January 1, 2016 Honorable James T. Kirk, Judge County Probate Court 123 Court Street Anytown, CA 12345 RE: Sue Jones CASE NUMBER: 2016-GI-00000 Mental health evaluation Dear Judge Kirk: Sue Jones is a 52 year old Caucasian female who was referred by the Court for a guardianship evaluation. Dr. Betty Rubble interviewed Ms. Jones at Anytown Nursing Home on January 1, 2016 for approximately 105 minutes. She was administered the Independent Living Scales on that date. Prior to the commencement of this evaluation and psychological testing, Ms. Jones was advised of the nature and purpose of the evaluation. Ms. Jones was informed that the resulting report was not confidential, and that information obtained could be included in the report that would be submitted to the Court. She was aware this information was not related to treatment, but rather for her current case. Ms. Jones was provided this information both orally and in a written format. She stated that she understood the information provided to her, including the limits of confidentiality and her rights concerning the evaluation. SOURCES OF INFORMATION: 1. Collateral contact with Wilma Flintstone, Ms. Jones’ legal guardian, via telephone on January 1, 2016. 2. General Hospital, psychiatric records. 3. Guardianship Services records. SOCIAL HISTORY: Ms. Jones reported that she was born on January 1, 1963 and reared in Kentucky. She said her father worked as a security guard and died eight years ago, while her mother worked as a waitress and died five years ago. She identified having a “good” relationship with her parents. Ms. Jones said she has two brothers with whom she has an “all right” relationship, as well as one older maternal half sister that she “[doesn’t ] get along with at all.” Ms. Jones stated that one of her brother has been diagnosed with bipolar disorder, and noted her brothers and her father had difficulties with alcoholism. She denied any childhood history of abuse and reported that she ran away from home at 17 years of age when she became pregnant. Ms. Jones reported that she lived independently until two years ago when she was placed in a nursing home. She said she remains in a nursing home against her will because the court has appointed her a legal guardian due to her alcoholism. She would like to return to her home of Nowhere, California, where her cousin lives. She said that she talks with her cousin regularly on the phone, but acknowledged that she has not seen her in many years. She does not want a guardian and would like to make her own decisions. According to her legal guardian, Ms. Flintstone, prior to her nursing-home placement, Ms. Jones was in sober housing. That home had staff present on site, but Ms. Jones continued to drink alcohol and visit hospital emergency rooms to obtain opiates. EDUCATION HISTORY: Ms. Jones stated that she last completed the 9th grade and had “all right” grades. She said that she was not diagnosed with any learning.

1. January 1, 2016
Honorable James T. Kirk, Judge
County Probate Court
123 Court Street
Anytown, CA 12345
RE: Sue Jones
CASE NUMBER: 2016-GI-00000
Mental health evaluation
Dear Judge Kirk:
Sue Jones is a 52 year old Caucasian female who was referred
by the Court for a guardianship evaluation.
Dr. Betty Rubble interviewed Ms. Jones at Anytown Nursing
Home on January 1, 2016 for approximately 105 minutes. She
was administered the Independent Living Scales on that date.
Prior to the commencement of this evaluation and psychological
testing, Ms. Jones was advised of the nature and purpose of the

2. evaluation. Ms. Jones was informed that the resulting report was
not confidential, and that information obtained could be
included in the report that would be submitted to the Court. She
was aware this information was not related to treatment, but
rather for her current case. Ms. Jones was provided this
information both orally and in a written format. She stated that
she understood the information provided to her, including the
limits of confidentiality and her rights concerning the
evaluation.
SOURCES OF INFORMATION:
1. Collateral contact with Wilma Flintstone, Ms. Jones’ legal
guardian, via telephone on January 1, 2016.
2. General Hospital, psychiatric records.
3. Guardianship Services records.
SOCIAL HISTORY: Ms. Jones reported that she was born on
January 1, 1963 and reared in Kentucky. She said her father
worked as a security guard and died eight years ago, while her
mother worked as a waitress and died five years ago. She
identified having a “good” relationship with her parents. Ms.
Jones said she has two brothers with whom she has an “all
right” relationship, as well as one older maternal half sister that
she “[doesn’t ] get along with at all.” Ms. Jones stated that one
of her brother has been diagnosed with bipolar disorder, and
noted her brothers and her father had difficulties with
alcoholism. She denied any childhood history of abuse and
reported that she ran away from home at 17 years of age when
she became pregnant.
Ms. Jones reported that she lived independently until two years
ago when she was placed in a nursing home. She said she
remains in a nursing home against her will because the court has
appointed her a legal guardian due to her alcoholism. She would

