Knock and the Door Will Be Opened to You: Pauline’s Story
When “Pauline” opened her door to me, she was hostile, defensive and angry. She wasted no time letting me know she’d seen the likes of me before, and she hadn’t been impressed with any of us. “No-good caseworkers,” she said. “Useless.” She was pretty sure I wouldn’t be any different.
Although I’d served hundreds of clients as a program director and case manager at an agency that helped older adults of low income, this was the first time anyone had said anything like that so directly. I’d been accustomed to being greeted by individuals who were anxious to find out about the services and resources my agency offered. But that wasn’t Pauline. To say she was reluctant would be an understatement.
Pauline, who was in her late 70s, lived alone in a two-bedroom townhouse in a low-income apartment complex. I met Pauline because her landlord, a new apartment management company, had concerns about her health and safety. It seemed Pauline was no longer able to manage the stairs in her townhouse, and this meant she didn’t have access to the only bathroom in her home or either of the bedrooms. The landlord referred Pauline to my agency. They needed someone to intervene.
My boss gave me the referral for Pauline, telling me the landlord was prepared to move her to another apartment – a one-story unit where she could easily access the bathroom and her bedrooms. In addition to providing her with a different unit, they also were offering to move her belongings. But Pauline was adamantly refusing to move. The situation had become so heated that the landlord was threatening Pauline with eviction. They couldn’t have her in a two-story unit long term if she couldn’t use the bathroom.
For her part, Pauline had gained the support of a local advocacy group that was acting in opposition to broader changes the landlord was making at the apartment complex. The advocacy group was working to ensure the residents’ rights, and they were actively fighting the landlord on Pauline’s behalf. My boss warned me that I might get heat from this advocacy group if they believed I was on the landlord’s side. They were a particularly vocal group, and our small agency couldn’t afford bad press.
While I understood objectively what the advocacy group was trying to do on the larger scale, it was evident they were doing a disservice to Pauline at the individual level. In no way could it be in Pauline’s interest to be evicted or to remain in a townhouse where she couldn’t use the bathroom.
Seek First to Understand
I couldn’t advocate for Pauline’s interests until I understood what they were. I had to know: How did Pauline perceive the situation? What would prompt her desire to stay in a townhouse that wasn’t accessible to her? What did she think about living in a one-story unit? What would she prefer to happen?
The apartment management made the referral, so I called them first. The manager told me they were concerned about Pauline. It had been quite some time since she was able to handle the stairs in her townhouse. The manager told me Pauline had a portable commode chair in her living room. She also told me that Pauline’s neighbor had been emptying it, but the neighbor had grown weary of the task. The commode wasn’t being emptied or cleaned regularly. The management perceived this to be a health and safety issue not only for Pauline but for others in the building. They were unhappy that Pauline was refusing to consider the one-story unit they’d offered. They didn’t want to evict her, but the situation could not continue indefinitely.
When I called Pauline, she agreed to meet with me at her home.
I entered Pauline’s home through the door into her kitchen. She wasn’t happy to see me. She clearly was skeptical, looking at me disdainfully and expressing her distaste for “useless caseworkers.” I glanced around her kitchen, noting that she had a pot of water boiling on the stove. I also noticed the amount of mail and other papers that were piled on her dining table. She quickly showed me her living room, which she’d modified as a bedroom. The curtains were drawn, and the room was dark. A television was at the foot of her bed, and the odor from the portable commode near the stairs was unmistakable. Pauline invited me to go upstairs on my own and take a look. She said it had been a long time since she’d been up there, but the neighbor had been using the bathroom to clean out the commode. The bathroom was at the top of the stairs with the bedrooms on either side.
When I returned downstairs, I praised Pauline for adapting her living room as she had. I told her I understood how it must have been hard for her to use those stairs. It would be more comfortable for her to live on one level. Her open hostility was still showing, but she invited me to sit at her kitchen table anyway.
