Between meetings at homes across the city, I'd pull over at the side of the road and retrieve the messages from my $8 answering machine that sat on the kitchen counter of my loft. "Hi, my name is Mary and I am in a nursing home in Olathe. Susan said to call you because you could get me out," or "I am a social worker at the Rehab and I heard you could help me with a discharge," or "This is Jill and I am looking for work as an attendant." It wasn't uncommon to have 70 messages a day.
It took two years to realize I needed to formalize things a bit. I needed a name for my company, Corporation papers and a bank account. I applied for the requisite home health license (with no nurse needed) and provider numbers to categorize what I did so I could pay the rent and buy food for Lulu and Billy. Until then I pretty much existed on a few consulting contracts and my part time job as a student at the University of Kansas.
Fast forward 21 years and a lot of things have happened. There are now two companies, one for case management and one for therapies; we've morphed up to 700 employees and back down to 150. We've lived through 10% Medicaid cuts, a few recessions, and many administrations. We have won awards: Provider of Excellence in Kansas in 2011; National American Brain Injury Society Clinical Award 2010 and named by the University of Toronto for the Top 12 programs in the World for Community Integration of People with Brain Injuries. And the beat goes on, still supporting people to get their lives back and move on.
People ask if we are going to survive and I have to laugh. We have already survived. We have helped over 3,000 people move out of nursing homes, hospitals, rehabs, get jobs and move on. We aren't going anywhere.
Admittedly, it is time to reinvent. Last week it was finally confirmed that the three managed care companies would be providing all case management for the Home and Community Based waivers in Kansas. That is a huge change for us, given we have 23 case managers supporting over 600 people right now. Disassembling our amazing system is far more difficult than it was to build it and those who have been involved in building it, know it was a mammoth task. I don't allow myself to spend much time thinking about the number of relationships that will be affected by this change. I do know it's those relationships that will get us through.
We are working through our own plan to work with the MCOs and the State of Kansas to make sure no one goes one day without a case manager. We are also committed to making sure that no case manager goes without a job. Of course, we are working with moving deadlines and dates, none of which have been confirmed. Managed care is supposed to start January 1st. There are several deadlines along the way (still not clear the exact dates) that determine if the January 1st deadline will work. If it doesn't work, there is no published date or variables to determine next implementation dates. We know we need to be able to adjust to any twist in the road, as we have for 21 years.
We will go back to one company, communityworks inc. We will ask people what outcomes they want to measure in their own lives, and we will educate the MCOs about the dangers of the medical model when imposed on the community. We will also continue to celebrate success, have fun and make sure we advocate for what people tell us they want.
We have a lot to offer and will get back to basics, focusing on one person at a time.
