Parker Family Episode 5
Parker Family Episode 5
Program Transcript
FEMALE SPEAKER: So you’ve been hospitalized, let’s see, four times
altogether.
FEMALE SPEAKER: Well actually, I should have only been in the hospital three
times.
FEMALE SPEAKER: Why do you say that?
FEMALE SPEAKER: Well, on the third hospital visit they kicked me out before I
was ready to leave. They said I was just in there to get away from my mom, but I
told them they were wrong. My sister even backed me up on this. But they didn’t
care. They just checked me out, and home sweet home I went. I was barely gone
like a month and I was back in their monkey house.
So technically, for me, hospital visits three and four are the same. I remember
going back to that hospital seeing the same docs and nurses, and I just smiled
and waved and said, see, I told you so. I mean, we picked up right where we left
off.
FEMALE SPEAKER: What do you mean your sister backed you up?
FEMALE SPEAKER: Jane, that’s my sister. Jane, she knew how crazy my mom
is, so she took pictures of all that mess and all that junk my mom hoards, and
she showed them to the social worker in the hospital.
FEMALE SPEAKER: What happened?
FEMALE SPEAKER: You know what the social worker said? She said that there
was nothing that she can do about it, that her job was to only make sure that
patients have a place to go when they leave the hospital. Translation, when
you’re out the door, good riddance and good luck. Some policy, huh?
Parker Family Episode 5
Additional Content Attribution
MUSIC:
Music by Clean Cuts
Original Art and Photography Provided By:
Brian Kline and Nico Danks
©2013 Laureate Education, Inc.
1
The Parker Family
Sara is a 72-year-old widowed Caucasian female who lives in a two-bedroom apartment with her 48-year-old
daughter, Stephanie, and six cats. Sara and her daughter have lived together for the past 10 years, since Stephanie
returned home after a failed relationship and was unable to live independently. Stephanie has a diagnosis of bipolar
disorder, and her overall physical health is good. Stephanie has no history of treatment for alcohol or substance abuse;
during her teens she drank and smoked marijuana but no longer uses these substances. When she was 16 years old,
Stephanie was hospitalized after her first bipolar episode. She had attempted suicide by swallowing a handful of
Tylenol® and drinking half a bottle of vodka after her first boyfriend broke up with her. She has been hospitalized
three times in the past 4 years when she stopped taking her medications and experienced suicidal ideation. Stephanie’s
current medications are Lithium, Paxil®, Abilify®, and Klonopin®.
Stephanie recently had a brief hospitalization as a result of depressive symptoms. She attends a mental health
drop-in center twice a week to socialize with friends and receives outpatient psychiatric treatment at a local mental
health clinic for medication management and weekly therapy. She is maintaining a part-time job at a local supermarket
where she bags groceries and is currently being trained to become a cashier. Stephanie currently has active Medicare
and receives Social Security Disability (SSD).
Sara has recently been hospitalized for depression and has some physical issues. She has documented high blood
pressure and hyperthyroidism, she is slightly underweight, and she is displaying signs of dementia. Sara has no history
of alcohol or substance abuse. Her current medications are Lexapro® and Zyprexa®. Sara has Medicare and receives
Social Security benefits and a small pension. She attends a day treatment program for seniors that is affiliated with a
local hospital in her neighborhood. Sara attends the program 3 days a week from 9:00 a.m. to 2:00 p.m., and van
service is provided free of charge.
A telephone call was made to Adult Protective Services (APS) by the senior day treatment social worker when
Sara presented with increased confusion, poor attention to daily living skills, and statements made about Stephanie’s
behavior. Sara told the social worker at the senior day treatment program that, “My daughter is very argumentative
and is throwing all of my things out.” She reported, “We are fighting like cats and dogs; I’m afraid of her and of losing
all my stuff.”
During the home visit, the APS worker observed that the living room was very cluttered, but that the kitchen was
fairly clean, with food in the refrigerator and cabinets. Despite the clutter, all of the doorways, including the front
door, had clear egress. The family lives on the first floor of the apartment building and could exit the building without
difficulty in case of emergency. The litter boxes were also fairly clean, and there was no sign of vermin in the home.
