As a result of retiring earlier this year from San Francisco Superior Court as the Director of the Probate Department, I was asked to give a keynote speech reflecting on my work and life. At first, it seemed a daunting assignment; I didn’t think of myself as “retiring,” but rather as “graduating” from thirty-four years of employment with the Court. After all, I plan to continue my work in the fields of elder mistreatment and guardianship. In the end, the task allowed me to review my life, and I was filled with deep gratitude and appreciation for all that has gone before.
As a child, I was fascinated by nursing and medicine. As a teenager, I worked as a nurses’ aide and wanted to become a physician. However, in 1950’s America, this was not a realistic aspiration for a young woman so, instead, I attended a diploma school of nursing and later graduated from the University of Oregon with a Bachelor of Science in Nursing. I taught operating room nursing for two years and then served as a public health nurse in the Sunset District in San Francisco where I worked with elders in the community and organized various nursing, baby, and immunization clinics. After seven years as a public health nurse, I decided to work as an operating nurse at a small hospital.
Soon after starting my new job, I learned that Jack McKay, a well-known gerontologist at the San Francisco Council of Churches, was searching for a nurse to work with three of the Council’s programs providing mental health services for community-dwelling older adults (e.g., home visits), managing a psychiatric day center, and organizing activities for people living in residential care homes. Eventually, I became the Director of the Geriatric Day Treatment Center. We were doing cutting edge work with psychiatrically ill older people. There was no other program like it in the United States at the time. We carefully worked with psychotropic medication which often had unexpected effects on older people. We began to tease apart the differences between mental illness and the various dementias. And we became familiar with paranoid states specific to older adults as well as the temporary acute delirium caused by medical conditions.
While working at the Geriatric Day Treatment Center, I earned a master’s degree in clinical psychology at Lone Mountain College where I focused on both gerontology and psychology of women. My master’s thesis was on the connection between reviewing one’s life and late-life depression. I learned that people who refuse to review their lives are likely to become depressed. I graduated in 1977 with a specialty in gerontology years before it became a field or an area of study in universities.
Why did I study aging? I enjoyed older people and was fascinated by their wealth of knowledge. I’d had a very interesting maternal grandfather and grandmother and was fascinated by older people in general. They seemed certain and calm about so many of the life dilemmas I was dealing with. They had fountains of information that they could easily access. They seemed to know how detect fakery. While I’ve learned a good deal from older people, I also slowly learned that I had to live my own life to gain the knowledge that they have.
About four years after I started working with the Council of Churches, a lawyer friend told me about new legislation that had been passed in 1977 which created the role of the Court Investigator in Probate Courts in California. Federal funding for community mental health was winding down and I knew it was only a matter of time before I’d need another job. My friend said the work would involve visiting older adults with physical and mental deficits, advising of them of their rights with conservatorships (termed guardianships in other states), and reporting, contacting family members and third parties such as physicians, social workers, and discharge planners. After distilling, this information, and including the proposed conservatees’ express statements, written report had to be made for the judge. I applied for the job and was hired; I came to the Probate Court from the community perspective, with knowledge about older people, and with a medical background.
When I started with the court, it was a bit of a culture shock to go from the medical model to the legal model. It was also shock to go from being the director of a psychiatric day treatment center for older adults in a small private non-profit agency to being a court investigator with a very public role. Fortunately there were many threads of knowledge I could apply as I was accustomed to being on the cutting edge of a field, creating protocols and procedures, working with a team, and advancing knowledge. Together with others, I created new forms, figured out how to apply the new conservatorship laws, became familiar with legal and court culture and learned how to interact with judges and other court personnel. I became accustomed to thinking that all the cases that came before the court had two--and probably more--sides to the case. It was up to the court to find the truth among the conflicting information, to weigh and measure the application of the law, and then to make a decision. This was very unlike the medicine model where there was usually only one scenario which was defined and controlled by the physician.
Several significant events happened in 1977. That year marked the first congressional testimony in the US Congress about elder abuse that sparked the movement into existence. The role of the Court Investigator was created and I was the first one hired in San Francisco Superior Court. Additionally, on a personal note, I received my master’s degree and met Frank Quinn, the man who would become my husband.
While these connections seem obvious now, it was not so while I was living them. It was a jig saw puzzle that got assembled over the years, and it was not a traditional career path. It was dependent on increases in funding for mental health and in the courts, the various civil rights movements (i.e., women’s rights and disability rights), the societal interest in psychology and, eventually, gerontology. Additionally, I was fortunate to have various mentors and colleagues who were steadfast and encouraging. My parents too deeply influenced me.
They valued hard work and had a positive outlook on life. They were curious, innovative, had great senses of humor, and knew how to enjoy life. My marriage to Frank Quinn, a civil rights worker all his life, also helped me understand what leadership was about as well as the value and pleasures of a diverse work force.
My contact with elder abuse and neglect began when I started working as a Court Investigator. I couldn’t believe what I was seeing and hearing in the cases especially the financial abuse and the neglect of elders. It was astonishing and far outside my moral code of ethics. I was indignant and outraged by the cases and the rationalizations alleged abusers gave. That, by the way, never changed. Up to the date I left the court’s employment, I could always be surprised by the amount and types of abuse and neglect we were seeing, usually before a conservatorship was established. As recently as a week ago, I was told about a case where family members left Probate Code and proceeded to get into a physical fight in one of the court’s elevators. They left a trail of blood from the elevator to the door out the courthouse. They were quarreling about who should be their mother’s conservator.
During the twelve years as an investigator and twenty-two years as the director of the Probate Court, the judges, staff, and I were able to reduce the amount of elder abuse and neglect in existing conservatorships. We did this by paying attention to the cases that had “gone wrong” and by fashioning new judicial procedures. For instance, the court started requiring full bonding for all liquid assets and the recording of all conservatorship appointments with county government. We also initiated much closer monitoring of conservatorship cases by scheduling them for review on the court’s calendar rather than waiting for conservators to file their accountings.
Early on in my work with the Probate Court, I became aware that I was encountering situations that were not commonly seen by professionals working with impaired older adults in the community. I felt an obligation to inform and educate others because I had this unique knowledge and because they expressed interest. I began making presentations locally and nationally. In 1983 at the American Society on Aging (ASA) meeting in Albuquerque, I met Susan Tomita, a geriatric social worker from Harborview Medical Center in Seattle. We both were presenting on elder abuse and neglect and we were appalled by it. We were both seeing elder abuse and neglect in our respective work settings and we combined forces to publish the first clinical book in 1986 entitled Elder Abuse and Neglect: Causes, Diagnosis, and Intervention Strategies. We also did training for Adult Protective Services workers around the country.
I’ve gone on to write various articles on elder abuse and neglect, guardianships and conservatorships, and undue influence as it occurs with living elders. I wrote another book, this time on my own, which was published in 2005--Guardianships of Adults: Achieving Justice, Autonomy, and Safety.
In time, my curiosity led me to two major research projects. I received funding from California Administrative Offices of the Courts to examine the nature of existing guardianships in 2005. In 2010, I received funds from a private foundation, the Borchard Foundation Center on Law and Aging, to research undue influence as it occurs in community dwelling elders. These studies yielded important information and implications for clinical practice.
In addition to the day-to-day work of the Probate Court, by giving presentations, publishing articles, and conducting research I felt I discharged my duty to impart information that was needed by other practitioners. I’m grateful for the opportunities I’ve had and am pleased that I was able to recognize them as opportunities when they surfaced. Further, I’m grateful for the advice, assistance, insights from others over the years. It has been a good run. And, it’s not over.