Thursday, December 31, 2009

Your Face Sounds Familiar to Me

As I'm walking into our agency's main lobby a woman turns from a staff worker and asks me (before I say anything):

"Didn't I talk to you on the phone the other?"

Wednesday, December 30, 2009

Book Review: Scratch Beginnings

While reading a review about Nickel and Dimed I learned that Adam Shepard, a college grad had responded to Ehrenreich's book with his own case study: Trying to make the American Dream happen with only $25 in a randomly chosen city. Starting his journey with a promise that he won't use his contacts, Shepard heads to Charleston, South Carolina. After one year he will be successful if he has a car, a furnished apartment, and $2500 in savings.

A few important approaches Shepard takes in contrast to Ehrenreich: Openness to take advantage of a homeless shelter (not to mention the ease with which he got in), thus putting more money aside for savings. Decent access to public transportation, while Ehrenreich kept her car. Shepard also thinks strategically when contemplating sharing an apartment with another roommate while Ehrenreich never seriously considers this option.

On the one hand I generally agree with Shepard on one point: People should take responsibility for their lives. Be ready to help themselves [Putting aside people with mental illnesses or physical impairments that prohibit them from functioning well on their own day to day.]

On the other hand, I'm well aware of the advantages and supportive backgrounds both Shepard and I have. It's not possible to hide a college education or 12 years of education regardless of saying you will. Significantly Shepard mentions at one point that he had people supporting him throughout his childhood through his early 20s. This likely had an immense positive influence on him that if a person doesn't get as a child, he doesn't get it. And of course, as a single male, a white male who's healthy, possibilities are typically easier, and Shepard admits in part to this. His argument remains that he's still proof that anyone in the US can make it because he did and that hopefully his characteristics (health, race) won't detract from his message. 


Yet if his situation was different (if he had a child, lacked a GED, was a minority) he would be at a disadvantage even as simply as in regards to finding work. Shepard grossly underestimated his advantages. What he does do though, is acknowledge and recommend ways US social systems (i.e. education) should provide support for people of less fortunate backgrounds.

Despite my critiques, I would recommend this book because I enjoyed reading Shepard's journey. His project took strength. I recognize Scratched Beginnings as a book that would be more easily accessible to people in their mid twenties from privileged backgrounds. 

Monday, December 28, 2009

But Tell Me How You're Doing

Harry, an elderly client (who's still waiting to join the social program I had written about) was telling me he gets annoyed at other people asking him about his arm cast. "I go through so many different medical situations," he said, "and people are always asking me about them. I appreciate they're asking but I don't want to go through the whole explanation each time.
 
Putting aside the fact that I was floored by Harry warming up to the idea of other people asking him how he's doing, I told him, "Give them a short answer. You don't even have to be specific. Then then ask them how they're doing. People like to talk about themselves."
 
A week passed and Harry left me a message saying "It worked! Tyrone asked me how I was doing, and I said, 'God bless, but tell me about how you're doing,' and he started telling me all about how he's doing." I was glad it worked.
 
It's not completely accurate though that everyone wants to talk about herself. My dad tells a story of an aunt who would ask him about him, his family, his job, his health, and the moment my dad turned the questions on her she would give him a look of surprised disdain, as if shocked he asked her personal questions. Though she didn't respond, it did stop her stream of questions.

Saturday, December 26, 2009

A Resident Seen Just Once

About half a dozen times in the past three years I made an intake appointment with a resident who didn't show up to the appointment. Once it was a lady who said she knew no one and wanted to get connected with a place like AA ("but not AA" she added), another time it was a gentleman who had just moved to the city and a neighbor told him about us. He was especially interested in our health services. But neither came back.

Occasionally I wonder to myself, what choices did they make? Did they find another agency or place of support? Maybe they ended up relying on themselves. Sometimes I imagine different scenarios of what these folks did and where they are.


It's probably the end of the year that's making me look back and think about choices and paths.

Wednesday, December 23, 2009

Don't Stay for the Clients

A coworker of mine described her job today to someone like this: "I walk along the journey with [my clients]." I loved the idea behind her words. It made me think of an incident that took place around six months ago.

I was riding on the bus with a coworker she turned to me and asked how long I think I would stay at the agency. I answered that I'd want to stick around for a couple more years if possible. I liked the coworkers, the atmosphere, the work. But I chose to start talking about the clients and that I felt they needed me.  "Don't stay for your clients," my coworker said. "Your clients don't need you. They'll be fine without you," she admonished me with a tone that sounded a bit cruel. 


I thought about her words later, and while I agreed with her, I admit it took me several months to truly accept them. Clients would be fine without me as well they absolutely should. Connections have been made and relationships developed but they'll be made again. High turnover is likely not ideal in sensitive situations where vulnerable population is concerned but what's particularly ideal is that folks who come to the case management job do it more than for the sake of having a job, that they're ready to teach, learn, collaborate, be patient, have an open mind. All things that can be learned. Latter is something I try and work on every day.

Also see Hello, I'm Your Case Manager and I'll be Your Superhero Today

Saturday, December 19, 2009

A Public Aid Case Worker Making me Laugh Again

Dear public aid case worker,

If you don't know if client's [medication] is covered through medicaid, would you please tell me who is supposed to know?

---------------------------------------------------------------------------------------------------------
Could you imagine calling your insurance company and being told they don't know whether a specific medication is covered?

????????????????????????