Upon questioning by the APS worker, Sara denied that she was afraid of her daughter or that her daughter had
been physically abusive. In fact, the worker observed that Stephanie had a noticeable bruise on her forearm, which
appeared defensive in nature. When asked about the bruise, Stephanie reported that she had gotten it when her mother
tried to grab some items out of her arms that she was about to throw out. Stephanie admitted to throwing things out to
clean up the apartment, telling the APS worker, “I’m tired of my mother’s hoarding.” Sara agreed with the description
of the incident. Both Sara and Stephanie admitted to an increase in arguing, but denied physical violence. Sara stated,
“I didn’t mean to hurt Stephanie. I was just trying to get my things back.”
The APS worker observed that Sara’s appearance was unkempt and disheveled, but her overall hygiene was
adequate (i.e., clean hair and clothes). Stephanie was neatly groomed with good hygiene. The APS worker determined
that no one was in immediate danger to warrant removal from the home but that the family was in need of a referral
for Intensive Case Management (ICM) services. It was clear there was some conflict in the home that had led to
physical confrontations. Further, the house had hygiene issues, including trash and items stacked in the living room
and Sara’s room, which needed to be addressed. The APS worker indicated in her report that if not adequately
addressed, the hoarding might continue to escalate and create an unsafe and unhygienic environment, thus leading to
a possible eviction or recommendation for separation and relocation for both women.
As the ICM worker, I visited the family to assess the situation and the needs of the clients. Stephanie said she was
very angry with her mother and sick of her compulsive shopping and hoarding. Stephanie complained that they did
not have any visitors and she was ashamed to invite friends to the home due to the condition of the apartment. When
I asked Sara if she saw a problem with so many items littering the apartment, Sara replied, “I need all of these things.”
Stephanie complained that when she tried to clean up and throw things out, her mother went outside and brought it all
back in again. We discussed the need to clean up the apartment and make it habitable for them to remain in their home,
based on the recommendations of the APS worker. I also discussed possible housing alternatives, such as senior
housing for Sara and a supportive apartment complex for Stephanie. Sara and Stephanie both stated they wanted to
remain in their apartment together, although Stephanie questioned whether her mother would cooperate with cleaning
up the apartment. Sara was adamant that she did not want to be removed from their apartment and would try to accept
what needed to be done so they would not be forced to move.
The Parker Family
Sara Parker: mother, 72
Stephanie Parker: daughter, 48
Jane Rodgers: daughter, 45
Stephanie reported her mother is estranged from her younger sister, Jane, because of the hoarding. Stephanie also
mentioned she was dissatisfied with her mother’s psychiatric treatment and felt she was not getting the help she
needed. She reported that her mother was very anxious and was having difficulty sleeping, staying up until all hours
of the night, and buying items from a televised shopping network. Sara’s psychiatrist had recently increased her
Zyprexa prescription dosage to help reduce her agitation and possible bipolar disorder (as evidenced by the compulsive
shopping), but Stephanie did not feel this had been helpful and actually wondered if it was contributing to her mother’s
confusion. I asked for permission to contact Jane and both of their outpatient treatment teams, and both requests were
granted.
I immediately contacted Jane, who initially was uncooperative and stated she was unwilling to assist. Jane is
married, with three children, and lives 3 hours away. At the beginning of our phone call, Jane said, “I’ve been through
this before and I’m not helping this time.” When I asked if I could at least keep in touch with her to keep her informed
of the situation and any decisions that might need to be made, Jane agreed. After a few more minutes of discussion
around my role and responsibilities, I was able to establish a bit of rapport with Jane. She then started to ask me
questions and share some insight into what was going on in her mother and sister’s home.
Jane informed me that she was very angry with her mother and had not brought her children to the apartment in
years because of its condition. She said that her mother started compulsively shopping and hoarding when she and
Stephanie were in high school, and while her father had tried to contain it as best he could, the apartment was always
cluttered. She said this had been a source of conflict and embarrassment for her and Stephanie all of their lives. She
said that after her father died of a heart attack, the hoarding got worse, and neither she nor Stephanie could control it.
