51茶馆

鈥淪uzanne is really here to listen,鈥� Thomas Keady told a group of about 30鈥攊ncluding second-year MSW students in the Older Adults and Families concentration from the Boston College School of Social Work (51茶馆SSW) as well as faculty and alumni in the field鈥攇athered in a conference room in McGuinn Hall. Keady is Boston College鈥檚 vice president of governmental and community affairs. Christina Matz, 51茶馆SSW associate professor and chair, Older Adults and Families, moderated the discussion.

The Commonwealth鈥檚 longest-serving female constitutional officer, Bump conducts regular performance audits of state agencies (e.g., the Executive Office of Elder Affairs) to determine whether they鈥檙e running efficiently and effectively. 鈥淲e focus on, 鈥楬ow are you spending the money? Are you following the rules?鈥欌�� Bump explained. 鈥淏ut also: 鈥楢re you fulfilling your mission? Where are the bottlenecks? Are the people being well served?鈥欌��

Bump contacted Keady to request the meeting at 51茶馆SSW, one of a series of informal fact-finding conversations she鈥檚 been holding with students and practitioners of social work focused on elders. Her goal is to learn where the glitches are in state-run elder services鈥攑roblem areas where she might next train her gaze as auditor. That afternoon, Bump heard from those working on the ground, struggling to help people dealing with social isolation, dementia, and mental illness. The social workers told the state officials about the challenges they face as they help older adults navigate state services鈥攁nd the gaps between them.

Danielle Lubin, MSW 鈥�19, who works in the geriatric psychiatric unit at McLean Hospital in Belmont, finds herself thwarted when trying to arrange a lift home for an outgoing patient through the MBTA鈥檚 The RIDE program, a resource for people who have a disability that prevents them from using other forms of public transportation.聽 Her patients are often released with psychotropic medications, Lubin said, and many are unable to drive. Yet 鈥淭he Ride does not recognize mental illness as a reason to grant a 30-day medical necessity order for its services, as they do for patients discharged from a medical hospital.鈥�

鈥淰ery interesting,鈥� said Bump, as she and her colleague Bill Keefe, director of audit planning and review, took notes. 鈥淚 can see that making its way into an audit quite readily.鈥�

Kenna Sullivan, an assistant director of field education at 51茶馆SSW, also works at McLean Hospital as well as Winchester Hospital. She outlined an all-too-common scenario. First, someone sees an older, self-neglecting neighbor wandering about, looking disheveled, and calls 911.

鈥淎 lot of times these folks are socially isolated,鈥� said Sullivan. 鈥淭hey may have family members that are either not engaged or they鈥檙e estranged from them for whatever reason. There may be memory issues. Some of these folks are help-rejecting.鈥� Sullivan says the patient is brought to the emergency room聽for assessment. Following the medical examination, the emergency room doctor finds no acute medical problem, and tells Sullivan, 鈥淭hey have no medical issues.聽They do not require a medical admission and therefore they are your problem鈥� as the emergency room social worker.

聽鈥淪o then, we鈥檙e kind of stuck,鈥� related Sullivan. 鈥淭he dollars-and-cents people in the hospital are saying, 鈥榯here鈥檚 no medical justification to admit them and therefore there will be no reimbursement鈥� however, I don鈥檛 feel safe sending them home given their mental status and their inability to care for themselves.鈥澛� 聽聽

Kelsey Anderson, MSW 鈥�19, finds instances of self-neglect in her work on a local Alzheimer鈥檚 Association help line. In one case, she said, a man with a dementia diagnosis called and revealed to Anderson that he hadn鈥檛 been eating. 鈥淗e didn鈥檛 have food in the home,鈥� she said.

When Anderson asked a superior what to do, she was told, 鈥溾�榃ell, you could report it to [Adult Protective Services], but they鈥檙e going to say, 鈥業f you haven鈥檛 had eyes on him, you don鈥檛 know that he鈥檚 not eating, so we鈥檙e probably not going to substantiate this.鈥欌��

Connecting socially isolated and mentally ill individuals to the services they need is a constant challenge made harder by systemic flaws of that sort, Anderson continued. 鈥淏asically, we have to wait until he gets worse and he can鈥檛 live alone, or something happens that鈥檚 so severe that he ends up hospitalized. It鈥檚 a major gap and it creates silos that get in the way of being able to help these adults to live successfully in the community.鈥�

After listening to these and other tales of bureaucratic snags and snarls, Bump said that not only might the issues raised that afternoon become areas of inquiry for future audits, but also that her office serves as a resource for the state legislature, potentially putting data on such failings in elder services directly into lawmakers鈥� hands.

鈥淭hank you for the service you鈥檙e providing to all of your clients, and to our society,鈥� Bump added.

Before concluding the meeting, Matz noted gains on issues facing older adults in recent years, including Massachusetts Governor Charlie Baker鈥檚 first-ever mention of aging in a State of the Commonwealth address in 2017. 鈥淭here鈥檚 a lot that鈥檚 really great that鈥檚 going on in Massachusetts right now around aging,鈥� said Matz. 鈥淎nd then there鈥檚 a lot that we could do better.鈥