I didn’t take my agency’s intake form out of my bag. We’d have time later to deal with paperwork. Instead, we sat in the kitchen and talked. The pot of water was still boiling away on the stove, so I asked Pauline if she was getting ready to cook. She replied that she always had a pot of water on the stove. The steam helped with her dry skin, she said. She admitted that she sometimes forgot to watch the water and it would boil out, leaving the empty pot hot on the burner.
I asked Pauline about her family. She didn’t have any. We talked about what she used to do for a living. Like so many of my clients, she’d retired from a low-paying service job when the work became too much for her. She’d always lived in poverty. She mentioned that she talked to her next-door neighbor sometimes, but she didn’t have friends. She rarely left her home except to attend church on Sundays.
In the minutes that followed, Pauline told me that she took sponge baths in the kitchen sink. She didn’t like using the commode chair, but she didn’t think it was all that bad as long as someone would empty it for her. She said her neighbor wasn’t coming by as much anymore to help with the commode. She hadn’t been to the doctor in years, and she didn’t receive any services. I listened to her intently. She told me about all the caseworkers who had visited her before and how they hadn’t done anything for her. She’d been let down too many times by the empty promises of well-meaning folks who didn’t follow through.
I asked Pauline about the other caseworkers. What had they promised her? She picked up a piece of paper from the pile on the table, pointed at it, and said a caseworker left it there. She told me to read it. I looked at the paper in her hand. It was an ad she’d received in the mail.
That’s when I realized Pauline couldn’t read. I didn’t let on that I knew. I nodded my head and asked her more about what the paper said. More accurately, I was asking what she remembered hearing from the caseworker. Pauline said caseworkers promise everything and never do anything.
As we continued to talk, I realized that she wasn’t opposed to having services; she simply wasn’t aware she was eligible for them. I glanced around the table and spotted some paperwork from a state agency. I asked Pauline about it. She said she’d received it in the mail. She wasn’t able to tell me what the paperwork said. She just knew it was from a caseworker, and they weren’t going to do anything for her. To the contrary, the paperwork explained the services Pauline might be eligible to receive and what she needed to do to start the process. The date on the cover letter was from several months earlier.
I pulled a release form out of my bag and explained to Pauline what it was. She agreed to sign it, allowing me to contact other agencies and her minister. I asked Pauline if she’d mind if I took the state paperwork with me, and she agreed to that, too. Knowing the landlord was pushing for a resolution, I asked Pauline for a follow-up meeting a couple of days later. Her skepticism returned, and I assured her that she’d see me again.
When Pride and System Failures Get in the Way
When I got back to my office, I met with my boss to fill her in. I confirmed the commode chair’s presence and told my boss that it had not been emptied for some time. I explained that literacy appeared to be a barrier for Pauline. She was eligible for state services, but she wasn’t able to read the paperwork to complete the applications. Rather than tell anyone she couldn’t read, Pauline remained immobilized. She had taken the position that there wasn’t anything worth reading in the paperwork she’d received. While her previous caseworkers might not have known about the literacy barrier, they also didn’t take steps to follow up with her. She had fallen through the cracks.
I told my boss about Pauline’s open hostility. She believed other caseworkers had let her down, and she was skeptical about my intentions as a result. Trust was a big issue for Pauline, and it might take a few visits to establish that. I’d have to prove to her that I was trustworthy.
The next day, I called the state caseworker whose name was on Pauline’s paperwork. The caseworker had moved on, and Pauline’s case had been reassigned to an intern. As my call was transferred to the intern, I wondered whether she was up to the challenge Pauline would likely present.
The first thing the intern told me was that they’d closed the file because Pauline was argumentative and unresponsive. This was not a surprise. I asked if anyone followed up with Pauline about the application. No, they had not. With my advocate hat firmly in place, I told the caseworker that sometimes clients may not understand the content of written forms or what is expected of them. I asked her if she would be willing to meet with Pauline and me to talk about services and assist Pauline in completing the forms. I told the intern about Pauline’s living situation, the imminent eviction and her need for services. The intern agreed to meet with us. I told the intern I’d clear the meeting with Pauline and schedule it.
Two days after our initial meeting, I returned to Pauline’s home. When I arrived, the neighbor came outside and greeted me, saying she was relieved someone was helping Pauline. She had become overwhelmed serving as Pauline’s caregiver. As Pauline and I went into her home, I told her I had news.
