THE MONTHS PASS

It's been a full six months since I started my "new" job. I'll be taking vacation next week in order to spend time with my visiting mom, so thought this would be a good occasion to look at what I've accomplished.

The part time, benefited Nurse Care Manager position at MSSP was the job I had my heart set on when we were preparing to move here. I've not been disappointed.

It's a difficult time right now, with the economy imploding, the California budget impasse being not so much resolved as punted forward 6 months, and with no political will to tax the people or businesses who actually have money (don't get me started on how "free market" advocates once again jump to socialized big bidness when it comes to protecting investors...).

The bottom line is that our clients, low income frail seniors, are losing pieces of all their "safety nets" and at the same time our non-profit is also losing money so that we have to cut back on services. But as I keep reminding folks, our mandate is "monitoring, referral and advocacy;" it sucks not to be able to continue also purchasing goods and services, but at least we are here and making a difference.

So what difference do I make in, say, a week during which I work three days? Typically, I'll see a half dozen clients in their homes, assessing their medical, functional, emotional and safety issues, then making follow up phone calls and documenting it all. I'll talk to that many on the phone, following up on things we were working on, or just to check in. I might go visit one in the hospital, chat with the hospital discharge planner, and call a family member, to advocate for a short stay in rehab so they can get home. I find a client a new doctor (one who takes Medicare/MediCal), set up the appointment, and verify transportation, then write a letter so the client has the details in writing. I meet with our new Executive Director (who started just in time for the budget mess to be clear, and who is so good that our mood and morale seems better than when times were more flush) to discuss a fundraising idea. I get a report that a client pushed the button on his emergency response system, but didn't go to the hospital, so I call him and find out what happened. I meet with "my" social worker a couple of times a day to compare notes and re-divide our tasks, and we meet daily with our supervisor and the other nurse/social worker team to problem solve. The two teams spend one morning a week updating clients' care plans. I surf the 'net for updated regulations that might mean something is now a covered benefit for a client, or to research a medical condition or medication side effect. I scrounge gently used medical equipment, call Social Services to ask them to reassess a client for more In Home Support Services hours, do the work needed to get the ball rolling for MediCal to cover nutritional supplements for a client with swallowing problems and weight loss, and ask a family member to help a client with medication refills so we can cut the LVN we pay to set up medicines in a MediSet from weekly to every other week.

Sometimes "all" I do is visit a homebound person who has no local family and sit and listen and chat for a while.

This job rocks.

This picture is of quite small (6" high) native plants that are making our Anna's hummingbirds very happy.