Jane also told me she felt her mother was responsible for Stephanie’s relapses. Jane reported that Stephanie had been
compliant with her medication and treatment in the past, and that up until a few years ago, had not been hospitalized
for several years. Jane had told Stephanie in the past to move out.
Jane also told me that she “is angry with the mental health system.” Sara had been recently hospitalized for
depression, and Jane took pictures of the apartment to show the inpatient treatment team what her mother was going
home to. Jane felt they did not treat the situation seriously because they discharged her mother back to the apartment.
Stephanie had been hospitalized at the same time as her mother, but in a different hospital, and Jane had shown the
pictures to her sister’s treatment team as well. Initially the social worker recommended that Stephanie not return to
the apartment because of the state of the home, but when that social worker was replaced with someone new, Stephanie
was also sent back home.
When I inquired if there were any friends or family members who might be available and willing to assist in
clearing out the apartment, Jane said her mother had few friends and was not affiliated with a church group or
congregation. However, she acknowledged that there were two cousins who might help, and she offered to contact
them and possibly help herself. She said that she would ask her husband to help as well, but she wanted assurance that
her mother would cooperate. I explained that while I could not promise that her mother would cooperate completely,
her mother had stated that she was willing to do whatever it took to keep living in her home. Jane seemed satisfied
with this response and pleased with the plan.
I then arranged to meet with Sara and her psychiatrist to discuss her increased anxiety and confusion and the
compulsive shopping. I requested a referral for neuropsychiatric testing to assess possible cognitive changes or decline
in functioning. A test was scheduled, and it indicated some cognitive deficits, but at the end of testing, Sara told the
psychologist who administered the tests she had stopped taking her medications for depression. It was determined
Sara’s depression and discontinuation of medication could have affected her test performance and it was recommended
she be retested in 6 months. I suggested a referral to a geriatric psychiatrist for Sara, as she appeared to need more
specialized treatment. Sara’s psychologist was in agreement.
Because they had both stated that they did not want to be removed from their home, I worked with Sara and
Stephanie as a team to address cleaning the apartment. All agreed that they would begin working together to clean the
house for 1 hour a day until arrangements were made for additional help from family members. In an attempt to
alleviate Sara’s anxiety around throwing out the items, I suggested using three bags for the initial cleanup: one bag
was for items she could throw out, the second bag was for “maybes,” and the third was for “not ready yet.” I scheduled
home visits at the designated cleanup time to provide support and encouragement and to intervene in disputes. I also
contacted Sara’s treatment team to inform them of the cleanup plans and suggested that Sara might need additional
support and observation as it progressed. Jane notified me that her two cousins were willing to assist with the cleanup,
make minor repairs, and paint the apartment. Jane offered to schedule a date that would be convenient for her and her
cousins to come and help out.
Key to Acronyms
APS: Adult Protective Services
ICM: Intensive Case Management services
SSD: Social Security Disability
We then discussed placement for at least some of the cats, because six seemed too many for a small apartment.
Sara and Stephanie were at first adamant that they could not give up their cats, but with further discussion admitted it
had become extremely difficult to manage caring for them all. They both eventually agreed to each keep their favorite
cat and find homes for the other four. Sara and Stephanie made fliers and brought them to their respective treatment
programs to hand out. Stephanie also brought fliers about the cats to her place of employment. Three of the four cats
were adopted within a week.
During one home visit, Stephanie pulled me aside and said she had changed her mind—she did not want to
continue to live with her mother. She requested that I complete a housing application for supportive housing stating,
“I want to get on with my life.” Stephanie had successfully completed cashier training, and the manager of the
supermarket was pleased with her performance and was prepared to hire her as a part-time cashier soon. She expressed
concern about how her mother would react to this decision and asked me for assistance telling her.
We all met together to discuss Stephanie’s decision to apply for an apartment. Sara was initially upset and had
some difficulty accepting this decision. Sara said she had fears about living alone, but when we discussed senior living
alternatives, Sara was adamant she wanted to remain in her apartment. Sara said she had lived alone for a number of
years after her husband died and felt she could adjust again. I offered to help her stay in her apartment and explore
home care services and programs available that will meet her current needs to remain at home.

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