A family at war, and Kay Dexter is caught in the crossfire.
Geriatric care manager Kay Dexter is savvy, fierce and determined as she protects and advocates for elderly clients. Kay left the big city to care for her parents in their small mountain town, so she knows from experience that eldercare is hard on families.
Betty Garvin needs Kay, especially when her daughters battle over Betty’s care. Kay tries to mediate the dispute, and finds herself on the front lines. Is there more to the conflict than the sisters’ concern for their mother’s health? Does Betty’s valuable estate come into play?
When the two daughters go to war, someone winds up dead. And Kay could be collateral damage.
“In this suspenseful novel, Janet Dawson tackles one of the most serious problems facing us today: how to provide for an increasing population of aging citizens. Well-researched, with engaging characters and vivid settings, this is another winner for Dawson.”
—Marcia Muller, author of the Sharon McCone series and Grandmaster, Mystery Writers of America
“Kay Dexter helps her clients navigate the changes and challenges that come with growing older—issues that can lead to discord in even the best of families. Can lead, in fact, to murder. Award-winning author Janet Dawson has crafted a fine tale of the high price one family pays for its greed, lies, and misplaced loyalties. The Sacrificial Daughter is a satisfying first entry in a promising new cozy mystery series, and Kay Dexter is a heroine you’ll want to have on your side.”
—Margaret Lucke, author of the Jess Randolph series and the Claire Scanlan Haunted House mystery series
“I’m at my wit’s end,” Sheryl Garvin said.
I could see that.
She had the stretched-too-thin aura of someone who wasn’t getting enough sleep. Her voice sounded tired. Her manicured fingertips played with the heavy gold chain around her neck. She had been fiddling constantly with the necklace ever since she arrived. The diamonds in her matched wedding set sparkled in a shaft of afternoon sun from the window.
Like me, Ms. Garvin was a woman in her fifties. She sat in a comfortable chair in my office, wearing tailored blue slacks and a matching jacket, the necklace set off by the scooped neck of her pale pink blouse. Her face was angular and sharp-featured, her short brown hair expertly cut and styled, with no sign of gray.
I had offered coffee at the start of the appointment, but Ms. Garvin declined. I took a sip from my mug and set it on the table to my right, next to the purple African violet, the ceramic bowl containing my business cards, and the folder I’d prepared for this prospective client.
“Tell me what’s going on,” I prompted.
“Last Thursday, she left the stove on. Again.” She rubbed the chain between thumb and forefinger, as though it was some sort of talisman. “I’ve told Mother repeatedly not to use the stove, that she needs to use the microwave to heat food. Only the microwave. But she forgets. She put some eggs into a saucepan to boil. Of course, she forgot them. The water boiled dry, the eggs exploded, and the smoke alarm went off. The fire department came. That’s the second time she’s done that this year. One of the neighbors called me and I got on a plane.”
“You don’t live nearby,” I said.
She left off worrying the necklace as she shook her head. “No, Ms. Dexter, I don’t. I live in Seattle. I have lots of commitments. Once again, I had to take time off to come down here and deal with Mother. The last time I made the trip was because she drove her car to the grocery store and got in an accident, a small one, just a fender-bender. I’m really concerned about her.” She pressed her hands against her temples, as though attempting to push the feelings back into her head. “I try to visit every couple of months, but it’s not enough. I know that.” She sighed. “I insisted that she get one of those alert devices, but half the time she won’t wear it. She leaves it hanging on a doorknob or on her dresser. I hired a caregiver to visit Mother several hours a week. The aide lasted two days. Mother fired her.”
“I hear that a lot.” My smile was meant to be reassuring, but it didn’t relieve her tense expression. “How old is your mother?”
“Eighty-seven. She was fine until—” She stopped and thought for a moment, her fingers plucking at the chain again. “It’s been a couple of years now that I started noticing Mother’s memory loss. I realized it had been going on for a while before that. It was gradual, over several years. It’s Alzheimer’s, senile dementia, I guess.”
