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Summer 2008 | Vol 11 No 4

Focus

It’s never too late

Reaching out to give older adults hope

By Elizabeth Scott

It’s a brilliantly sunny April day in Toronto and I’m on my way to spend the day with Teresa Morski, a community service provider with Community Outreach Programs in Addictions (COPA) in Toronto, an agency that serves older adults with substance use and mental health issues.

Today Teresa and I are venturing into the community to see five clients, a typical day. “By seeing them at home we get a better picture of what’s really going on and how to help,” says Teresa. Almost all of her clients, like herself, are Polish immigrants, a cultural diversity that adds a further level of complexity to her clients’ situations. “For many immigrants, health and addiction are related to their adjustment to a new country,” she says, as we start the day.

Most of Teresa’s clients have been in Canada for many years. When they arrived, long hours, poor wages, working two or three jobs to support themselves and family back in Poland consumed all of their time and energy. Sadly, when finally able to sponsor family to come to Canada, for many, “it was too late; they didn’t want to come,” says Teresa.

Teresa herself fled Poland 22 years ago – a nursing degree in hand and husband by her side. During her seven years at COPA, her language skills and cultural heritage have proven valuable in reaching out to older adults in Toronto’s Polish community. Her roster of Polish and Ukrainian clients – most of whom do not speak English – has grown from four to 32, in addition to three Canadian-born clients.

In their loneliness and loss of meaningful reasons to make life alone in Canada work, many of Teresa’s clients started to drink, which lead to job loss, financial hardship, homelessness and an almost inexorable downward spiral of bad circumstances and hard luck.

Today, most of Teresa’s clients struggle with depression, isolation and alcohol and prescription drug misuse. “In addition to supporting them around these issues, we help with housing, finances, welfare, disability support” – the fundamentals that give clients some stability, says Teresa. Her connection with clients helps boost their self-esteem by providing an all-important ongoing relationship.

Teresa’s first client, Joanne, one of her Canadian-born clients, lives in supportive housing in Toronto’s west end. On our way, Teresa explains that Joanne is a heavy smoker and that she has been trying to get her out of her small apartment – which she hasn’t left in months – to attend a nearby day program. The winter weather has made it difficult. Teresa is concerned because Joanne’s breathing is getting worse, although she is pleased that Joanne has stopped drinking.

Inside the sparse but tidy apartment, Joanne sits on her sofa under a blanket, crossword in hand, TV on. She is extremely thin and weak, having recently experienced a fall. Teresa wants to ensure that Joanne’s progress continues, so after some friendly repartee, she observes, “Your appetite isn’t good right now.” “No, it’s OK. I’m eating,” Joanne replies, slightly defensive.

The two women talk a little about nutrition; then Teresa moves to her next concern: “We talked about Sistering [the day program]. Now we have nice weather and we can go out. Remember I promised you that?” But Joanne is concerned: “How am I going to get off the chesterfield?” she asks. “It hurts to move.”

As with all of Teresa’s clients, dealing with Joanne’s immediate physical concerns is top priority. “It’s easier to work on the addiction when we know everything medically is OK,” says Teresa. For Joanne, this means arranging a myriad of appointments – from Wheel Trans, a public transportation service for people with disabilities, to a dietitian, a dentist and Joanne’s family doctor.

“I’m glad you don’t drink anymore,” Teresa continues, shifting topics. “We will give you more information about relapse prevention, we’ll work on that. Do you have cravings for alcohol?” “No,” Joanne replies. Teresa also wants Joanne to cut down on smoking. “She’s trying to make a saint out of me already!” laughs Joanne.

It’s almost 11 a.m. and after our goodbyes, we head off to visit Mieczyslav, who lives on another floor in the same building. An occupational therapist is assessing him for home safety but Mieczyslav doesn’t speak English, so Teresa is going to translate.

Depending on need, Teresa sees most clients once or twice a week. I’m beginning to grasp that Teresa’s energy is spent on being tuned into each client’s physical and emotional reality and the pace at which change for the better may be possible. In addition to being their counsellor, Teresa becomes their advocate and friend. “They don’t know where to find resources, where to go. They’re afraid to ask the wrong questions,” she says.

On the elevator to Mieczyslav’s, Teresa tells me she has worked with him for about six months, through referral by the building superintendent. It turns out that Mieczyslav almost lost his apartment. The drinking and noise – sometimes there were as many as four people in his bachelor apartment at one time – disturbed other tenants, the rent was always late and Mieczyslav was uncooperative. Initially, Mieczyslav didn’t have a telephone, so Teresa would leave notes on his door saying she’d been there for an appointment when he didn’t show. When he was in, he was drinking. “He was unable to communicate at all,” says Teresa, “but recently I have seen improvement. I have many clients in this building, so he never knows when I might show up.” Mieczyslav’s rent is now paid directly to the superintendent by his disability support program and the disturbances have stopped; a phone has been installed and Mieczyslav is seeing his family physician regularly.

Inside Mieczyslav’s tiny apartment, a large dining table consumes most of the space and there’s a flimsy rollaway bed by the window. “No drink, one month. Nothing!” Mieczyslav announces as he moves with the help of crutches to sit at the table. “You do speak English!” Teresa cajoles, and he smiles at us, continuing the discussion in Polish.

“Counselling, employing the stages of change to help clients, is a big part of this job,” Teresa tells me later. That’s how she encouraged Mieczyslav to stop using alcohol. But identifying the reason for drinking can be difficult: “People may drink because of isolation and depression, but they may also become depressed and isolated because they drink,” she says.

