Posted by Pamela Decolo

For most people, guardianship brings to mind lost rights and restricted freedom. In the JF&CS Guardianship Program, we see it as a powerful means of protecting the most vulnerable of elders from harm and often, clearing the path to their profound transformation.

Eleanor* has lived most of her life with paranoid psychotic illness as well as a severe hoarding disorder. Her fearful rage and suspicion drove away family, friends, and neighbors. She lived alone in a house where the rare visitor stepped through paths lined with dense piles of debris reaching the ceiling. The floor too was buried beneath many layers of debris. A small area cleared on the corner of her bed served as a nest just big enough for her to curl up in to sleep. It all reached a breaking point when the house, literally falling down around her, began to pose a risk to both her and her community. Years of untreated psychiatric illness had taken their toll; she had lost the ability to provide for her most basic needs. Her doctors determined she lacked the capacity to make decisions due to her psychotic disorder.

Eleanor was in the hospital when Elder Protective Services petitioned for JF&CS to be appointed guardian. She demanded to go home, yet she also declared to the hospital social worker that she felt unsafe at home. At the same time she fought for her autonomy, there was a part of her that seemed to recognize she was being engulfed by her own hoarding. In a paradox familiar to social workers, her ambivalence held the seeds of transformation. Thus, we recognized the tension between Eleanor's strong drive to protect her hard won place in the world and her exhaustion from the struggle. The cost of her struggle was evident in her social isolation and confinement in a prison of her own making. We listened to the voice in her that told us she felt unsafe. Using the authority of legal guardianship in combination with social work expertise, we worked to support the healthy impulse that led her to ask for the option of staying in the skilled nursing facility.

There is no storybook ending with an epiphany or a group hug. On the surface, the outcome is mundane: Eleanor simply lives in a skilled nursing facility where she eats three hot meals each day, takes medications, has clean clothes, and a warm bed to stretch out in. But there is real transformation. There are quiet signs like winter's last thaw. For instance, no one anticipated that after decades of bitter rage and social isolation, Eleanor would find friendship with her roommate and develop an ability to trust. With our help she has begun to repair family relationships. Eleanor goes downstairs to visit the social worker daily. She attends musical performances and gets manicures. These are small signs that because of her newfound experience of being cared for, Eleanor is venturing out into a world where at long last she feels safe.

Turning assumptions on their heads, for Eleanor, home was her prison and the nursing facility has become her sanctuary.

*Name changed to protect privacy.

Pamela S. DeColo, LICSW is the Clinical Director of the JF&CS Guardianship Program. Pamela has practiced in geriatrics for more than twenty years since receiving her MSW from Boston University. The Guardianship Program serves as legal guardian for elders who have lost decision-making capacity. Guardianship staff work with individuals and their families to ensure the needs of the whole person are met – physical, emotional, and spiritual.