FEATURE STORY (continued) — November/December 2004

Seeing ...

The Challenges Facing Case Managers

Case managers handle 12 to 15 cases per week. This year, the unit has 4,150 active cases, although "that figure," Bennett adds, is "down slightly from a few years ago because of demographic changes on the West Side. Many seniors can't afford to live here anymore."

Even if parts of the West Side have gentrified, many clients remain in some of the city's poorest housing. Case managers have learned to judge the severity of a case by the zip code alone. (The initial referral comes in from the Chicago Department on Aging, goes to the appropriate management unit in the city, which then assigns it to the case manager working in that zip code beat.)

While many cases are manageable, some can pose a challenge. At the extreme end, the conditions in clients' apartments may be so unsanitary that case managers must conduct the assessment outside. Case managers will double up if visiting areas that are considered unsafe. For example, gangs in public housing projects can make access difficult. During one home visit to a Chicago Housing Authority unit, two case managers kept losing their footing on a greased stairwell, the only means of getting to the apartment—and evidence of gang activity.

Holidays can be busy for the staff. During these times, families often visit elderly relatives and decide to take action. Sometimes it's too late. Case managers have encountered clients suffering from elder abuse or neglect.

Adrian Rivera, a 10-year veteran on staff, once found a man lying naked on the floor, with electrode patches from the hospital still attached to his chest. He was dehydrated, with no family to help. Rivera gave him some water and immediately called an ambulance. A month later, the man died.

Fortunately, cases such as these are the exceptions; most elderly people find support in time to improve the quality of their lives.

Clients and the Lives They Lived

"Case managers need to have compassion for older adults, compassion for human needs, and they need to be good listeners," says Bennett. "We can't train someone to be empathic."

"Clients tell you wonderful stories about how life has changed," says Marybel Flores, a supervisor. She marvels at one man, "100 pounds at the most," who lived to be 100. In his apartment hung pictures of all his wives. "He would tell people, 'I outlived all of them.' And everyday, rain or shine, he would get up, put on a suit and tie, and take a walk."

"There's never a dull moment," adds Candace Bruder, the "in-house" case manager, who holds down the fort at the office. "If things aren't that busy, I'll stay on the phone and listen to them. I'm glad I got into this kind of work."

Case managers also have their share of strange encounters during home visits. One woman noticed that case manager Royal Wallace didn't have a Chicago accent, so she asked him where he was from. When Wallace told her New Orleans, she became convinced he was going to practice voodoo on her.

" I said, 'Mame, I don't know voodoo,' and then I put my hands together and said 'Oh, my god.' She started screaming, 'No! There's voodoo in my house!' and she got up and got the Bible. 'You can't have this voodoo in my house!' she was screaming. Now she calls up when she needs something and I laugh, saying, 'Are you sure you want me in your home?'"

Wallace also remembers responding to a first-time call in Chicago's Gold Coast neighborhood where he walked into a luxurious apartment with indoor waterfalls. All Wallace could do was recommend a private homemaker service to the person.

"You've got to demonstrate a need," explains case manager Chris Garnaat, standing outside a client's home in Ukrainian Village one afternoon. Garnaat, 30, is a graduate of Western Michigan University, where he studied sociology and criminal justice. He's been with the unit five years and says he's never caught up on his paperwork.

Garnaat terminated a case when he spotted his housebound client up on the roof, hauling a 60-pound load of shingles on his back. He asked the man, "What are you doing up there? Did you get the meals?" To which the man replied, "Yeah, they're good. I'm doing the shingles."

The Job's Best and Worst Parts

When asked what is the hardest part of their jobs, case managers say it's telling clients that they're not eligible.

"It's difficult sometimes when family members want [someone there] eight hours, seven days a week. It's not that kind of program," explains Jay Miller, another case manager. "We have to educate them and...help them to see their role."

Every case manager can recall a special client. For one, it was a famous jazz musician. For another, it was an academy-award winner ("I thought he was joking!"). Still others find dealing with clients inspirational.

"I look forward to what gifts I'm going to receive today," says Gwen Miller, MSW '04, a "Choices for Care" case manager who works in a hospital setting, "because when you go into these rooms, you never know who you are going to meet."

Most agree, however, that the best part is "seeing their faces when you tell them that they're going to get help," says Wallace.

"They're very appreciative that you went out of your way to help them," adds Rivera.
"In our assessments, we look at the strengths of a client," explains Bennett. "You could look at an older adult as a person with a bundle of problems, but we train our people to see them as a bundle of strengths."

Touching People's Lives

Today, Garnaat is doing a follow-up visit in Little Italy. Youthful and polite, he's had clients try to set him up with their granddaughters. Standing out front with his clipboard, he rings the doorbell a second time. It's 11 a.m. and the client is still in bed.

A large man wearing a gray overcoat and underwear eventually opens the door and welcomes Garnaat inside. The man moves slowly. One of his feet is Velcroed into a soft shoe on an elevated heel.

"I've been trying to get good enough to run the four-minute mile," he jokes.

Tony (not his real name), 71, rarely leaves the apartment these days, spending most of his time in bed, resting. His disabilities are numerous: he's legally blind, overweight and diabetic (resulting in four operations on his foot), and he suffers from asthma and congestive heart failure.

"Everything you get when you get old," he says.

The front room is in a state of orderly disorder: filing cabinets and boxes are everywhere. Tony is a journalist who writes neighborhood histories. With the help of two nuns who help him file and type, he continues to work.

Tony practiced law before becoming a journalist. "I was an honest lawyer. My job was disbarring shysters. They ended up rich and I ended up here," he says.

Four years ago, Tony returned to the neighborhood where he grew up. This is Garnaat's sixth visit with him. A nephew no longer visits him but a niece does. Also, one homemaker from the community care program comes by twice a week to help with cleaning and groceries. He receives home-delivered meals, which are frozen and can be prepared easily.

Tony talks about the various projects he's working on. One of his articles was nominated for a major journalism prize this year. His next one is about WWII heroes, many of whom "are dying of old age."

Tony shakes Garnaat's hand before the case manager leaves. "Sure is great to have someone to talk to."

"I'll be back," says Garnaat.

Editor's note: Since this article was accepted for publication, Jonessa Cannon has left Central West Case Management Unit. She lives in Kenosha, Wisc., with her husband, and hopes to continue her career in social work.

Photography: Andrew Campbell