A STORY OF CARING SHAREEN BOWMAN

Extraordinary examples of caring & support within HCS are often overlooked by the enormity of the services we provide. This is not the case for Shareen Bowman. This story revolves around respect for a woman who defined her own terms of living. This story also reflects the value we have for our clients in deciding their fate.

Respect for a person’s right to dictate care often presents complex dilemmas for care coordination. The underlying goal of providing the best care possible shares an inherent, single deciding factor that the outcomes are not ours to choose. The determining factor for Shareen Bowman was based on meaningful conversations from a caring team devoted to supporting her ultimate decision to allow Hospice care at a critical juncture of recovery versus acceptance. This portrayal of Shareen’s decision is based on multiple care providers and family who participated with her journey towards end-of-life care. Sharing this story is an opportunity to celebrate Shareen’s independence in thought and action as well as addressing the need for a shift in perspectives when confronted with complex medical and psychiatric coordination of care.

Shareen’s story requires acknowledging that she was an exceptionally independent person who experienced numerous emotional and health struggles throughout her life which was complicated by difficulties forming meaningful, trusting relationships. Despite these concerns, Shareen’s perseverance allowed her to remain independent in the community until she experienced her first major psychotic episode at the age of 67. This life altering event required extensive psychiatric stabilization which resulted in a Western State Hospital admission. The lengthy hospitalization of almost two years identified that Shareen had multiple physical & psychiatric concerns that required significant supports. The most predominant psychiatric concern was Shareen’s persistent paranoid and persecutory delusions that raised questions about her judgement. This required the interventions of a caring WSH Discharge Planning Team who were instrumental for bringing Sunrise ESF into the conversation about the types of care available to support her transition from WSH. Shareen was able to dispel any cognitive concerns by accurately identifying likely outcomes associated with her decisions, recognizing that she was dependent on assistance managing her ADLs and mobility, and relied on effective behavior interventions to maintain her emotional stability. Shareen ultimately agreed that Sunrise ESF was a better solution to returning home which would of likely exposed gaps in care that she wanted & needed. coordinated with Shareen, her daughters (Guardians), & the WSH discharge team to target the development of a medical & psychiatric support plan that incorporated the need for extensive nursing care for the emerging medical concerns involved with immobility. This was a delicate, on-going discussion between the ESF staff, her RSW case manager, Shareen, and her daughters to ensure that all options of care were openly discussed. These discussions were also mindful of the importance of trust, respect, and dignity and also also took into account the complexities of providing effective interventions for mitigating behavioral concerns that often interfered with her personal care. This ESF was able to adapt their level of care for Shareen’s unique care needs & responded accordingly when her status worsened over time. They also never faltered in being non-judgmental about Shareen’s choices which allowed for a greater sense of trust between provider and Client. Hospice care was eventually introduced as Shareen began to evidence failure to thrive.

In most circumstances, Shareen’s care needs would typically exceed ESF level of care & would necessitate a transfer to a higher level of care facility. Sunrise staff was able to incorporate extensive medical care & psychiatric supports that allowed Shareen to age in place. This was an incredible effort by the staff of Sunrise ESF who addressed the complications of pain management, wound care, and comfort that allowed Shareen to maintain an extraordinary sense dignity and independence.

The brilliance of how this story evolved is that Shareen created the direction of her passing. She allowed a dedicated team to develop a plan of care that recognized her independence in choice. Later conversations with the ESF staff, her RSW case manager, and her family revealed the recognizable sense of trust Shareen expressed for the support she received. Additionally, the ESF administrator later acknowledged that other residents found that this experience created a greater sense of belonging and appreciation that the staff supported Client self-directed care. Shareen’s daughter expressed immense appreciation for the care her mother received and cited that her mother’s passing was pain-free and without the fear of being alone. Shareen’s daughter also was specific in her gratitude for the existence of DSHS services. She cited that this type of supportive behavioral care in this type of setting was exceptional, and this experience revealed a working model to support others like her mother who would of otherwise remain isolated, homeless, and in pain. Shareen’s daughter expressly thanks the staff of Sunrise ESF, her mother’s RSW Case Manager, and DSHS for supporting her mother through the final days of her mother’s life.

A comment from JD Selby, RSW Program Manager:

This story came to my attention as a result of exploring options to support medically fragile individuals who were residing in ESFs. Traditionally, Clients with extensive physical, medical, and behavioral concerns had no choice in their care options which were confined to either acute hospital or skilled nursing facility level of care. This was not the case for Shareen Bowman. I was able to find in my review and discussions with the ESF administrator, RSW Case Manager, and Shareen’s daughter that there was ample evidence to indicate Shareen’s care needs were met and that Shareen’s care plan was carefully orchestrated around the simple facts that Shareen felt safe, supported, and in charge of her care. The power of this story is not only emotional but affirming that our shared commitment to the best level of care is possible. Shareen was able to avoid transitioning into another setting or experience the isolation or fear that was inherent to her delusions. This is a true representation that this type of service and setting creates a working model of providing positive, supportive outcomes without being restrictive or invasive. This is also a reminder that this story supports our shared belief that Client-centered care is possible through diligence and thoughtfulness that would be otherwise lost to outdated models of care. It was Shareen’s daughter who expressed the hope that this story can be replicated for other people who are living lives similar to Shareen.

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