3. like to return to her home of Nowhere, California, where her
cousin lives. She said that she talks with her cousin regularly on
the phone, but acknowledged that she has not seen her in many
years. She does not want a guardian and would like to make her
own decisions.
According to her legal guardian, Ms. Flintstone, prior to her
nursing-home placement, Ms. Jones was in sober housing. That
home had staff present on site, but Ms. Jones continued to drink
alcohol and visit hospital emergency rooms to obtain opiates.
EDUCATION HISTORY: Ms. Jones stated that she last
completed the 9th grade and had “all right” grades. She said
that she was not diagnosed with any learning disabilities, but
offered, “I skipped school a lot.” She denied receiving any
further education.
WORK AND MILITARY HISTORY: Ms. Jones denied any
military history. She said she has held “quite a few jobs,”
including positions as a waitress, factory worker, and
convenience-store manager. She said her longest position was
the convenience-store job, which lasted for three years. Ms.
Jones indicated she was never fired from any jobs. She
estimated she most recently worked 20 years ago. She has
received SSDI benefits for at least 20 years for being “bipolar”
and “schizophrenic.” Ms. Jones indicated she has a payee to
manage her finances, and she does not mind having one.
RELATIONSHIP HISTORY: Ms. Jones has been married once
and is currently divorced. She indicated she “ran away” to New
York with a boyfriend at 17 years of age because she was
pregnant. She ultimately had an abortion and was unable to bear
children thereafter. Ms. Jones was married from 1982 to 1992.
Her husband worked as a contractor. She said they divorced
because he was “always in jail.” Her most recent romantic
relationship was “five years ago.” She indicated she left that
man because “we argued a lot” and he engaged in domestic
violence against her. Ms. Jones said she is not dating at this
time.

4. SUBSTANCE USE HISTORY: Ms. Jones reported that she first
drank alcohol at 16 years of age, during which time she drank
on “weekends.” She said her heaviest use of alcohol occurred in
her 30’s and 40’s, during which time she drank a “30-pack” of
beer daily. She offered, “I’m an alcoholic,” but indicated she
has been sober for the past three years that she has been in
nursing homes. Ms. Jones reported that she developed tolerance
to alcohol, experienced withdrawal symptoms when she could
not drink, craved alcohol, gave up important activities to drink,
had difficulty controlling her alcohol use, frequently drove a
vehicle under the influence of alcohol, and continued to drink
despite the legal and financial problems it caused her.
Ms. Jones said that she first used marijuana at 16 years of age,
during which time she used that substance once every few
weeks. She said her heaviest use of marijuana was in her 40’s,
when she used marijuana daily. She stated that she last used
marijuana three years ago. Ms. Jones reported that she gave up
important activities to use marijuana and frequently drove a
vehicle under the influence of marijuana, but otherwise denied
any problems associated with her use of that substance.
Ms. Jones reported that she began using crack cocaine in her
40’s, when she used that substance a “couple times a week.”
Again, she indicated she stopped using that substance three
years ago. Ms. Jones reported that she developed tolerance to
cocaine, craved it, had difficulty controlling her use of that
substance, spent a great deal of time involved in activities
related to her cocaine use, gave up important activities to use
cocaine, frequently drove a vehicle under the influence of
cocaine, and continued to use it despite the financial problems it
caused her.
Ms. Jones indicated that she began abusing her Percocet
prescription in her 40’s. She said that whenever she ran out, she
bought more off the street. She estimated that she took four to

5. five pills per day. Ms. Jones reported that she gave up important
activities to use opiates and frequently drove a vehicle under
the influence of opiates, but otherwise denied experiencing any
difficulties related to her use of opiates.
With regard to substance-abuse treatment, Ms. Jones said she
received inpatient treatment due to her alcohol dependence in
her 30’s. When asked how she would prevent substance relapse
if in the community, Ms. Jones replied, “I’d plan on going to
meetings” and get a “sponsor.” When asked how she would
attend such meetings, she responded, “Have someone pick me
up.” When asked who might be able to do so, she replied, “I
don’t know,” but possibly “friends” or other people in
Alcoholics Anonymous.
LEGAL HISTORY: Ms. Jones denied any juvenile legal history.
She reported that as an adult, she was convicted of “Petty
Theft” once after she stole a candy bar from a store and ate it in
front of the clerk because “I was trying to go to jail to see him”
(her husband). Ms. Jones indicated she also has one “DUI”
conviction as well.
MEDICAL HISTORY: Ms. Jones reported that she cannot walk
due to neuropathy related to diabetes. She said she also has
COPD, cirrhosis of the liver, and cancer in her left kidney. She
could not recall all of her current medications, except that she
takes ibuprofen for pain related to cancer and insulin for
diabetes. She denied any history of seizure, stroke, coma, or
traumatic brain injury. Ms. Jones identified her only surgeries
as a tonsillectomy and an appendectomy.
Records from General Hospital indicate Ms. Jones has cirrhosis
of the liver, COPD, diabetes mellitus type II,
hypercholesterolemia, hypothyroidism, GERD, hyperlipidemia,
pulmonary disease, endocrine disease, and hypertension. Her
surgeries, serious illnesses, and accidents included an
appendectomy, cholecystectomy, tonsillectomy, and
adenoidectomy, and right ankle fracture.