Pauline’s initial reaction about the meeting with the state caseworker was what I expected. She responded with the same skepticism I’d encountered in our first meeting. I reassured Pauline about her eligibility for services. Despite her reluctance, she agreed to the meeting. For the first time, we talked about the possible eviction and Pauline’s resistance about moving to the one-story unit. Pauline didn’t think she should have to move. She was making due with the sponge baths and the portable commode. She liked her home, and she didn’t want to leave it. She certainly didn’t want anyone forcing her to leave.
I asked Pauline to imagine what it might be like to live in the one-story apartment. We talked about the pros and cons. She’d have a bedroom and a bathroom she could use on her own. Her bed wouldn’t be in the living room anymore. She wouldn’t have to rely on anyone to empty the commode. She could take a real bath or shower. The cons? Moving isn’t a pleasant task, and Pauline felt overwhelmed by the prospect of it. We talked about the landlord’s offer to move her at no cost. Pauline was contemplating the possibilities.
Before I left, I asked Pauline if she’d like her minister to participate in our meeting with the caseworker. Maybe he could support her as she made these decisions. Her eyes widened, and she said yes. I told her I’d be back in touch as soon as I had the meeting scheduled. She asked me if I’d visit her again before the meeting. No reluctance; no resistance. She wanted me to visit her. I told her I’d come by and let her know when the meeting was scheduled so we could talk more about it.
Intervention and Intercession
I returned to the office and called Pauline’s landlord, telling the manager that we seemed to be making progress. I tracked down Pauline’s minister and left a message for him. I called the caseworker intern, and we set a date the following week for the meeting with Pauline.
The minister returned my call the next morning. When I explained Pauline’s request and her predicament, he was surprised. He had no idea Pauline was having such difficulties. He told me that church members picked her up in the van for church services, but no one had been inside her home. He and other members of the church had offered to visit her and help her, but she had declined. He agreed to participate in the meeting with Pauline and the caseworker.
The next day, I went back to Pauline’s home and told her the meeting was set. She was cautious but agreeable, and I reassured her that both her minister and I would be there to support her. We were all behind her.
A few days later, I met the caseworker in front of Pauline’s townhouse. We talked for a few minutes in the parking lot before knocking on Pauline’s door. When Pauline answered the door, I could feel that same reluctance in her attitude. She wasn’t going to take anything lying down. The minister arrived shortly after that, and we sat down in Pauline’s living room.
By the end of the meeting, Pauline had agreed to sign up for services through the state, and she was seriously considering the move to the one-story unit. She wanted to talk privately with her minister about it. The next day, the minister called me to say that Pauline hadn’t made up her mind yet about moving, but she was leaning in that direction. He was due to speak with her again.
I spoke with the caseworker, who assured me that Pauline’s application was being processed and services would be available to her soon. Pauline and I talked by phone, and she seemed upbeat. She confirmed that she thought moving to the one-story unit might be a good idea. Things seemed to be falling into place.
And that’s when the unthinkable happened.
Pauline died the following day. The minister called to tell me she was gone.
I’ve thought of Pauline often in the days and years that have followed. What would have happened if I’d jumped in right away and told her I was there because of the eviction threat? What if I’d let her hostility and skepticism get to me? If I hadn’t taken the time to get to know her, if I hadn’t realized she had a literacy barrier, would she have opened herself up to me? Would she have trusted me? Would I have been able to connect her with the state caseworker? Would I have known to involve her minister? Would she have considered the benefits of moving and accepted that likelihood?
I visited with Pauline four times, talked with her several times on the phone, connected her with state services and engaged her minister in a little over a week. We were making progress on a move to the one-story apartment to head off the eviction. Her situation was one of the most intensive and urgent cases I’ve ever managed. I’d like to think that if Pauline had lived, she would have spent her last days in an apartment where she could handle her needs on her own. For her, that would have been a source of pride. Instead, she died in the home she loved and fought not to leave. I think she would have as much pride in that outcome.