This is Maggie’s story.
Maggie was one of the first supported living customers served out of our Columbia Tennessee office and the very first class member being supported by Bios of Tennessee in middle Tennessee in May of 2005.
For those of you who did not know Maggie, she was our real first test to see if we were going to survive as an agency in Middle Tennessee. DIDD blessed us with this young lady who was residing at the Greene Valley Developmental Center in Greeneville TN (East Tennessee). Maggie was the only female living in an all-male complex on GVDC’ s campus.
We weren’t given much of a chance at all to be successful supporting Maggie, and why would we? The odds were so not in Maggie’s favor. She had been in nearly every institution across the state from east to west and back again, along with several other community-based agencies who had their chance and failed miserably. The turnover in prior staff with other agencies was staggering because no one wanted to endure what Maggie had to dish out during those days.
Maggie was so challenging, so physically and verbally aggressive and so tough to support that she was the only individual that was allowed an exception for the use of prone restraints as part of her plan, authorized by the State of Tennessee and DMRS. BIOS did not agree with this, nor did we request approval to do so once we moved her to her new home in middle Tennessee. Maggie had more restrictions in place originally than everyone we have ever supported combined.
Maggie had never known unconditional love and compassion from anyone providing paid supports. She certainly had not encountered what she was about to experience from her new Bios staffing team, who were eager and willing to support her. Maggie learned that the group of people working for her at Bios was forgiving, loving and would never leave her no matter what. And no matter how hard Maggie made it for her staff to stay, they stayed and loved her through it all.
A little background from Maggie’s prior history:
At the time, Ms. Maggie was a 39-year old woman with mild developmental delays. She was admitted to GVDC for the third time on 10/24/02 following an emergency room visit in Knoxville. Ms. Maggie told the hospital staff that she had been beaten by her staff during an altercation. Ms. Kathy, her conservator/sister (since 12/01), pulled agency and ISC supports following this incident. Currently, Ms. Maggie has a new ISC but no residential provider agency. Ms. Maggie has received support services for mental health issues since 1979. There have been numerous agencies providing these services with no stability over the long-term other than admissions to GVDC and Nat Winston. Each of the other providers has either only provided temporary acute care or has rescinded services due to behavioral issues.
Maggie Risk Level: High
- While at GVDC, Ms. Maggie will have a staff ratio of 2:1 assigned to her 24 hours per day, 7 days per week (one female with one male available in the vicinity [ if on suicide watch, follow MHSP]) with the following exceptions: Ms. Maggie will have a staff ration of 2:1 (one female and one male) assigned to her when on campus away from Newel, when going on off-campus outings, or if criterion is met for physical or verbal aggression. The definition of 2:1 while on outings where transportation is required will mean 2 staff working directly with her. This means that a third staff will be driving. It is not acceptable for one of her designated staff to be the driver of the vehicle as this would not be providing her with 2 designated staff who could deal with crisis during transportation. These assistants have received competency training on Ms. Maggie’s BSP and MHSP and PCM. Staff will have a radio/phone communication system available on their person. Staff will be available to assist Ms. Maggie in participating in her activities; however, remember staff are not friends or “buddies” and will remain emotionally neutral. Staff assignments will divided into 4 hr shifts. Her level of supervision listed in the current ISP is immediate area in the unit and line of sight in all other areas (she may have privacy in her bedroom and bathroom unless on suicide watch). She is not integrated into a specific group at this time; however she may associate with peers upon peers’ request including up to 4 possible off-campus outings per month contingent upon absence of target behavior. This will continue, with an understanding that it can change based upon a number of factors.
- No staff person will purchase or provide Ms. Maggie with any gifts/activities that are not preapproved by the BA or designee. If Ms. Maggie requests to purchase an item using her own personal funds, a specific person will be designated to account for these funds and receipt of the item. All transactions will be logged.
- For Ms. Maggie’s protection, she will not carry a lighter for her cigarettes. Staff will have a lighter available for Ms. Maggie to light her cigarettes. Staff will hold the lighter when lighting a cigarette. Staff will discourage smoking more than one cigarette at a time due to increased seizure probability.
- Ms. Maggie expects to have control over her own life and to be treated with dignity: being respected as an adult, staff requesting that she do something, respecting privacy issues, and having others valuing her opinion.
- She had a special diet due to diabetes and obesity. She has visual deficits for which eyeglasses are prescribed. She has a hearing deficit and should be encouraged to wear her hearing aid. Following a period of significantly increased blood sugars and some loss of feeling in the bottoms of her feet, the PCP has requested that Ms. Maggie follow her 1800 cal. diabetic diet. She will receive all her meals and snacks from the central kitchen at GVDC with the exception of one meal on Fridays and one snack per week on Tuesdays. Staff will ensure that “outside” foods are compatible with her diet. For Ms. Maggie’s protection, staff will keep the environment free of sharp items (including metal drink cans, glass, pens, pencils, and paperclips) including Ms. Maggie’s personal property. Ms. Maggie will be encouraged to keep her CDs in “soft, fabric-type cases”. Maintenance of a “sharp-free” environment will be accomplished by daily searches of public areas in the unit, of Ms. Maggie’s bedroom and bathroom, front unit bathroom, and Ms. Maggie’s person. Since being at GVDC, she has hidden these among personal belongings and used these items as weapons. Searches will be randomized. Ms. Maggie will be encouraged to actively participate in the search of her personal property and person including unlocking her locker with a locker key. Staff will receive specific training in searching Ms. Maggie’s person.
- Follow GVDC policy and procedure for suicidal statements as stated in the MHSP. A copy of this policy is available to staff.
