2 DISSUSSION RESPONSES

The Parker Family

ara is a 72-year-old widowed Caucasian female who lives in a two-bedroom apartment with her 48-year-old daughter, Stephanie, and six

cats. Sara and her daughter have lived together for the past 10 ye ars, since Stephanie returned home after a failed relationship and was unable

to live independently. Stephanie has a diagnosis of bipolar disorder, an d her overall physical health is good. Stephanie has no history of

treatment for alcohol or substance abuse; during her teens she drank a nd smoked marijuana but no longer uses these substances. When she was

16 years old, Stephanie was hospitalized after her first bipola r episode. She had attempted suicide by swallowing a handful of Tyl enol® and

drinking half a bottle of vodka after her first boyfriend broke up with her. She has been hospitalized three times in the past 4 years when she

stopped taking her medications and experienced suicidal ideation. Stephanie’s current medications are Lithium, Paxil®, Abilify®, and

Klonopin®. Stephanie recently had a brief hospitalization as a result of de pressive symptoms. She attends a mental health drop-in center twi ce a week

to socialize with friends and receives outpatient psychiatric t reatment at a local mental health clinic for medication management and weekly

therapy. She is maintaining a part-time job at a local superma rket where she bags groceries and is currently being trained to become a cashier.

Stephanie currently has active Medicare and receives Social Sec urity Disability (SSD).

Sara has recently been hospitalized for depression and has some physical issues. She has documented high blood pressure and

hyperthyroidism, she is slightly underweight, and she is displaying signs of dementia. Sara has no history of alcohol or substance abuse. Her

current medications are Lexapro® and Zyprexa®. Sara has Medicare and receives Social Security benefits and a small pension. She attends a

day treatment program for seniors that is affiliated with a local hospital in her neighborhood. Sara attends the program 3 days a w eek from

9:00 a.m. to 2:00 p.m., and van service is provided free of charge. A telephone call was made to Adult Protective Services (APS) by the senior day treatment social worker when Sara presented with

increased confusion, poor attention to daily living skills, and s tatements made about Stephanie’s behavior. Sara told the social w orker at the

senior day treatment program that, “My daughter is very argumentati ve and is throwing all of my things out.” She reported, “We are fighting

like cats and dogs; I’m afraid of her and of losing all my stuff.” During the home visit, the APS worker observed that the living room wa s very cluttered, but that the kitchen was fairly clean, with food in

the refrigerator and cabinets. Despite the clutter, all of t he doorways, including the front door, had clear egress. The family lives on the first

floor of the apartment building and could exit the building without diffic ulty in case of emergency. The litter boxes were also fairly clean, and

there was no sign of vermin in the home. Upon questioning by the APS worker, Sara denied that she was afra id of her daughter or that her daughter had been physically abusive. In

fact, the worker observed that Stephanie had a noticeable bruise on her forearm, which appeared defensive in nature. When asked about the

bruise, Stephanie reported that she had gotten it when her mother t ried to grab some items out of her arms that she was about to throw out.

Stephanie admitted to throwing things out to clean up the apartment , telling the APS worker, “I’m tired of my mother’s hoarding.” Sara agreed

with the description of the incident. Both Sara and Stephanie adm itted to an increase in arguing, but denied physical violence. Sara stated, “I

didn’t mean to hurt Stephanie. I was just trying to get my things back. ”

The APS worker observed that Sara’s appearance was unkempt and di sheveled, but her overall hygiene was adequate (i.e., clean hair and

clothes). Stephanie was neatly groomed with good hygiene. The APS worker determined that no one was in immediate danger to warrant

removal from the home but that the family was in need of a ref erral for Intensive Case Management (ICM) services. It was clear there was

some conflict in the home that had led to physical confrontations. Further, the house had hygiene issues, including trash and items stacked in

the living room and Sara’s room, which needed to be addressed. The APS worker indicated in her report that if not adequately addressed, the

hoarding might continue to escalate and create an unsafe and unhygie nic environment, thus leading to a possible eviction or recommendation

for separation and relocation for both women. As the ICM worker, I visited the family to assess the sit uation and the needs of the clients. Stephanie said she was very angry with her

mother and sick of her compulsive shopping and hoarding. Stephanie complai ned that they did not have any visitors and she was ashamed to

invite friends to the home due to the condition of the apartment. When I asked Sara if she saw a problem with so many items littering the

apartment, Sara replied, “I need all of these things.” Stephanie complained that when she tried to clean up and throw things out, her mother

went

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