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  1. Final countdown

    Nearing the end of my time in this RN Case Manager job.

    It’s a daily struggle to force myself to say “This cannot be my problem anymore”. 

    • Uncontrolled diabetes and living with caregivers who may or may not be correctly dosing, if at all, insulin and checking blood sugar levels twice a day?
    • Just found out from this physician that this person hasn’t followed up for scheduled appointments in almost a year?
    • This person left the nursing home against medical advice, before her therapy was complete, to live with her daughter with a history of financial exploitation of her own mother and keeping her locked in a crack house?
    • This person may or may not be filling her medications at one of 3 pharmacies and may or may not be taking them correctly because 2 of the medications have very similar names but are for very different diagnoses?

    All of these things and more. Cannot be my problem. 

    All I can do is write it down and offer advice for follow up to whoever is taking over this case in my absence until the new nurse is hired. 

    Can’t be my problem, but I can sure continue to stress out about it. Because when you’ve been working with the same clients for 5 years, you get a bit emotionally invested in their well-being. You know those clients inside and out, all their behavior patterns, the best approach for their caregivers, how to follow up with their doctors for the best response. Long term care is intense and you can give all the advise you want to the new nurse, but the new nurse is still basically going to start from scratch. Because the new nurse doesn’t know that client. But s/he’ll learn. Hopefully.

  2. Possibly my best assessment to date.

    1. Me: Can you tell me who the president is?
    2. Client: Barack Obama.
    3. Me: And who was president before that?
    4. Client: George Bush.
    5. Me: And before that?
    6. Client: Clinton?
    7. Me: Yup. And who was before Clinton?
    8. Client: Umm... It was... Jeffrey Dahmer?
    9. Me: Did you just say Jeffrey Dahmer?
    10. Client: Hahaha yeah.
    11. Me: I really hope he wasn't president...
    12. Client: *laughs hysterically*
  3. When we get a new enrollee, we have to make face to face contact within 10 business days. The first, second, and third attempted visits failed. We are on the last business day. We haven't been able to get in touch with this guy ever. We've only been able to talk to his mom on the phone...

    1. A: His mom's phone is shut off now. Should we just stalk his house for a while? We don't have a number for him.
    2. B: We know he works at [Place].
    3. A: Ok. There are 2 [Places] in Milwaukee.
    4. *Call them. He just left*
    5. A: Ok. So now we know where he works.
    6. B: But he's not there.
    7. A: He could be anywhere.
    8. *Look through many many documents from county*
    9. A: Oh! He's in Daily Living Skills with [company]!
    10. *Call. No answer*
    11. A: Huh.
    12. *more spy stuff*
    13. A: Ok, as far as I can tell, he doesn't have a Facebook page.
    14. *One hour later*
    15. B: I was able to get a hold of his step dad. He doesn't know his cell phone number. He said he goes to Special Olympics Basketball after work, but he didn't know where they practice.
    16. A: Ok. Maybe try calling [Person] from [Group Home]. He also coaches Special Olympics Basketball. He might know.
    17. B: Maybe we should quit this job and start a private investigation business.
    18. *The adventure continues...*
  4. Today

    Today the case manager and I went to a client’s home for a care plan review. While there, she told us her daughter’s cat just had kittens and they didn’t even know the cat was pregnant. She led us into the bedroom where this cat was laying with five tiny balls of fluff that couldn’t even open their eyes yet. Three days old.

    And we both thought, “Why is her daughter’s cat here?”. “Who is going to take care of these fucking kittens?”. “Oh great. That cat’s been outside often enough to make babies and now probably has fleas everywhere.”

    And that is what happens to your brain when you go into Social Work.

  5. I am a volunteer guardian with the Legal Aid Society. I have one ward. My ward can’t talk, but has a giant smile. She lives in an apartment with 24 hour supports. She loves Reese’s Peanut Butter Cups. She made me a very glittery box for Christmas which makes my bedroom floor beautiful every day. She loves dancing. She has Down Syndrome. She also has a rep-payee to manage her social security income, pays her rent, gives her caregivers money for groceries and clothes and outings, etc. And, until she got that rep-payee, she had a family. She still has a picture of her family hanging on her wall.

    I am the legal guardian for someone who’s family abandoned her as soon as they were no longer able to control her money.

    Let me rephrase that.

    Some people took advantage of someone with a severe disability until she was no longer serving a purpose for them.

    I became a volunteer guardian because half my case load has a similar story and I figured I could provide more than case management to at least one person.