I nodded. I’d had this conversation many times, with many different people. Regardless of who was sitting in the chair across from me, the feelings of frustration and helplessness were the same. “Memory loss and senile dementia can be caused by many things, some of them physical. If you haven’t already done so, I suggest that you and your mother visit her doctor.”
“I’ll see what I can do,” Ms. Garvin said. “Mother hasn’t had a check-up since her doctor died last year. I’ve suggested it, but she insists that she’s fine. And she doesn’t want to see anyone except the doctor she went to for so many years. I’ve told her several times that he died, but she forgets.”
“When are you going back to Seattle?” I asked.
“As soon as reasonably possible. This latest incident with the fire department happened on Thursday. I took time off work and came down here. I do have some important obligations at work, things it will be difficult for me to get out of. And my husband—” Ms. Garvin frowned as she twisted the chain. “I had to back out of an event with his family this past weekend. My husband wasn’t happy about that. It’s Monday now. I really would like to get Mother settled and go back by the end of the week.”
I could make that happen, I thought, if she decided to hire me. I had more questions, though. “Do you have any other family members who could help you deal with your mother’s situation? Siblings, cousins?”
“I had an older brother. He died a long time ago.” She paused. Her frown deepened. “My younger sister is out of the picture, has been for years. I’m not sure where she is. As far as I know, she hasn’t been in contact with Mother. I do have a few cousins. But my mother was the youngest sibling in her family. All her brothers and sisters are dead. There aren’t any relatives in the immediate area, no one I can call on for help, not on a regular basis. Besides, what relatives are left all have their own obligations, just like me.”
“So, there’s no one else,” I said.
She shook her head and sighed again. “No. I’m it. I’m the one who has to take care of my mother. I hesitate to take the car away from her, but I don’t want her to get into another accident. I plan to sign her up for Meals on Wheels deliveries. She hasn’t been eating properly. If she’s left to her own devices, she’d live on cottage cheese and crackers. Sometimes canned soup. Whatever is handy, but that sort of diet is not particularly nutritious. Certainly not enough fruits and vegetables. Her neighbor has been kind enough to buy groceries from time to time, but that’s a temporary fix.”
Her fingers moved once again to the gold chain. Then, realizing what she was doing, she folded her hands in her lap, attempting to keep them still. “I’ve suggested hiring a caregiver, several times. She says she doesn’t want any strangers in her house. I’ve also brought up the subject of Mother moving to a senior apartment or an assisted living facility. But she won’t consider any of those things. She could certainly afford it. Her financial situation is comfortable. She’s lived in the same house for over fifty years. She wants to stay in her own home.”
I nodded. “Most people do. And I find that forcing an elderly parent into a facility often backfires.”
“Even if that elderly parent can’t cope with living alone?” she shot back.
“It’s a natural feeling,” I said. “Most of us don’t want to admit that we need help.”
“Mother won’t admit it, that’s for sure,” she said. “But I need help. Long-distance caregiving has got me completely frazzled. I’m not coping very well. That’s why I’m here.”
Her bag was on the floor near her feet. She leaned down and reached inside, pulling out a business card, bent at the corner. It bore the logo and name of my care management firm, with my name, Kay Dexter, and my contact information printed below that. “My mother’s neighbor gave me this card. She told me you’re a care manager. Just what is that? And what could you do for me and my mother?”
I appreciated the referral. Word of mouth was how I got much of my business.
“A geriatric care manager plans and coordinates care of aging adults or others who have ongoing health issues. My firm specializes in assisting older people and their families with long-term care arrangements. Frequently our clients are people in situations like yours, an aging parent here in town, with family members living elsewhere. We also help people with physical or mental impairment, although the majority of my clients are older adults.” I reached for the folder and handed it to her. “I’ve collected some information that will explain it in more detail.”
“Thanks.” She opened the folder and sifted through the papers and brochures.
I continued with my explanation. “What I can do to help you and your mother varies, depending on her needs, and yours. The first step is for me to assess your mother’s situation. That will serve as a road map to guide us. I’ll recommend services that will help improve her quality of life. And reduce your stress level.”
