Wednesday, March 05, 2008

taking care of the elderly

props to my mother for calling parenthood a benevolent dictatorship as I was growing up. Only now do I appreciate that she was right.


Benevolent dictators guard county elderly
By Sam Bhagwat
of The Valley Mirror

It may be the smallest department in the county, but department isn’t really the right word for the public guardian’s office, anyway.

More like fief. Dominion. Or perhaps protectorate.

Though its two rulers are headquartered in a two-room office tucked behind the sprawling Human Resources building, the citizens of this protectorate are scattered from Eureka to Riverside.

The population of 47 isn’t too suitable for empire building. They're elderly Glenn County residents with family unable or unwilling to care for them, and they end their days under the legal guardianship and care of Jeannie Rakestraw and Becky Wunsch. The majority have dementia or Alzheimers.

Call it a benevolent dictatorship.

Usually, that’s parenthood. But “we’re the county mothers,” as Ms. Rakestraw jokingly puts it when Ms. Wunsch makes me tie my shoes before I leave.

The job comes with a dose of affection.

Those with dementia “don’t get worse, they don’t get better,” says Ms. Rakestraw. “It’s a horrible, horrible disease.”

“You can’t help but get close to some of them.”

Ms. Rakestraw and Ms. Wunsch pay bills, manage assets, and monitor care of those under their guardianship. They consult with families when possible, about half the time. Outright starvation is never an issue; MediCal will cover nursing home care costs for those with assets under $2,000. But nine out of 10 people under their care will be cremated, because there is no money for a funeral.

New citizens usually come through referrals by other public agencies, like the police, rather than families.

Sometimes, neighbors will call 911 with concerns about the person. Or, Ms. Wunsch says, when they’re manic they “always think someone’s knocking on the back door.”

“Law enforcement will realize what’s going on.”

But not having a lot of family referrals is okay by them; they realize they’re more of a last-resort safety net.

“We don’t know their (specific) needs,” says Ms. Rakestraw. “We don’t know what their wishes and desires are. Family and friends are better positioned than us.”

“People don’t know about us until they need us. And that’s the way it should be.”

“(People) ask, ‘what’s a public guardian? What do you do, guard the public?’” Ms. Wunsch laughs.

Glenn County’s small population presents some challenges; openings in-county are rare and care mostly generalized, so conservatees end up elsewhere.

“Even though SunBridge is a fine facility,” says Ms. Rakestraw, “It’s not for meant Alzheimer patients. You have to have a secure, locked facility with a perimeter fence to provide psychotropic drugs.”

Larger jurisdictions, such as Los Angeles County, often have specialists dealing only with issues like real property or mental health, said Gene Kent, executive secretary of the state public guardian association.

"In smaller counties, the same person will wear all those hats," said Mr. Kent. "(You've) got to be a jack of all trades."

And more people per worker: Los Angeles County has twice as large a caseload. It also has 60 public guardians.

The far smaller two-woman office here can make for some interesting dynamics – especially because the duo has been working together for 11 years.

“Sometimes when I’m having a PMS day, Jeannie just shines the light on me,” says Ms. Wunsch.

“Don’t print that,” she adds quickly.

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