6. PSYCHIATRIC HISTORY: Ms. Jones denied any history of
inpatient psychiatric hospitalizations. She said she received
began receiving outpatient psychiatric services many years ago,
and is currently a patient at Psychological Services. Ms. Jones
said she has been prescribed “Risperdal, Haldol, Geodon,
Trazodone, and Seroquel” in the past, but was unsure what she
is taking now. She indicated that without the medication, she
hears “voices.” She stated that she is unable to discern what the
voices are saying because they are “like in the distance.” She
indicated that she has never been frightened of the voices or
experienced any delusions or paranoia.
Ms. Jones also reported a history of mood disturbance. She said
she has attempted to commit suicide on two occasions, once by
cutting her wrists and once by attempting to overdose on her
medications. She estimated those occurred in her 30’s and 40’s.
Ms. Jones reported that she has also experienced symptoms
consistent with mania, including a decreased need for sleep for
three days, a significantly increased energy level, and increased
goal-directed activity; specifically, shopping and spending all
of her money on clothing and household items. She said that
during those periods, she did not experience any grandiosity,
racing thoughts, or rapid speech. Ms. Jones reported that those
periods would cease when her friends would encourage her to
resume taking her medications and go to see her counselor.
Records from General Hospital indicate on January 1, 2014, it
was determined that Ms. Jones should be placed in a nursing
home. She was diagnosed with schizoaffective disorder,
cannabis abuse, and borderline personality disorder. It was
noted that during periods of psychological decompensation, Ms.
Jones becomes physically and verbally aggressive and
moderately violent. She has also had auditory hallucinations.
When informed that she would be going to a nursing home, Ms.
Jones became verbally abusive, swung her walker at others,

7. threatened to harm others, and threatened to harm herself.
Indeed, she reportedly grabbed a phone cord and wrapped it
around her neck. It was indicated that Ms. Jones had a lengthy
history of psychiatric hospitalizations and had not been
compliant with medications. Within the previous 30 days prior
to that report, Ms. Jones’s symptoms included suicidal thoughts,
suicidal threats, suicidal attempts, gestures, medication refusal,
lability, hallucinations, anxiety, worry, panic reactions, verbal
aggression, physical aggression, combative behaviors,
destructive behaviors, threats toward others, abrasiveness,
irritable behaviors, disruptive behaviors, conflicts with others,
inappropriate communication of anger, self-injurious, self-abuse
behaviors, need for restraints, refusal of care, resistance
receiving care, inappropriate statements, inappropriate
behaviors, and homicidal behaviors. It was reported that Ms.
Jones required assistance with decision making, judgment,
mobility, and ambulation.
In a similar assessment at General Hospital on January 1, 2015,
it was again opined that Ms. Jones required nursing home
placement. Her diagnosis at that time was bipolar disorder not
otherwise specified and schizoaffective disorder.
PSYCHOLOGICAL TESTING: On the Independent Living
Scales, Ms. Jones obtained a Full Scale score of 95, in the
moderate range of functioning, consistent with individuals who
live semi-independently. On the Memory/Orientation and Health
and Safety subscales, her scores were in the high range,
consistent with individuals who live independently. However,
her scores on Managing Money, Managing Home and
Transportation, and Social Adjustment were all in the moderate
range. Her scores on Problem Solving were in the high range,
but her scores on Performance/Information fell in the moderate
range.
Specifically, on the Memory/Orientation items, Ms. Jones can
remember her phone number and address and recall a list of