She looked skeptical. “All of that sounds good, Ms. Dexter. But I’d like to hear some examples.”
I nodded. “First, I’ll look at your mother’s housing situation, to see if she’s a good candidate to stay in her own home. If that’s possible, I can help make that happen, such as determining what kind of home care services she needs. I’ll also monitor her at home and recommend adding things to help with her safety, such as grab bars at various locations in the house. The best choice may be that she stays in her home, helped by these modifications and caregivers. Those could be people like a home health aide, either one that visits or one that lives with her, or people to come in, help her bathe, buy groceries, cook simple meals. There are lots of possibilities there. And if I feel she shouldn’t stay in her home, I’ll recommend appropriate facilities and help you evaluate and select where your mother should live.”
“Good luck with that.” She looked doubtful, fingers tweaking the gold chain. “What if she won’t agree to a caregiver, or she won’t go to an assisted living place?”
I smiled. “Let’s take it one step at a time. I’ve had good results persuading people like your mother to act in their best interests. Sometimes the suggestion is better received if it comes from me, rather than a family member. If you like, I can assist you in monitoring her finances. I also help with medical management. That means going with your mother to doctors’ appointments, helping you and your mother communicate with doctors, and if need be, making sure your mother is following her doctors’ instructions and taking her prescribed medications.”
She nodded, her expression moving from doubtful to thoughtful. “What are your qualifications and experience? And your references?”
“I’m happy to provide you with references,” I said. “As for my qualifications, I have an MSW, a master’s degree in social welfare, from the University of California in Berkeley. I’ve had additional training in gerontology, the study of aging. I have experience working in Alameda County, as a social worker for Adult Protective Services. Then I was a health care social worker for a hospital. I became interested in working with elderly people and worked as a geriatric care manager with a firm in Oakland. Several years ago, I moved here to Rocoso and started my own firm. I have two other care managers working with me. One has a lot of experience as a social worker, and the other is a registered nurse who has worked extensively with elderly people.”
“Why here?” she asked. “After working in the Bay Area?”
“Aging parents, just like you. I know what it’s like. I’ve been where you are, worrying about my parents. I moved back up here before my father died. After he was gone, I stayed, to be close to my mother, and to fill a need here in town.”
She stared at the folder on her lap, then she looked up. “Okay. What I’m hearing sounds reasonable and workable. I’d like to move ahead. What’s the first step?”
“Please fill out the preassessment form. It’s the one on the right side of the folder,” I said. “As you do that, you can describe your concerns in more detail. The information gives me an overview of the situation with your mother. Ordinarily, I would say take as much time as possible to answer the questions. But you’re in town for just a few days, so it would be helpful if you’d fill out the form now. Then we’ll set a time for the care-planning assessment. That involves a home visit with you and your mother, perhaps two visits. The home visit can take an hour or two. While I’m there, I’ll take a look at her living situation, to see what issues she has around safety. And transportation. You said earlier your mother still driving,”
“Yes, but that needs to stop,” she said. “She had several minor accidents. Her eyesight isn’t as good as it used to be. I know her eye doctor mentioned cataracts, but he didn’t think surgery was needed at the time. That was several years ago and I’m sure the diagnosis has changed. I don’t know when her driver’s license is up for renewal. I’ll check that later.”
“Good idea. If her driver’s license needs to be renewed and she can’t pass a test, that may make it easier to get her to stop driving. The physical therapy department at Rocoso Medical Center has a computerized driving simulation test that looks at things like reaction time. We could schedule your mother for a test, to see how she does, and then make a recommendation that she stop driving.”
She nodded. “The suggestion comes from the medical people, not me nagging Mother to stop driving. I like that.”
