Saturday, May 7, 2011

Turning down cases

At the program I work for, as providers, we always have the option to turn down a case if we feel we are not going to be able to safely service them in the community and we can document that decision with facts.

I work at a for-profit home care agency though, so the fact is, we rarely turn down any case, especially if they will require a heavy number of home care hours.

Anyways, a few months ago, I went out and met with a case to do their intake, and ended up having to call Adult Protective Services right away for a variety of issues going on.

Everything from the home not having heat on the coldest day of the year, to the "guardian" (who has yet to be confirmed as being an actual guardian because the guardianship took place out of state!) not following up on getting the client medical and psychiatric providers.

To make a long story short, the office that oversees the program I work for initially ended up turning down this case because they did not feel the client could be safely served in the community.

Note: past medical records show the "guardian" taking the client out of a nursing home setting as well as inpatient psych many times against medical advice.

This should come as no surprise, since challenging cases never go away, a few months went by and they are back again, in need of services, and I've been directed to do the intake so our agency can service them.

In just a couple of weeks of trying to get out there to start the intake, a ton more red-flags have begun to pop up.

The "guardian" only wants our agency to hire two of her "friends" (who are related by the way) and no one else to provide the home-care piece.

"Guardian" refused to sign intake paperwork without having our agency put in writing that we will pay these "friends" a certain salary (which is a lot higher then anyone else in this role is currently making).

Now, "guardian" is refusing to sign any medical consent forms allowing myself and our agency to have interactions with the client's PCP/specialists/psychiatrist. (Note: I would need these completed to confirm that client is actually in treatment like "guardian" says).

The "guardian" also wants it in writing that our agency will never make an unannounced or last-minute home visit (something that is done on occasion, especially to ensure the aides are doing what they are supposed to be doing!) AND the kicker: the "guardian" wants it put into writing that we will never call APS again on them.

As a social worker, I would like to try to service this family, (Note: I also really have no choice but to try to service them!) however, it does not sit well with me that services are not even in place yet and the "guardian" is trying already to bend or break all the rules.

I can already tell there's going to be a ton of trouble with this case and our field nurse is already saying she does not want any part of it because it puts her license on the line.

Because I work where I do though, I know it's inevitable we will get this case, red flags and all.

Have you ever had someone you HAD to work with, where the family especially was super difficult from the beginning? What did you do to make it work?


  1. Wow, this sounds like a really difficult situation. Obviously this client needs some help, other than the questionable care of their "guardian". Has your agency agreed to any of those demands? There are just so many ethical problems here...

  2. I passed this one onto the supervisor, who spoke to them today on the phone and basically told them these are "deal-breakers" and we wouldn't be able to service the case otherwise.

    Nothing was put "into writing" either.

    I am sure that once services start there will be more issues that come up. You can just TELL with certain cases.