8. items and the details of an appointment. She was well oriented
to time and place. On the Health and Safety items, she was
aware of how to call the police, get medical help, and handle
her physical care and hygiene. She was also aware of how to
take precautions to protect her safety. On the Managing Money
items, Ms. Jones knew how she was supported financially, knew
how to complete a money order, knew why it was important to
pay bills, knew what health and home insurance are for, knew
the purpose of a will, and knew why it was important to read
documents carefully. On the other hand, she was unable to
calculate how much change she should get back for a small
purchase and was unable to perform basic math calculations. On
the Managing Home and Transportation items, Ms. Jones knew
how to use the phone, address an envelope, utilize public
transportation, and figure out how to get home repairs done.
However, she was unsure how to manage routine household
problems or utilize a map. On the Social Adjustment items, Ms.
Jones does not have any regular, in-person contact with anyone
and was not sure she would be missed if she was no longer
around. With regard to Problem Solving, Ms. Jones exhibits
adequate ability to manage situations requiring reasoning
ability. However, the Performance/Information items indicate
she cannot perform many tasks independently and does not
know the basic information for answering a question.
MENTAL STATUS EXAMINATION:
Appearance, Attitude, & Behavior: Ms. Jones is a 52-year-old
Caucasian female of average height. She is overweight and used
a wheelchair. She has short brown and grey hair. She was
casually dressed and she had good hygiene. She made
appropriate eye contact. She provided information in a clear and
coherent manner, and she did not demonstrate any unusual
physical movements. She needed glasses to read. Ms. Jones was
cooperative and pleasant during this evaluation. She was
friendly and offered personal information with ease. As the

9. interview was conducted in her room, this examiner noted Ms.
Jones kept her room neat and tidy.
Speech, Perception, Thought Process, & Thought Content: Ms.
Jones’s speech was normal in tone and volume. Ms. Jones
denied experiencing any current delusional beliefs, auditory or
visual hallucinations, and there was no indication by her
behavior or speech that she was experiencing any perceptual
disturbances during this evaluation. Her thought process was
logical and goal-directed.
Mood & Affect: Ms. Jones did not present with any observable
symptoms of mania, including an abnormally elevated or
irritable mood, grandiosity, increased talkativeness, or racing
thoughts. In addition, Ms. Jones denied current suicidal and
homicidal ideation. Her mood was euthymic and her affect was
appropriate.
Cognition: Ms. Jones was oriented to person, place, and date.
Her recent and remote memory were intact as demonstrated by
her ability to recall recent and past personal information with
ease. Ms. Jones displayed no difficulties with immediate recall,
and could recall three of three words after a brief delay. Her
attention and concentration were adequate, and she was able to
spell world backwards and perform Serial 7 subtractions without
error. Ms. Jones was able to sustain attention without difficulty
throughout this interview.
Overall, results of the Folstein Mini-Mental State Exam
indicated normal functioning (score 30 out of 30) in the areas of
orientation, immediate recall, attention and calculation, recall,
and language.
Insight & Judgment: Ms. Jones appeared to have good insight
into her mental-health issues. When asked, “What do you do if
you are the first person in a movie theater to see smoke and
fire?” Ms. Jones replied, “Holler ‘Fire’ and get out,” and tell
others to leave. When asked, “What would you do if you found
on the street of a city an envelope that was sealed, addressed,
and stamped?” she responded, “If it’s money, I’m keeping it,”

10. but “maybe take it to the post office” otherwise. When asked,
“Why shouldn’t people smoke in bed?” she replied, “Might
catch fire.”
DIAGNOSIS (DSM-5):
1. Alcohol Use Disorder, Severe, In a Controlled Environment
(303.90)
Ms. Jones has a problematic pattern of alcohol use. She reported
that she developed tolerance to alcohol, experienced withdrawal
symptoms when she could not drink, craved alcohol, gave up
important activities to drink, had difficulty controlling her
alcohol use, frequently drove a vehicle under the influence of
alcohol, and continued to drink despite the legal and financial
problems it caused her.
2. Stimulant Use Disorder, Severe, In a Controlled Environment
(304.20)
Ms. Jones also has a problematic pattern of crack cocaine use.
She reported that she developed tolerance to cocaine, craved it,
had difficulty controlling her use of that substance, spent a
great deal of time involved in activities related to her cocaine
use, gave up important activities to use cocaine, frequently
drove a vehicle under the influence of cocaine, and continued to
use it despite the financial problems it caused her.
3. Unspecified Bipolar and Related Disorder (296.80)
Ms. Jones reported a history of manic episodes during which
she experiences a decreased need for sleep, a significantly
increased energy level, and increased goal-directed activity. At
times, she has reportedly experienced auditory hallucinations as
well. However, it is difficult to determine the extent to which
her significant substance abuse and maladaptive personality

