personal health-related information to a stranger if they thought, or were told, that it was the law. I’ve already seen some of what appears to be this type of operation opening in some neighborhoods, typically the poorer ones where people tend to be less educated. It still astounds me that so much of this Act relies on computers when those people who are in the greatest need are the least like to own, much less know how to use, a computer. I find myself asking, “What were they thinking?” As you said, all of this makes the problem of dealing with the real issues of aging considerably more difficult.”

La Doña continued. “The problems will only get larger and more complex; building more facilities like La Vida Aureo is not a practical solution. I believe that you and I share the belief that people should help themselves as much as possible. I challenge you to think of potential approaches which allow people to preserve their dignity. We need to seek ways to empower them so that they do not fall victim to what I believe will be an increasing army of healthcare criminals.”

As they parted, Isabella once again felt privileged to know La Doña Jaramillo and fortunate to have the kind of working relationship they shared. At the same time, Isabella realized the importance and difficulty of the challenge she had been given. She would share this conversation with her husband this evening as they enjoyed a small glass of wine in their den and seek his input.   Driving into the grounds of La Vida Aureo, Isabella had another thought. I told Matthew Dudley that one of the reasons I hired him was because of his planning expertise. If I believe what I said to him, it would be foolish of me not to engage him in addressing this challenge! I obviously can use all the help I can get.

A few days later, Matthew Dudley walked into the dining room in the middle of the afternoon, surprising Paloma. “You are not usually here this time of day, Señor Doc. Is there something on your mind you wish to discuss?”

“Paloma, are you certain that mind reading was not one of the things you also learned from your Tia Luisa? There is something I wanted to ask you about. I just had a brief conversation with Isabella about Martina Trujillo.”

“I pray that she is not in any trouble.”

“Oh no; certainly not. Isabella wanted to talk about Martina’s parents and others who are in a similar situation. Evidently, Isabella met with La Doña Jaramillo and Father Michael recently and they share a growing concern for the aging population in our community. They believe that there are many other elderly people, like Martina’s parents, who need an increasing amount of support but are unable to afford it. Isabella feels that the problems are more diverse and complex than those faced by Martina and explained that these are similar to what we experience here in our Memory Care Unit, but they are happening out in the community at large. Both La Doña Jaramillo and Father Michael expressed serious concern and asked Isabella to think about potential ways to address this growing problem. They also realize that it is simply not practical to have more facilities like this one. Isabella asked me to think about this problem and come up with some suggestions.”

“I am certain that you will do a good job, Señor Doc. Isabella values your opinion. Let me tell you about a discussion that the house staff had recently. You know that they often sit in the smaller dining room after their shift while waiting for their ride home. The other day, they were talking about this very issue. From what I heard, I would assume that many of our own employees are in a similar situation to Martina.”

“I assume that many families are struggling with aging parents and cannot afford a facility like La Vida Aureo.”

Paloma continued. “From what I heard the staff discuss, I do not believe that money is their major concern. I believe they simply do not know what to do. Many of them could keep a loved one in their home, but are unprepared to deal with some of the issues that accompany aging. For many of them, they believe that it is their responsibility to care for their aging parents and are willing to do so. Some said that, even if they had the money, they would prefer to keep their parents at home. And, I believe most of the parents would prefer that as well. ”

“It is a very different situation from when my parents were alive.”

“And mine as well. People worked hard all their lives and lived only a short while after they stopped working. But, today, many people seem to suffer long periods of physical and mental decline. Maybe it is a result of not living a very healthy life. I don’t know. These are new problems and the mental deterioration is particularly difficult. The primary thing I understood from the staff was that simply want to know what they should expect. They would like to know what are the typical things to be aware of and perhaps some suggestions of what to do.”

“I know that Isabella would like to offer some suggestions to La Doña Jaramillo and Father Michael to help the community. I also got the impression that she would also like for me to think about ways to grow La Vida Aureo from a business perspective.”

“I do not see those as incompatible requests, Señor Doc. Perhaps you will find a way to do this. I believe that if La Vida Aureo is more successful, it could provide the means to help more people.”

“Thank you for your time, Paloma. I will give this much more thought and would appreciate being able to share my ideas with you before going to Isabella.”

“You know that you are welcome in my kitchen at any time and I will listen to your ideas. Together, I am sure we can help Isabella and La Doña Jaramillo.”

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