State Auditor Suzanne Bump
“Suzanne is really here to listen,” Thomas Keady told a group of about 30—including second-year MSW students in the Older Adults and Families concentration from the Boston College School of Social Work (BCSSW) as well as faculty and alumni in the field—gathered in a conference room in McGuinn Hall. Keady is Boston College’s vice president of governmental and community affairs. Christina Matz, BCSSW associate professor and chair, Older Adults and Families, moderated the discussion.
The Commonwealth’s longest-serving female constitutional officer, Bump conducts regular performance audits of state agencies (e.g., the Executive Office of Elder Affairs) to determine whether they’re running efficiently and effectively. “We focus on, ‘How are you spending the money? Are you following the rules?’” Bump explained. “But also: ‘Are you fulfilling your mission? Where are the bottlenecks? Are the people being well served?’”
Bump contacted Keady to request the meeting at BCSSW, one of a series of informal fact-finding conversations she’s been holding with students and practitioners of social work focused on elders. Her goal is to learn where the glitches are in state-run elder services—problem areas where she might next train her gaze as auditor. That afternoon, Bump heard from those working on the ground, struggling to help people dealing with social isolation, dementia, and mental illness. The social workers told the state officials about the challenges they face as they help older adults navigate state services—and the gaps between them.
Danielle Lubin, MSW ’19, who works in the geriatric psychiatric unit at McLean Hospital in Belmont, finds herself thwarted when trying to arrange a lift home for an outgoing patient through the MBTA’s The RIDE program, a resource for people who have a disability that prevents them from using other forms of public transportation. Her patients are often released with psychotropic medications, Lubin said, and many are unable to drive. Yet “The Ride does not recognize mental illness as a reason to grant a 30-day medical necessity order for its services, as they do for patients discharged from a medical hospital.”
“Very interesting,” said Bump, as she and her colleague Bill Keefe, director of audit planning and review, took notes. “I can see that making its way into an audit quite readily.”
Kenna Sullivan, an assistant director of field education at BCSSW, also works at McLean Hospital as well as Winchester Hospital. She outlined an all-too-common scenario. First, someone sees an older, self-neglecting neighbor wandering about, looking disheveled, and calls 911.
“A lot of times these folks are socially isolated,” said Sullivan. “They may have family members that are either not engaged or they’re estranged from them for whatever reason. There may be memory issues. Some of these folks are help-rejecting.” Sullivan says the patient is brought to the emergency room for assessment. Following the medical examination, the emergency room doctor finds no acute medical problem, and tells Sullivan, “They have no medical issues. They do not require a medical admission and therefore they are your problem” as the emergency room social worker.
“So then, we’re kind of stuck,” related Sullivan. “The dollars-and-cents people in the hospital are saying, ‘there’s no medical justification to admit them and therefore there will be no reimbursement’ however, I don’t feel safe sending them home given their mental status and their inability to care for themselves.”
Kelsey Anderson, MSW ’19, finds instances of self-neglect in her work on a local Alzheimer’s Association help line. In one case, she said, a man with a dementia diagnosis called and revealed to Anderson that he hadn’t been eating. “He didn’t have food in the home,” she said.
When Anderson asked a superior what to do, she was told, “‘Well, you could report it to [Adult Protective Services], but they’re going to say, ‘If you haven’t had eyes on him, you don’t know that he’s not eating, so we’re probably not going to substantiate this.’”
Connecting socially isolated and mentally ill individuals to the services they need is a constant challenge made harder by systemic flaws of that sort, Anderson continued. “Basically, we have to wait until he gets worse and he can’t live alone, or something happens that’s so severe that he ends up hospitalized. It’s a major gap and it creates silos that get in the way of being able to help these adults to live successfully in the community.”
After listening to these and other tales of bureaucratic snags and snarls, Bump said that not only might the issues raised that afternoon become areas of inquiry for future audits, but also that her office serves as a resource for the state legislature, potentially putting data on such failings in elder services directly into lawmakers’ hands.
“Thank you for the service you’re providing to all of your clients, and to our society,” Bump added.
Before concluding the meeting, Matz noted gains on issues facing older adults in recent years, including Massachusetts Governor Charlie Baker’s first-ever mention of aging in a State of the Commonwealth address in 2017. “There’s a lot that’s really great that’s going on in Massachusetts right now around aging,” said Matz. “And then there’s a lot that we could do better.”