Milwaukee VA Medical Center
Team rescues Veteran from 'atrocious' squalor
An elderly Veteran living in squalor, being preyed upon by neighbors and crooks, has been rescued thanks to a ground-breaking partnership between the Milwaukee VA Medical Center and the Wes Allis Fire Department.
The 79-year-old Veteran is now being treated at the Milwaukee VA, residing in the Community Living Centers until arrangements are finalized for his move to an assisted living facility.
The man’s plight was discovered by A.J. Ottow, a lieutenant with the West Allis Fire Department’s Mobile Integrated Healthcare program.
Launched last year, the proactive program seeks to address problems Veterans may be having before they wind up in the Emergency Department or worse.
After being alerted by Milwaukee VA staff, paramedics make house calls to Veterans, checking for unsafe living conditions, problems with medications or anything else that could endanger them.
In April, Milwaukee VA social worker Ann Baggett asked the West Allis crew to check on the Veteran – referred to in this article as Mr. H to protect his confidentiality as a VA patient -- after his recent actions and visits to the hospital raised some red flags.
Baggett discovered that Mr. H – who was a frequent visitor to the Emergency Department -- had not been seen by his primary care team in four years – despite Mr. H continually telling VA staff he was seeing his doctor and that everything was fine. And he seemed to be in good health.
"His room was absolutely atrocious. The bedsheets were threadbare, and the mattress – I wouldn’t have my worst enemy sleep on that mattress. And he had no clothes, no food."A.J. Ottow, West Allis Fire Department
But during recent visits, Mr. H was showing signs of physical decline and cognitive impairment, Baggett said: His shoes were ragged; he was complaining of foot pain, and his Parkinson’s disease appeared to be getting worse.
“He seemed more disheveled – not all the way confused, but you knew something was going on,” she said.
Mr. H had lived in the same rooming house for decades – a building he owned until recently, when he lost it due to financial hardship. He then became a tenant in the house, and it wasn’t long until unsavory neighbors and others started taking advantage of him.
It got so bad at one point that Mr. H spent a week sleeping under the porch.
When Baggett heard that, she alerted the county’s Adult Protective Services as well as the MIH team in West Allis.
And when Ottow arrived at Mr. H’s home, he was shocked and appalled.
“His room was absolutely atrocious,” he said, saying it was the worst situation he had ever seen. “The bedsheets were threadbare, and the mattress – I wouldn’t have my worst enemy sleep on that mattress. And he had no clothes, no food.”
There was no kitchen, no refrigerator or even a microwave oven. Mr. H had been subsisting on sweet rolls given to him by a neighbor.
Ottow learned that Mr. H’s Meals on Wheels deliveries were being stolen routinely, along with clothes he would receive via the county. He had been robbed at gunpoint just weeks prior, and a 22-year-old woman he referred to as his “fiancée” was continually scamming him out of cash.
Mr. H would go to his bank regularly to withdraw cash – often large sums of it – and when his neighbors caught on, the scamming, bilking and thefts escalated.
“This was by far the worst because it was on so many levels: It was on a health-care level. It was on a mental level. It was on a living situation. It was a safety consideration. It was neglect and malnutrition. And you had criminal aspects,” Ottow said.
‘100% not acceptable’
After that first visit, Ottow knew immediate action was needed.
“This was 100% not acceptable. … This required 911-like attention,” Ottow said, saying he alerted the Milwaukee VA and the county and sprang into action himself.
He contacted outreach groups that aid the homeless and Veterans, which responded with clothes, food, toiletries, furniture and new bedding for Mr. H.
Ottow personally cleaned up Mr. H’s room, hauling out multiple bags of garbage, repairing furniture and putting away his new clothes.
But more significantly, Ottow was able to convince Mr. H he needed to see a VA doctor, and an appointment was set for one week later.
When Ottow arrived to take Mr. H to his appointment, nearly all of the new clothes, bedding and toiletries were gone.
“That was it,” Ottow said, telling Mr. H, “We’re not coming back here.”
At the hospital, Ottow stayed with Mr. H until he was seen by medical staff – and he was confident there was no way he was going back to the boarding house.
“I told them, ‘I’m not leaving this guy. You do whatever you have to do. We’re not going anywhere,’” he said, saying he didn’t want a situation where he left and “20 minutes later, (Mr. H) was in a cab, going back home”
Mr. H was admitted to the hospital, which triggered a chain of events that led to a room in the Community Living Center. Family members were contacted, and plans are in motion to get Mr. H into an assisted living facility.
After Mr. H was admitted, Ottow returned to the boarding house and retrieved some of Mr. H’s valuables. When he returned to the hospital, Mr. H was showered and shaven.
“He looked like an entirely different guy,” he said. “I literally walked in a did a double take.”
Despite the signs being there, action to help Mr. H couldn’t take place sooner because Mr. H was continually lying to VA and county agents about his situation, downplaying his living conditions and shunning almost all attempts at aid, Baggett said.
Ottow believes it took someone such as him – wearing a uniform, representing a well-respected fire department – to get him to finally accept help.
“People trust the fire department,” Ottow said, noting he was able to cajole Mr. H into facing reality. “I think once I physically got in there and was able to spend time with him … and see what was actually going on compared to what he said was going on … is what really made it work.”
"It was a great save. It got (Mr. H.) out of a really horrible situation and into a pretty good place."Ben Thelen, Milwaukee VA Emergency Department program manager
But Ottow credited the collaboration among his department, Milwaukee VA and Adult Protective Services in creating the positive outcome.
“(Ottow) convinced him that he needed a higher level of care, which we tried to do but couldn’t,” Baggett said. “Getting him to that level of care is what was needed.”
“It had to be a collaborative effort,” she said. “If it wasn’t for West Allis getting in there with Adult Protective Services and with us (telling him), ‘You have to be admitted,’ you just don’t know what would have happened. It was an effort above and beyond.”
“It was a great save,” said Ben Thelen, Milwaukee VA Emergency Department program manager. “It got (Mr. H.) out of a really horrible situation and into a pretty good place. He’s now re-established with the VA … so there will be a structure and people to make sure he gets to his appointments.”
The MIH mission
The outcome reinforces the mission of the Mobile Integrated Healthcare program. Such programs – sometimes referred to as “community paramedics” -- are relatively new but gaining traction throughout the country, Ottow said.
“I really enjoy the program. It allows the Vets to realize they are not out here on their own,” Ottow said. “We’re there to help them with their needs and wants. The goal is to keep people as healthy and as happy as they can be.”
Thelen agreed, saying when Veterans come to the Emergency Department, they often won’t admit to their struggles with medication, food or housing.
“The beauty of the MIH program is that it’s immediate,” he said, noting the firefighters can get in the home, objectively assess the situation and build trust with the person.
“(That) is phenomenal,” he said “(Once that happens), there’s a lot we can do for these people, but we just need to get everything in alignment.”
It’s been less than a year since the Milwaukee VA cemented its relationship with the West Allis MIH, and it has already paid big dividends: Thelen said unnecessary Emergency Department visits have been reduced by 50%.
“It’s been really great,” Thelen said. “The Vets love it, and the staff likes knowing they have that option.”