- When talking with Ms. Maggie: 1) state her name frequently, 2) use language that suggests the current problem is temporary (“currently”, “at this time”, “for now”), 3) stay in the immediate time frame (deal with what is happening right now), 4) word all statements positively (even problems), 5) suggest several alternatives to solve a problem but never solve one for her (use “could you ….” ), 6) let her do the talking, 7) avoid using “always”, “ never”, “if”, “we”, and 8) use “ when” and “you”. These are difficult skills to use and will take practice.
- Language (both verbal and gestural) needs to be matter-of-fact and respectful AT ALL TIMES so that Ms. Maggie does not have difficulty understanding the intent. Let “junk” comments drop. Do not respond to them, they are not personal. If you need to walk away before your behavior escalating, get relief and remove yourself from the situation.
Summary Of Previous Treatment:
Ms. Maggie was removed from her biological family in 1973 due to severe neglect and placed in the same foster care home as her sister. Her first known contact with mental health services was in 1979 when she was seen at Oak Ridge Mental Health Center for resisting discipline, confrontations, sudden mood swings, fighting, and hitting her foster mother with a broom. She was placed in a second foster home beginning 1/5/81. She was placed in juvenile detention 8/13/81 due to aggression and Oak Ridge Mental Health 9/9/81 – 1/19/82. After a suicide attempt and a short stay (1/16/82 – 1/26/82) in McHarry hospital psych unit, she then went to live at Dhaman Home in Nashville. There she was treated for depression and suicidal attempts. There are also incidents of knife throwing. Numerous other inpatient treatment placements for several aggressive behavior followed: Middle TN Mental health Institute 3/6/82 – 3/29/82, Western State Timber Springs Youth Center 3/29/82 – 7/26/82, back to initial foster home, Oakridge mental health Center (ORMHC) 1/83 – 8/83, Michael Dunn Center day program 8/83 – 4/84, Lakeshore 4/13/84 – 4/18/84, back to initial foster home, ORMHC 6/84 – 9/18/84, and 9/18/94 Lakeshore (which included seclusion). At some point between 1983 – 1984 through 1986, Ms. Maggie returned to her biological family to live with her mother and brother. Further treatment placements occurred: 4/11/85 – 4/18/85 Lakeshore after threatening to stab her sister with a butcher knife, and 10/21/85 removed from school due to assault of a teacher. Interestingly, when Ms. Maggie was sent to Moccasin Bend, she was denied admission because she was calm upon arrival. Instead she went to jail until 10/23/85. Due to inability to deal with the aggression and threats of eviction, Ms. Maggie’s family requested admission to GVDC. She was evaluated at GVDC in 2/26/86 and admitted 9/25/86. Ms. Maggie remained at GVDC (changing cottages based on behavior status) from 9/25/86 – 1/5/90 until she was transferred to Nat T. Winston. She remained at Nat T. until it closed and she was placed with Mentor in 2/98. Once Ms. Maggie returned to community living, the acute admissions to psychiatric facilities and burnout of provider agencies escalated again: 8/12-16/99 Lakeshore, 5/14-16/00 Lakeshore, 6/00 Lakeshore, 7/7-12/00 Lakeshore, 1/2/01 – 1/12/01 McFarland, 5/01 – 8/01 Sunrise (turnover of staff was 57 and police were called an average of 2x/mo). Ms. Maggie was charged with assault, arrested and returned to GVDC 8/22/01. She was discharged to a new agency (D&S) on 11/9/01. After an initial “honeymoon” period, the pattern repeated itself: 4/18/02 arrested for assault; 7/15 – 7/25/02 Lakeshore; 8/10 – 8/19/02 Lakeshore, 8/02 (2nd time) Lakeshore. She was readmitted to GVDC on 10/24 following an emergency room visit on 10/20/02.
Throughout all these facilities, available records indicate little to no improvement.
How were we going to be different than anyone else who previously supported Maggie, and how would she ever trust us or anyone with what she had been through?
Maggie transitioned to Bios in May of 2005. At the time she was angry and physically aggressive, and had been angry and physically aggressive for a long time. People working for the State of Tennessee who knew Maggie actually referred to her as a monster. Plexiglas was placed on her windows and over her television to prevent expensive property destruction. Maggie’s caring and dedicated staff began nurturing her, reassuring her that she was safe and that they would be back day after day. Slowly they earned her trust and taught her that she was a person of value. Maggie learned to talk over her issues in advance of an angry outburst that would not solve the underlying problem. As she began to feel safer with the people who supported her, she gave up on her violent and destructive behaviors.
Maggie often tested administrative staff to see if they would pay attention to all of her issues. When she expressed a desire to meet potential new staff before they were hired, this was arranged. When Maggie noted that one of her staff spent a little too much time discussing her personal life, Maggie informed her program manager that she did not want to hear it. An in-service was conducted with the staff concerned, and the issue was resolved to Maggie’s satisfaction.
In 2008, all the Plexiglas in her home was removed because there had been such a long interval since Maggie’s last incident of property destruction.
In March of 2010, Maggie’s LON 6-Individual was reduced to a LON 4-Individual. Maggie the “Monster’s” life had become so much richer and fuller that she no longer qualified for a LON6. In fact, proving that feeling safe and loved makes a person want to be loving and engaged, Maggie decided that she wanted to reach out to a friend of hers who was having difficulty. She wanted to be this woman’s roommate so that she could mentor and inspire her. Maggie wanted her friend to feel safe and loved as well. The roommate process was begun.
However, in May of 2010 Maggie was taken from us by a combination of health issues culminating in a fatal heart attack. She had become a friend to us all, as well as a success in her own life. We made a difference in Maggie’s life and she died happy knowing she was loved. She touched so many people during her life and we are proud to say she touched ours.
Bios of Tennessee, LLC