11. traits contribute to her mood disturbance.
4. Borderline Personality Traits
Ms. Jones also displays a pervasive pattern of instability in her
interpersonal relationships and affects, as well as marked
impulsivity. She has shown recurrent suicidal behavior,
gestures, and threats.
5. Opioid Use Disorder, Mild, In a Controlled Environment
(305.50)
Ms. Jones reported that she abused her narcotic pain
medication, Percocet. She said she gave up important activities
to use opiates and frequently drove a vehicle under the
influence of opiates.
6. Cannabis Use Disorder, Mild, In a Controlled Environment
(305.20)
Ms. Jones reported that she used marijuana daily for many
years. She said she gave up important activities to use
marijuana and frequently drove a vehicle under the influence of
marijuana.
OPINION: According to all available information, Ms. Jones
has adequate cognitive skills to reside semi-independently at
this time (with significant assistance from case managers and
other professional services). However, her psychological
functioning is only at this adequate level currently because of
the structure and supervision provided by the nursing home.
Indeed, when last in an independent housing situation, Ms.
Jones was heavily abusing alcohol and cocaine as well as
marijuana and opiates. It does not appear that she has any
significant periods of sobriety while living in the community.
She was not always compliant with her psychotropic medication
due to her substance use and other factors, which has resulted in

12. psychological decompensation for her bipolar disorder. Ms.
Jones also has a lengthy history of suicide attempts and
aggression towards others. In addition, Ms. Jones has several
serious medical conditions, including but not limited to: the
inability to ambulate without a wheelchair, cancer, cirrhosis,
and diabetes. Despite all of the aforementioned issues, Ms.
Jones continues to believe that she could live independently in
her own apartment, which is unrealistic. She does not have an
adequate plan for maintaining sobriety and it is unlikely that
she would be able to do so without her current level of support.
Therefore, at this time, it is recommended that she continue to
receive guardianship services.
Respectfully Submitted,
Dr. Betty Rubble
p. 7
Chapter 12
Employee Benefits
Benefits Planning
attracting, motivating and retaining good employees in a

13. competitive environment.
satisfaction.
packages.
y
employers accommodate diverse employee needs.
-friendly and flexible-workplace benefits .
•Social and recreational events
•Employee assistance programs
•Credit unions
•Housing
•Tuition reimbursement
•Paid jury duty time
•Uniforms
•Military pay
•Paid transportation and parking
•Free food
•Childcare services or referrals
•Pet health insurance
•On-site fitness centers
•Free massages
•Haircuts
•On-site health care
of the content
of their benefit packages.

14. -mails, social
media, employee handbooks, newsletters, lunch and learn
sessions, online benefits information.
Legally Required Benefits
Social Security:
based on a percentage of earnings.
surviving dependents .
Medicare .
https://www.ssa.gov/
state tax imposed on taxable wage base.
experience: the more layoffs, the higher the rate.
during periods of involuntary unemployment.
beyond 26 weeks when unemployment is high.
unemployment benefits:
e job offered through the
state agency.
-30 weeks, most pay 26 weeks

15. the type of industry.
or compensate for losses
resulting from work-related accidents or illness, regardless of
fault.
Employers have a right and should investigate
employee claims
(COBRA).
years after an employee leaves a job.
- The Health Insurance Portability and Accountability
Act of 1996:
nd health providers to protect the
confidentiality of employee health information .
https://www.hhs.gov/hipaa/index.html
duals must purchase minimum coverage or pay
fine.

16. loyees who do not
provide coverage
coverage
-existing coverage and lifetime limits
a critical benefit.
care costs are growing faster than wages.
employees pay.
centives for participation in wellness
programs.
-order with smaller co-pays or
mandatory generic prescriptions.

17. clinics.
1973.
“in network”.
ganizations (PPOs)
doctors, hospitals and medical service facilities in exchange for
reduced cost.
high deductibles.
employee.
HDHP, but more popular with employees because
it includes a Health Savings Account (HSA). Usually includes:

18. ry continuation for:
-term disabilities (sick leave)
-term disabilities (coverage usually effective
after 6 months)
to not use their sick leave.
-term disability plans usually replace a
rance
five-times the employee’s
Flexible Spending Accounts:
federal, state, and social security taxes for specified services
such as:
-care premiums
have lossen a little bit
Retirement Benefits

19. me Security Act (ERISA) of 1974:
– right to pension benefits even if one leaves
the company.
aims corporate assets to cover inadequately funded pension
plans.
retirement.
average final compensation.
in government and unionized industries.
rules established for contributions.
investments.
rchase Pension Plans
-Sharing Plans
businesses to buy insurance.
Leave Benefits

20. illness, vacation, personal time or holidays.
Benefits in a Global Environment
consider: