Whatever it takes

Yesterday, which was Sunday, one of my staff spent the day at the jail. A woman we work with was arrested for a minor infraction, which soon became a really big deal because she was off her medication and hit a police officer. She has been in jail for 4 weeks. She is struggling to contact her court appointed attorney, isn't on any of her meds and is worried sick about her cat. When the staff person held her business card up against the window, the woman started to cry. When she held up a note and said her cat was okay, she started visibly sobbing and shaking with relief. We know she is in dire straits because she has met the staff person a few times before and always knew her name but didn't recognize her. It is a bad situation. We are grateful to be able to do what we can to help.

If you are in human services and have a passion for this work, this is who you are and what you do. We can't bill anyone for that time. We don't need to. The doors are open and our money comes from the services we can bill to provide. It is part of what we signed up to do when we said we would do "whatever it takes" to help people live in their own home. 

In our new world of managed care, that is called a value added service. When we work with people there are a lot of value added services we provide. Not everyone likes all of them. We are noticing that some of the case managers with the insurance companies don't always want us involved. Perhaps they don't understand how this benefits people. Perhaps they don't want people watching. Or perhaps they just don't see the difference between what we do and what they are supposed to be doing. I also know what we do can be seen as a message that the insurance case manager isn't doing their job. That couldn't be further from the truth. We fully understand the constraints of having a clear line between what can and cannot be done. We are trying to fill the gaps. We are slowly limping toward a partnership that will work for everyone. I spend a lot of time thinking about those relationships and, in the end, I believe our intent will be recognized. It is the most amazing partnership when it works well. 

People often ask me how managed care is working for us. When I say it is going well, they look at me suspiciously. Is there something I am holding back? If I have complaints about managed care, they are the same complaints any healthcare provider would have about working with insurance companies. The paperwork, changing policies and trying to figure out how each insurance company is interpreting the guidelines of a program we have worked with for 21 years, takes up much too much of my time. We are mostly at their mercy. I look forward to the day, and I know it will come, that I won't have to spend days sending endless emails asking about very small details that affect payment and services. And wait for replies. 

So what's the upside? We get to go to the jail and the courthouse and the homeless shelter and the nursing home to get people out, we get to love what we do. We get to help people find a job at Dunkin' Donuts, get a car and get off Medicaid. We get to see someone communicate for the first time with his wife via his new Tobii that we fought hard for to be purchased. We get to try and fail, and try again. We get to have amazing relationships with our coworkers and clients, creating community. And that is why we signed up for this work.