“Exactly,” I said. “As for alternate transportation, we do have a senior ride program here in the county. I can provide information on that when I do the assessment. I will need a list of the medications she’s taking, how much, and how often. If you decide to hire me as your mother’s care manager, I will go with her to doctors’ appointments to make sure we’re all on the same page in terms of her medical issues and prescriptions. We’ll also talk about your mother’s meals and nutrition, as well as her legal and financial situation. I’ll make recommendations based on my assessment, and you and I can work with your mother to make some decisions. We have a very good senior services system here in Rocoso, with lots of resources. We’ll do what we can to keep your mother in her home. Having a caregiver is a good start. Together we might be able to persuade your mother to accept one. If she can’t continue living in her own home, we can look at what alternatives might work for her, such as assisted living. Once the assessment is done and the recommendations are made, I’ll monitor your mother regularly.”
“Let’s do it. As soon as possible. I’d like to hire you as Mother’s care manager. Starting now.”
“That’s fine,” I said with a nod, reaching for the appropriate paperwork. After those formalities were done, I stood and walked to my desk, where the calendar showed the week’s appointments. Today was Monday. Did I have a two-hour block free in the next few days? Yes, another appointment had been rescheduled, leaving a slot free on Tuesday. “As for the assessment, I have time early tomorrow afternoon. Would one o’clock work for you?”
She looked up from the form she was filling out. “Yes, it would. Mother’s name is Betty Garvin. She lives on Juniper Street.” She gave me the house number.
I noted the appointment on the calendar, then picked up the mug and carried it to the small kitchenette in an alcove off the main office. I dumped the rest of the coffee into the sink, rinsed the mug, and set it to dry on a dish towel.
When I returned to my office, she had finished filling out the form. I looked it over and we discussed the additional information and records needed for the assessment visit and preparation of a written care plan. “Getting those documents shouldn’t be a problem. I have power of attorney for Mother’s financial and medical matters. I also have a lawyer here in town, John Fielding at the Guisewhite firm.”
I nodded. “I know John. I’ve had dealings with him.”
She stood to leave. The appointment had taken about forty minutes. I walked her out and shut the door. The front office window was open, letting in some air on this May afternoon. Sheryl Garvin stopped a few paces from my door, took her phone from her bag, and peered at it. She touched the phone’s screen several times and raised it to her ear.
Unlike the more serious tone she’d used during our meeting, her voice on this end of the conversation was bantering and intimate. “I got your message. Of course, I want to see you.” She laughed. “Not dinner, I’m afraid. A drink. Sure, I’ll meet you there. Fifteen minutes.” She ended the call and tucked the phone back in her bag, walking toward the street.
She had been my last appointment of the day and while she was here in the office, I’d turned off the ringer on my cell phone, and the office phone had been forwarded to voice mail. I checked messages and email, responding to both. Then I leaned back in my chair and did a more careful and thorough read-through of the multi-paged preassessment form Sheryl Garvin had filled out, making notes on a lined pad.
Betty Garvin had lived in the same house for over fifty years. That meant Sheryl had attended Rocoso High School, as I had. At the time, it was the only high school in town. I didn’t remember Sheryl at all, but that wasn’t unusual. I was in my mid-fifties and I guessed Sheryl was a few years younger. Nor did I recall her younger sister. But I remembered her older brother. He had been a year ahead of me in high school. His name started with a G – George? Gary? No, Greg, that was it. He had played sports, football, but he hadn’t been one of the outstanding players. After graduation from high school, he’d gone off to college. Then he died, a year or two later. By that time, I, too, had gone away to college, far from home and the Rocoso grapevine. I’d heard that he’d died in a car accident but had no details.
During her meeting with me, Sheryl Garvin looked frazzled. And I knew why. I saw it all the time. She was the only one available to look after her mother. Her brother was dead and she wasn’t sure where her sister was.
Or so she said.
Something didn’t feel right. It wasn’t major, setting off alarm bells. Just a feeling I had, that gave me some reservations. The expression on Sheryl’s face when she mentioned her sister hinted that there was more to the story than simply losing contact with her remaining sibling. There was estrangement there, something that ran deep and bitter.
Eventually, I’d find out what it was. I usually did.