Case VIII: Chapter 3: A Focused Approach
Isabella asked Dudley to come to her office. “I assume you are aware of the request Mr. Blackburn and Ms. Elliott made? They make a great couple and I’m glad it happened here; we can certainly use the positive news. I’d like your input to what I want to propose to them. I’m concerned that Martha Arthur’s casita may be hard to re-rent because of the potential stigma of the murder. If Larry & JoAnne will agree to move into that unit, I believe I can work out a fair and equitable arrangement for their respective contracts with La Vida Aureo. That would open one casita and one apartment in Independent Living which we can easily fill from our Waiting List. What do you think?”
“Isabella, I think that is an ideal solution; everyone benefits. And, Larry and JoAnne are very mature people who would not have any apprehension about Mrs. Arthur’s casita.”
“I’ll need to talk with Denise Harris to confirm that arrangement, but I don’t see any problem. My understanding is that something similar was included in Mrs. Arthur’s Will.”
“While we’re talking about ways to help people move forward from that unfortunate incident, continued Dudley, I’d like to discuss Mrs. Branch.”
“I passed her in the hallway the other day and she seemed to be holding up pretty well.”
“But, Isabella, we both know Mrs. Branch well enough to realize that she will put on a brave front rather than let anyone see how much she is actually grieving.”
“You’re probably right, Doc. Do you have any suggestions about how we could help her without it being too obvious what we’re up to?”
“I was thinking about Señora Barela. She strikes me as another elderly woman who is alone and who could use some companionship. I suspect she and Mrs. Branch actually have much in common, despite their previous rocky start and that unfortunate episode with the poisonous tea (Case V, January 2015).”
“I agree, but getting the two of them together could be a real challenge! Is there a way to head off any potential fireworks?”
“I was thinking we could ask Señora Angostura to serve as mediator or facilitator. I imagine she would be very good at setting the right tone and getting things started on a positive note.”
“I hadn’t thought of that approach, but I believe it would work. Once again, Doc, you came up with a clever solution that makes total sense. Would you talk to Señora Angostura; it would be less official than if I were to ask her?”
“I’ll make a point of it. I assume you’ll talk to Mr. Blackburn and Ms. Elliott.”
Dudley had been thinking about the Community Assistance Program and wanted to share some of his ideas with the Team, but was hesitant to appear to be trying to control their actions. He decided a casual conversation with Beth Ford would be more appropriate and asked her to meet him for coffee in the Main Dining Room. He began by talking about his own experiences with the State Water Resources Department.
“When I was involved with planning activities at the State, we sometimes found it helpful to step back and to understand the bigger picture. We often got too intent on achieving a specific result that we lost sight of things. I’ve been watching the Team and am impressed by their overall enthusiasm and energy and the last thing I want to do is to inhibit that in any way. However, I don’t want us to move too quickly and find ourselves down the wrong path in a few months. That would be a discouraging development.”
“I understand”, said Beth. “Sometimes, when we’re all together, things get moving pretty fast and I get a feeling that we get caught up in our combined enthusiasm and rush past important details. My goal is to have us focus on accomplishing a few relatively small tasks to establish trust and credibility in the community. Things are changing very rapidly in the overall healthcare field and I want more than anything for us to be viewed as credible. I can already see that there are an increasing number of questionable organizations trying to capitalize on the uncertainty of things and people’s general ignorance of how to proceed.”
“I share that same concern, Beth. My sense of things is that the particular conditions here in New Mexico provide too much opportunity for people to be taken advantage of. So many people are in desperate need of healthcare which makes them easy targets for deception.”
“I have an idea about how our next Team meeting can be structured to decide on a relatively few specific objectives. And, I don’t think we’ve fully capitalized on the unique resource we have available to us through the La Vida Aureo Staff. We talked to them initially, but it was a more general discussion. I believe they have individual stories and experiences that would be invaluable to the Team at this point.”
“That is an excellent idea, Beth. Is there anything I can do to help?”
“I don’t think so, Doc. The Staff has been more than willing to work with us and, of course, Señora Paloma is always available should we need her. She makes sure we arrange our timing so as to not interfere with anyone’s schedule. But I want to emphasize that I’ve found this particular format of your coffee coaching very helpful and suggest we meet on a regular basis. Of course, that should not prevent you from sitting in on Team meetings anytime you wish. The Team respects your viewpoints and you are always welcome.”
Dudley left the discussion with Beth Ford feeling more confident that he had been able to express his concerns without appearing to inhibit Beth or the Team in any way. He was able to focus on the numerous maintenance requests that had been piling up in recent weeks. He knew he had promised Isabella that he would talk to Paloma about Millicent Branch and Ynez Barela, but that could wait for a later time.