Today, Teresa is concerned about Mieczyslav’s physical health; a bad knee, the result of a long-ago construction accident, requires surgery to relieve the pain, but due to Mieczyslav’s past drinking he can’t have the operation. However, through regular meetings and counselling, Teresa hopes he will continue to abstain, making the operation possible.

Mieczyslav’s story shows how easy it is for older adults to lose faith in life, to grow increasingly isolated and use alcohol or other substances to try to feel better

By the end of the OT’s visit, requisitions are drawn up for a new mattress to help Mieczyslav sleep better and several assistive devices: “If he had a wheelchair he could go to Alcoholics Anonymous,” says Teresa. He could also do more for himself, like grocery shopping or joining friends at a seniors centre. Teresa explains that encouraging clients to participate in activities leads to more involvement in the community, which means making new friends, which in turn reduces isolation and opportunities to drink and can ease depression.

Mieczyslav’s story shows how easy it is for older adults to lose faith in life, to grow increasingly isolated and use alcohol or other substances to try to feel better. “It’s a problem, that he’s lonely, separated from family. His wife and three children live in Poland but they don’t have any relationship anymore,” says Teresa.

But in Canada for 16 years, alone with so many grievous challenges, Mieczyslav has turned his life around with the help of regular contact with Teresa. As we leave, his gratitude is touchingly palpable. He stands and kisses both of our hands, a Polish gesture of respect.

But turning life around can be met with barriers like stigma and ageism. In order to reach older adults in a less intimidating way, COPA does not require clients to acknowledge their substance use issues before COPA will help. As relationships with clients build, opportunities to address issues and offer support multiply.

Our next visit is with Czeslow, a palliative care client who lives in a high-rise apartment in a different part of town. Czeslow came to Teresa through one of her clients who brought him to Teresa’s west-end satellite office. In Canada for 12 years, Czeslow lived in a small basement apartment when he met Teresa and couldn’t make it up the stairs on his own. Teresa discovered that Czeslow had been on a waiting list for subsidized housing for 14 years – that was in November. By December, Teresa had found a more suitable apartment for him with a view of Lake Ontario.

Concerned about his appearance, Teresa immediately suggested Czeslow visit his family doctor. That led to the diagnosis of stomach cancer, which is now spreading. Czeslow has grown very weak and spends most of his days sitting in an uncomfortable, heavy plastic wheelchair. Teresa’s first order of business today is to check whether a new wheelchair, ordered recently by an OT, has been delivered.

As we arrive, two of Czeslow’s male friends take their leave. Cable TV included in Czeslow’s rent means he can watch Polish TV and it’s now tuned into a Polish game show. The new wheelchair indeed arrived and Teresa and Czeslow enthusiastically discuss in Polish the improved comfort it provides.

Teresa draws me into the discussion and expresses concern about Czeslow’s medications, of which there are many. The risk of misuse is high. “Sometimes clients get confused and accidentally overdose because they may have more than one prescription for the same medication from different doctors,” Teresa says. “In that case, we try to contact the pharmacy to explain the situation,” which is what Teresa plans to do. She will also ask the pharmacist to arrange for a ‘blister pack’ to organize Czeslow’s many medications.

We wrap up with Czeslow and head out to visit Teresa’s last two clients. Andrzej, who lives in Czeslow’s building, was referred to Teresa by a local hospital alcohol withdrawal management unit. Andrzej voluntarily admitted himself to the unit, but he still struggles with alcohol.

In Canada for about 18 years, he married a Canadian – Andrzej speaks English – but his wife left him and he lost his job due to an accident. The previous week he had been in serious crisis – suicidal, ready to end his life due to overwhelming sadness and despair. “He’s very depressed with lack of motivation in life because he can’t work now. We referred him to a psychiatrist to be sure his depression is addressed,” says Teresa. After receiving a somber message from Andrzej, Teresa accompanied him to an emergency ward, but he was discharged a few hours after Teresa left. Today I see him struggle to maintain a sense of dignity in the face of receiving financial support: “That’s not good money, I want to work,” he says, visibly disconcerted.

As we sit at Andrzej’s kitchen table, Teresa has some news she hopes will encourage him: A nearby residential treatment program has an opening and has scheduled an assessment for the next day; Andrzej just needs to ensure he is alcohol-free for the 72 hours before he is admitted. Andrzej smiles but hesitates: He wants Teresa to accompany him to the assessment. I watch Teresa struggle to assess Andrzej’s mood and to make allowances for his need for support and to encourage him to go on his own. In the end, she decides to rearrange her schedule so she can accompany him.

Teresa’s last client of the day, Irena, lives in yet another high-rise building. When we arrive, Irena is visibly upset, although Teresa doesn’t know why. Irena has Lou Gehrig’s disease and a stomach hernia that requires special attention, but the appointment is cut short at Irena’s request, with her agreeing to a follow-up call. Teresa has never seen Irena so distressed before. “She needs more help,” she says under her breath, her concern palpable as we drive back to her office.

As our day together comes to an end, I’m struck by an overall sense of the tenuousness of each clients’ health and the importance of Teresa’s support as she helps clients deal with so many vital issues. I’m also awestruck by how much has been accomplished in just a few hours. “We do what we can to improve the quality of life of older adults,” Teresa says. While time and life’s difficulties may have imposed their inexorable effects on her clients, it is not without hope that Teresa works to improve upon what little her clients have.