Assignment #1

My fieldwork internship is with ABC agency located in Brooklyn, New York. ABC is a court appointed guardianship agency for people with dementia, Alzheimer’s disease, often coupled with other types of mental illness. When these people are found incompetent by a court of law, ABC may be appointed guardian over the incompetent person’s self and/or property.

ABC is often appointed guardian because the ward either has no family, the family and the ward do not have a positive relationship, with elder abuse sometimes occurring.

ABC provides services in the five boroughs, Westchester, Long Island and New Jersey. Most of the agency’s wards reside in nursing homes, hospitals, rehabilitation facilities and adult group homes. However, some of them remain in their own apartments or houses, where they are cared for by a home health aide.

ABC is divided into two departments: social services and finance. There is often tension between these two departments as each struggles with its own priorities. This tension contrasts with the need of the departments to work cooperatively to ensure the best treatment for the agency’s wards.

As a social work intern with ABC, I am the case manager for 26 wards of the agency. These wards range widely in age, physical and mental impairment and ability to communicate. My primary responsibility as a social work intern is to ensure that each of my wards is well cared for and placed in the least restrictive environment suitable for meeting the ward’s needs. I am legally responsible for visiting each of my wards at least four times a year to ensure they are receiving all necessary treatment and care, and that they are living in an appropriate environment. Although four is the requirement, I visit each of my wards far more often than this minimum.

In deciding which of my wards to use for my class project, my first difficulty is that many of my clients are so severely affected by dementia and Alzheimer’s as to be not oriented and unable to communicate and comprehend communications addressed to them.

I do currently work with a few wards who are possible project subjects. One of my wards, R.H., is a man in his 60s who is living with AIDS and suffers from AIDS related dementia. However, he is oriented x3, and his communicative abilities are unaffected by his disease. I visit R.H. quite often, and believe that he is a appropriate subject for my project. My goals with him are to encourage him to comply with his medication, and better adjust him to life in the facility so he will hopefully be happier and more integrated into the facility’s social life.

R.H. is noncompliant with his medication and isolates in his room, refusing to participate in any social or recreational activities. He is deeply unhappy at his current facility, and greatly wishes to change to another residence. However, no other facility is likely to accept him as long as he refuses his AIDS medications. I have attempted to use the possibility of changing facilities as an impetus to his complying with medication, but to no avail as of yet. R.H. finds the food at the facility extremely unappetizing, and I usually bring him candy, soda and McDonalds when I visit.

My second possible subject is another of my wards, S.L. S.L. suffers from dementia and schizophrenia. She has a history of chronic homelessness. ABC was appointed legal guardian over her after she was found lying in a subway station, covered with rat bites. S.L. eloped from her prior facility, and elopement remains a constant risk with her. S.L. is very unhappy in her current facility. She greatly wishes to get her own Section 8 apartment, and live in the projects in Brooklyn. However, this is not a realistic possibility due to S.L.’s history of homelessness and elopement, and her lack of funds to finance the home aide that she would require. Nor is she a likely candidate for a group home, also due to her elopement history.

S.L.’s lack of acceptance of life in the facility causes her to often act out verbally with staff and myself. My goals with S.L. are to help her realize that her living on her own is not a realistic possibility, help her adjust better to life in the facility and consequently lessen her behavioral issues.