    A huge percentage of my clients have family in their city, a few miles, some a few blocks away, that never sees them. They live in group homes or supported apartments. Their families stopped having anything to do with them when they got rep-payees. Or they found out they couldn’t get paid to be a caregiver 24/7 for their family member who sleeps 8 hours a night and goes to daycare 7 hours a day and doesn’t actually need 24 hour supervision. Or realized they could get more money by claiming a bullshit disability.

    It’s disgusting.

    I don’t care what your life or situation is like. If you can’t be bothered to make any kind of contact with your brother/sister/daughter/son/niece/nephew/etc even through a generically signed holiday card once a year unless there’s some kind of profit in it for you, you are a worthless piece of shit that doesn’t deserve to live, much less live off of my tax dollars that could be going to people that actually need it. People that you threw away.

  6. My name is Sarah, and I am a Registered Nurse working in Case Management.

The key word is “working”.

No, really.

    My name is Sarah, and I am a Registered Nurse working in Case Management.

    The key word is “working”.

    No, really.

  7. Tales From Case Management

    No. You do not get to consistently make bad choices, omit half your income on applications for tax payer funded resources, lie about your status, and get away with it.

    Or, I guess you can, because so many people do, but you don’t get to throw a fit when you get caught.

    I’m sorry your situation sucks, but resources are too limited to hand them out to people with enough financial and informal supports just because they don’t want to take responsibility for their actions or inactions.

    Consider yourself lucky that you have the cognitive abilities to make your own poor decisions, the family supports to help you through the consequences, and the financial means to continue to support yourself, even if that means not living the life you’ve been accustomed to.

    Some people don’t get to choose to have a disability.

  8. And I realized, fuck man, maybe that’s what hell is: the entire rest of eternity spent in fuckin’ Case Management.

  9. It’s not even 9am yet…

    After several back and forth phone calls on Friday with the Aurora St. Luke’s Medical Center’s Social Worker and Nurse regarding discharge plans, I was kind of expecting at least a voice mail letting me know when my client was discharged.

    Especially since we hadn’t actually established which services he’d be needing in the community. The only voice mail I have today was left by a provider needing authorization for services they started providing on Saturday.

    Because I didn’t specifically tell the Social Worker we need to know exactly what my client would need upon discharge and we would need to authorize it prior to him being discharged and, because he is consistently non-compliant with medical advice, I would need to be directly involved in discharge planning to help make sure he is getting the best services for him to ensure recovery in the community, and prevent readmission.

    Apparently the needs of the hospital to get the patient out of the hospital before the weekend trumps the actual needs of the patient.

  10. Today in the World of RN Case Management

    I spent the past few days arranging the discharge of a client from the hospital. He needs to have IV Antibiotics for 2 weeks, and would need a home health agency to do some cares for him outside of a hospital. No problem. He was all set to go back to his group home, which made special arrangements with the staffing schedule so he would be able to stay home during the day (the home generally isn’t staffed from 8am-3pm because all the residents go to a day program). The social worker at the hospital was going to make arrangements with a home health agency to go to the group home every day for skilled nursing cares. Everything was going to be just fine.

    Until today. I get a call from the home owner saying the hospital can’t find a provider for home health care. Ok. There are like 6 gazillion companies that do this. That makes no sense. I called the social worker at the hospital, who redirected me to the intake coordinator for one of the providers where I found out…

    Medicare won’t cover outpatient IV antibiotics so, instead of going home with a home care agency in place to manage the PICC line, my client has to go to a nursing home for 2 weeks for absolutely no reason. Thousands of dollars difference in cost for care, in addition to an increased risk of infection, wounds, communicable diseases, and readmission to the hospital. Nursing homes are just lovely. You’re welcome, taxpayers.

    If you want to know why health care isn’t affordable, it’s because shit like this, and completely not like this but just as stupid, happens every day. More than once. One bill isn’t going to fix that. It’s not even going to scratch the surface. But, hey. At least everyone can at least be financially covered while some politicians pretend they’re going to do something to fix things. Don’t get me wrong. I think it’s great that everyone gets health insurance. I’m just not going to sit here and pretend that makes health care more affordable or fixes anything wrong with the quality of care. Or the lack of emphasis on prevention, education, and community health. Or the way things are billed. Or the way records are kept. Or the lobbyists that influence every single decision made by politicians. Or even the overall uneducated and/or non-compliant American population. Seriously. Do you know how much Type 2 Diabetes and its complications cost to manage and treat every year? A lot. Type 2 Diabetes and its complications are almost 100% preventable. Twenty per cent of antibiotics prescribed every year are completely useless.

    America’s got work to do and no one willing to do it.

    So, I guess we took a tiny step in the right direction. Great. That’s enough. The bigger issues are all the way over there. But at least we made a little progress.