Do social workers really listen or have they heard it all before ?

My soon-to-be-82 year-old mother has been a diabetic since she was 40. For 25 years she has been injecting herself with insulin. She would jokingly say  that her face was the only spot still untouched by a needle.  When she joined my siblings to live here in the US, the doctors mercifully told her that her diabetes could be controlled by pills and she would only need her insulin at certain high glucose level readings. She was a changed woman after that,  popping her pills religiously. On a monthly basis, she could have 2-3 insulin injections.  Since  she has been under a US doctor, raised glucose level has never been her problem.

However, despite the many years of blood-pricking  and insulin injections, and despite diligently taking her  sugar-control pills, 10 years ago, she was diagnosed as being "legally  blind".  Age and long-term diabetes has taken its toll on her physical health and well-being.  As added complication, she also suffers from high blood pressure and high cholesterol levels. One also cannot disregard the cumulative effects of all the medication she has been taking for so many years.  Sad to say, incontinence and bouts of diahrrea has made my mother homebound.  Going places has become a source of stress for her which has limited our efforts at giving her a bit of a social life. On a daily basis, she has to be watched as she tries to do things for herself.

Earlier on, our family decided that it was more important for us to see her happy in the lenght of time she may still have with us, as opposed to being strict with her diet and actvities in order to prolong her life.  Quality versus quantity, so to speak. Short of life-threatening scenarios, we allow her to function as normally as any person in our household. We make her feel that she's not a burden but still a contributing member of the family. 

The result of this strategy means that one of us, mostly me,  has to doggedly watch her as she goes about her daily activities.  I have found her, several times, cooking , with the gas reeeking all over the house and no fire. I have rescued dried up and blackened pots that she had forgotten still cooking on top of the stove. I have become her shadow as I unobtrusively follow her to stop the dripping faucets or flush the toilet, turn off the lights, close the refrigerator or freezer door, or quickly mop the floors where she would inadvertantly spill something.

These past months, she has complained of cramps and loss of  feeling in her arms and hands.  The doctor said that circulation problem is a part of her disease. A vein in her neck has lost 30 % capacity. The recent results of ultrasound and her blood and urine tests warn us that she may be having dialysis sooner than expected, another logical progression of her diabetes and growing old.

A program in California has determined that it is cheaper for the state to pay family members to take care of their own than have the state pay for an institution to care for them. Every year, a social worker comes to evaluate the status of my mother's health and the kind of supplemental help needed for her care. The social worker came and spent half an hour interviewing us.  When she left, I  handed her a summary of my mother's condition with the list of her current medication.

A few weeks later,  we received a letter informing us of the changed hour allotment and enclosed was a form to be filled up and signed by her primary doctor to allow for paramedic services.  The social worker has recommended that my mother should have glucose reading three times a day, and insulin injections too.

The big question is, how did the social worker come up with her recommendations, given all the other more worrisome aspects of my mom's disease? Of course controlling high blood sugar helps prevent kidney damage, but the way her diabetes has been managed, especially during the last ten years, my mother's condition has been well-contained.  Even her eye specialist states that her vision will never improve, the best we can hope for is to have status quo.

So many studies have come out to say that  "if you don't fix  the depression of a diabetic, you cannot cure her diabetes!" The quality versus quantity is our way of keeping our mother live a comfortably happy life.

Bottom line, social workers should dig deeper into the  family dynamics involved before coming up with their evaluation.

when you lift a finger. . . you move a star. . .

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