The next morning, the La Vida Aureo Community Assist Team met in one of the small meeting rooms near the main lobby. The women were in good spirits and Mikaylah Willis seemed to be the center of attention. This pleased Beth and assured her that her intuition had been correct; Mikaylah would be a valuable addition to the Team. Once everyone settled into a seat around the table, Beth opened the meeting. “Let’s spend today developing a consensus about the major issues affecting what I will call our potential Market Opportunities. As we’ve said before, our primary objective is to help people stay independent for as long as possible. To achieve that goal, I believe we should ask ourselves this question: What do people need to remain independent and preferably in their own home?”
There was active discussion of this question for over an hour with each Team member contributing and building on each other’s comments. Everyone was making notes and Beth was trying to capture major themes on the whiteboard. When the discussion seemed to pause, Beth said, “Let me try to summarize what we’ve been saying.” She moved to a clean whiteboard on another wall and wrote:
- Safety in the home.
- Regular, nutritious, healthy meals
- Routine medical attention, including any necessary medications
- Check-ups focused on prevention
- Socialization, companionship
Beth stepped away from the board. “Is this what we’ve been saying? Are these the keys to personal independence?”
The Team seemed to briefly hesitate that it could be this straight-forward. Then Mikaylah spoke, “Mikey likes it!” Everyone laughed and joined in with similar expressions of approval.
“OK”, said Beth. “Can we identify existing organizations that could provide these elements and that we can assure ourselves are reputable and share our goal of achieving and maintaining personal independence? If we can leverage existing resources, then it becomes a matter of information and education.”
“That should not be difficult”, offered Mila. “I’ve had experience with Meals on Wheels, for example, and that could certainly address the nutrition issue for anyone who has no other source. I know that they have several financial options as well which would be a benefit.”
“Good, Mila. That is exactly the type of organization I’m thinking of. There is no need for us to reinvent the wheel, so to speak. Our role is to make people aware of that type of resource. Now, the second question we should address is: Are there factors in the community that are trying to prevent this?”
Arnetta looked puzzled as she raised her hand. “Are you saying, Beth, that there are people and organizations that don’t want people to remain independent?”
“I know it may sound ridiculous, or like some imagined conspiracy, but that is exactly what I’m asking. If our focus is to help people remain independent through readily available resources, we also need to identify anyone with the opposite goal. As a very simple example, someone selling wheelchairs would not want us to help a person remain ambulatory with a daily exercise routine. I’m just suggesting that we be aware of unscrupulous people who see these same conditions as a huge opportunity.
“If I can expand on that, said Mikaylah, there is one potentially shady operation we need to watch carefully. It seems like every time I drive across town to get here, I see another billboard advertising some sort of in-home health service. It could be because the most recent one I saw was next to some ambulance-chasing attorney’s flashing billboard, I don’t know. Maybe I’m not trusting enough, but I can’t believe all of these offer the level of care and quality that we’re advocating.”
“I’d like to offer another note of caution, added Minot. So much health-related information is being put on the Internet, including the application forms and other sign-up-related paperwork. Because many poorer folks don’t have internet access, they need some way to complete the sign-up process. In driving around town, I’m noticing lots of little store-front operations popping up that offer that assistance. Maybe I’m just a bit suspicious, but I can’t believe that all of these are legitimate. I don’t have any suggestions right now, but I think we need to keep our eyes on this going forward.”
“Again, said Beth, I don’t want to appear paranoid. We just need to stay alert as we go throughout the community and recognize that some activities may not be in the best interest of the people we’re trying to support. I think we’ve covered a lot of ground today and I really appreciate everyone’s enthusiasm and input. I think we have identified some short-term actions and I’m eager for our next meet to talk about what we’ve collectively learned.”
Mila turned to Arnetta and said, “Why don’t you and I spend the next few afternoons talking to the Staff when their shift is over and they’re waiting for their rides? We can ask them about their experiences with their families and neighbors. I’ll bet some of them have already taken steps to help their parents remain at home. They probably can expand our understanding of the specific types of services and organizations that are available.”
“That sounds great, Mila. I’ll stop and talk to Señora Angostura to make sure we’re not interfering and select a time that is most convenient.”
“I still have many friends at Pfizer, said Mikaylah and I’ll see what’s happening with medications these days. With all the generic drugs that have become available, I’m sure the situation is constantly changing. And, I want to inquire about the role of these so-called Pharmacy Benefits Managers. It seems like they are playing an ever-increasing role as middle-men between drug companies, physicians and patients.”
Minot remained quiet and at her seat until everyone had left. “Is there something troubling you?” asked Beth.
“I didn’t want to say too much in front of the Team, but with all of this personal information being made available, your fears of potential trouble may be the most important aspect of things. I’d like to do some research and see if there’s a way we can gather background information about any organization we recommend or support. I’d hate for us to get blind-sided if an organization shows up on the front page of the Albuquerque Journal with its Owner in handcuffs!”
“I agree, Minot. I want to keep the Team focused on all of the positive things we can do, but I share your concern. I plan to discuss this issue in depth during my next meeting with Mr. Dudley.”