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If not for Tim Malone, 86-year-old William Baldridge would spend most of his time alone in the small home he built on an expanse of juniper and sagebrush near Bend.
Baldridge tries to keep in touch with the outside world by writing letters to his children, who live out of the area. But most days his mailbox is empty.
“The mail is like a dead lizard, it don’t appear,” Baldridge said recently, during one of Malone’s weekly visits to check on his client’s health and well being.
Malone, 52, is a social worker specializing in senior mental health. As supervisor of the Deschutes County Mental Health Senior Program, Malone has built a five-person team that treats seniors with disorders ranging from minor depression to severe dementia and chronic mental illnesses like schizophrenia and bipolar disorder.
Malone and his team also counsel clients on adjusting to daily living as they age, from losing their driver’s license to being alone.
“We help them to adjust to and to accept their needs,” said Malone. “We make things OK.”
Of the 32 million Americans aged 65 and older, five million suffer from depression, according to the American Association of Geriatric Psychiatry Web site.
Depression, anxiety, dementia and substance abuse are often misdiagnosed or not recognized by primary and specialty care physicians. Left untreated, depression in seniors can cause unnecessary disability, excess health care costs and even death, according to the Web site.
Fifteen percent of Deschutes County’s population is made up of seniors — higher than the national average of 13 percent. In Crook and Jefferson counties the number is even higher at close to 19 percent.
For Malone and the others on the senior mental health team, advocating for elderly patients and their families is not a 9-to-5 job. There are emergency, late-night consultations with doctors, nursing homes and caregivers, trips to the hospital and other interventions.
Malone often takes Baldridge to doctor’s appointments, helps him figure out his medical bills and listens to his tales of old time logging camps, trapping coyotes and politics.
“I’ve essentially befriended him, and him me. So he kind of depends on me at this point,” said Malone.
On a recent weekend, Malone, who once worked as a telephone technician, installed a phone near Baldridge’s bed so he would not have to get up to call for help.
“It’s just a service mental health does, telephone work,” joked Malone.
Malone spends much of his work day zipping from place to place in his compact gold Toyota. After a recent visit with Baldridge, Malone drove to Bend’s Aspen Ridge Retirement Community’s Alzheimer’s Care facility for a consultation.
At Aspen Ridge, Administrator Adele Lavoie briefed Malone on 92-year-old resident Mildred Fitz, who was distraught over pain in her chest and legs. Doctors, however, could not find anything physically wrong with her.
According to Malone, depression can cause somatic illnesses. “It’s very difficult to discern what’s physical and what’s mental, but it’s key for good care for these folks,” said Malone, as he poured over Fitz’s chart in the Aspen Ridge day room.
Malone and Fitz sat outside her room at Aspen Ridge, where he asked her some simple questions, like what she likes to eat and where she grew up, to assess her state of mind.
During their conversation, Fitz repeatedly rubbed her chest and legs with her hands, and complained of pain. But Malone’s attention did get Fitz to smile.
“A lot of them like somebody like me talking to them because I’m addressing their complaints,” said Malone. “She had an opportunity to talk about what was wrong with her.”
Malone said he hopes that his assessment will help uncover the source of Fitz’s pain, but there are no guarantees. There are often complex psychological and physical factors at work.
“(Diagnosis) takes a lot of training and a lot of time and experience. If you get it right one out of 10 times, you’ve achieved expert status,” said Malone.
Malone does consultations at Aspen Ridge for four hours each month. In addition to seeing residents, he educates staff on dementia and helps prevent caregiver burnout by teaching staff how to better care for themselves and their patients.
“The more they know the more creative they can be in terms of interventions,” said Malone. “A lot of newer staff think these people are trying to manipulate them to get something. A demented person can’t manipulate, that’s an executive function.”
Curiosity at a young age
Growing up in Detroit, Malone spent a lot of time with the elderly Polish immigrants in his neighborhood, rather than play with other children.
“I ran errands for them, they gave me a dime or something to do it,” Malone said. “I always wanted them to be telling me things. I’ve always been curious about why people do the things they do.”
After serving in the U.S. Coast Guard during the Vietnam War and working as a Merchant Marine, a railroad laborer and a telephone technician, Malone’s lifelong curiosity and desire to help others finally steered him toward a career in social work at the age of 35.
While earning his master’s degree in social work at Portland State University, Malone interned at programs for teens, disabled adults and domestic violence victims. But something clicked during a 1992 internship as a social worker at an older adult day treatment center for veterans in Vancouver, Wash.
“I was the kid who hung out with the old people in the neighborhood,” Malone said. “It kind of flowed right in and I realized this was the match.”
Now, Malone has become part of the lives of many of Deschutes County’s elderly — even if they did not initially want him there.
Malone recalled one client, an elderly Polish woman, who became so depressed and lonely that she wouldn’t leave her home or open her door to Meals on Wheels.
When the alarmed Meals on Wheels personnel called Malone, he went to the woman’s home and knocked on her door. When she opened the door a crack, Malone said he stuck his foot in the jamb, threw the door wide open and told her, “I’m not going to let you die!”
Using a few Polish phrases he picked up in Detroit, Malone eventually convinced the woman to meet him weekly for coffee. Through their meetings, he learned how she and her husband, a Polish Air Force hero, had escaped Europe during World War II.
Another favorite client wanted to will her estate to Malone when she discovered that she was dying of cancer. Instead, Malone helped her locate a distant relative who operated an orphanage in Ethiopia. Eventually, Malone helped his dying client donate her estate to build a hospital wing for the orphanage.
Senior advocate
When Malone was hired to work in Deschutes County in 1993, he became the only employee in the county’s senior mental health department. With the cooperation of county commissioners, Malone hired others like Pat Kroll, who left her job at a resident care center in Redmond to work with Malone.
“He just had such genuine concern for the aging process and the things that people go through as they age,” said Kroll. “When I met him, I said, ‘This is a job I want to do. Do you have an opening?’ ”
With more funding cuts expected from Salem, Malone worries that he may lose staff and further reduce the number of new clients.
“We only get a certain amount of money to do the job. It’s a major constraint because I can’t just help everybody who needs help,” said Malone. “You’ve got to triage.”
On a recent afternoon at his office in Bend, Malone had to turn away a woman seeking help with her elderly mother. When Malone cannot offer help, he refers callers back to their physician or to private mental health care providers, none of whom take Medicare as payment. He also refers people to the Central Oregon Council On Aging and other local senior services.
“There’s a pretty good senior care network here in Deschutes County,” said Malone. “The one big niche that isn’t filled is private senior mental health. The primary reason is that Medicare doesn’t pay.”
According to Malone, the state budget crisis may place the future of senior mental health care in Deschutes County — and elsewhere — in jeopardy.
“It’s completely the wrong direction,” said Malone, of the cuts.
“The senior population is growing while the services being provided are getting smaller.”
Despite state health care funding cuts, Malone, who is vice chairman of the Governor’s Commission on Senior Services, continues to lobby legislators in Salem to increase services for seniors in Deschutes County.
“I know (the legislators) and I’m constantly bugging them. It keeps Deschutes County on the map,” said Malone. “I’m quick to advocate for seniors in general, but ours in particular,” he said.
Alisa Weinstein can be reached at 541-504-2336 or at aweinstein@bendbulletin.com