Thursday, December 17, 2009

Trouble with the Phone Line Again

I spoke on the phone today with Martin, an elderly client of mine. I talk to him every few weeks and typically it's extremely hard for me to understand him. This doesn't exclusively happen with Martin. At times clients mumble or it's hard to follow their thought process. With Martin it's a bit of both. Also, his mom was French so sometimes he defaults to French. In short, communication not always easy.

Last Tuesday though I couldn't understand Martin to the point that I told him we'd have to meet in person. I got a word here and there and the tone but that was it. I used my "Must be problems with the phone line" excuse, which is what I say after I ask a client a few times to take a deep breathe and slow down. I felt bad that I couldn't understand him but also frustrated. Cause when the person who's not speaking clearly needs to repeat himself he gets frustrated at you and tends to speak even faster.

Tuesday, December 15, 2009

Clients Calling Me to Refer Friends to Our Program (2)

I really do mean it. I appreciate you're enjoying working with a case manager at our agency. That you're getting enough out of it to want to refer a friend in your building for services. But it doesn't matter how many times you leave me messages about them. It won't move things forward because conversation is still going on between you and me, not the resident and me. If she is interested in services, she knows how to get my number or find the agency.

Maybe a year ago I would have been tempted to get the resident's number from the client and call her but experience has shown me that folks who need us reach out in their time and on their terms. They're also more invested that way.


Also see my first post about clients referring other residents to our program

Sunday, December 13, 2009

Denying a Rental Request -- What Next?

I've previously discussed how my department determines eligibility for rental assistance in its basic terms. We find out why the client(s) got behind and if they have income to sustain themselves should we assist with one month's rent. If the clients don't have an income we can't help them. The reason is that assistance in this case would only be temporary and the client would face the same problem of paying rent the following month.

So what's the next step for these clients? Generally when folks have no income we refer them to our job counseling services. But of course it's not typically a smooth path and not only because job supply is particularly low. Clients may lack experience or skills for many jobs. Referring folks to job counseling also presumes that they're physically and/or mentally able to work and this is not the case for many people we serve in my department. Applying for social security benefits (for reason of disability) is an option but one that in most cases takes at least a year or more.

So let's say a client has no income and is looking for work but not finding one, or applying for disability and waiting. What then? The bottom line is you need an income to stay in an apartment. When we can't help we refer folks to call the city and request short term rental assistance. But the truth is very few organizations have funds to help people with rental assistance when they have no income.

So we suggest people look at their social network. Is there a family member or friend they can stay with temporarily? We also give information on shelters and temporary housing programs (some have waiting lists so clients need to sign up as soon as they can). Occasionally we get word of openings for permanent housing programs for people at risk for/those experiencing homelessness. In such cases it may help to be tied in with an organization that would likely get news when such openings take place.

Sometimes when I tell clients we're not going to be able to help with rental assistance I don't hear from them again even when I offer to continue to work on other options. Some folks who are denied rental assistance come back a year later with new concerns -- they had solved their housing situation on their own. Other times I don't hear back from clients once their in temporary housing. I respect people's choice to figure things out on their own and appreciate the opportunity to be able to work with folks who choose to continue and work with me. I believe that if I was in a similar situation I'd want another person on my side. But I also know the limits of a case manager's role. In the end the client is the one dealing with what's going on. Whether I'm part of her journey is up to her.


How have you as a case manager/social worker dealt with a similar situation?

Note: This post was written based on my personal experiences as a case manager and should not be taken as the rule for every similar case.

Saturday, December 12, 2009

A Few Moments from the Week

A particularly intensive client slipping on the ice. The client was discharged from hospital to return home with order to stay off his feet. He has no family and close friends in the city. See where I'm heading with this?

Finding a bed bug strutting on a sign in sheet during a 'Tenants Rights' presentation.

A second client slipping on the ice and getting blue and black marks on her arm.


Work holiday party (behind me now). 

A third client slipping on the ice and getting a cast on his arm.

Getting only 2-3 pages further in Something Happened.

Tuesday, December 8, 2009

My Work Here is Not Done

A coworker told me yesterday with glee that his (non electronic) inbox was empty. "I'm all done," he smiled, referring to a few large assignments he had finished. I realized he was talking as if he wouldn't get new large assignments again. It took a lot, but I held myself back from commenting obnoxiously about how he'll always have more to do. He seemed too happy. I didn't want to be the one to say that that to-do list is always longer than what he has written down. It's only he may not know about the rest of the to-do items more than 5 minutes in advance. 

Today he told me slightly grudgingly about a new big assignment. He doesn't do case management work exactly, but it made me think of my own work. It helps me think about my work as project based (and ongoing at that). Many times I work with clients on specific goals: Help with finding housing, applying for social security benefits, legal assistance, etc. But ongoing maintenance (for exampe, in dealing with an unexpected crisis) is always needed. Like remodeling a house -- even once it's done you still need to upkeep it. And that doesn't include setbacks involved while building it. 

It helps not to expect my inbox to be empty. Though it's not easy to accept.

Saturday, December 5, 2009

*Cough* *Cough*

Lots of coughers in my immediate surrounding this past week at work. Larger than usual number of folks coughing right in front me without covering their mouths, including clients and staff.

The other day I was talking with an elderly lady during an outreach event and and suddenly she coughed this loud wet cough. Those are the tough ones, the unexpected coughs. I froze for a second and inwardly grimaced. I know she didn't do it on purpose, but -- gah. I could feel her germs invading into my bloodstream. Asking my germs for help in crossing the street.

On another note, it's unfortunate that you can't say something to someone once she has coughed. Saying bless you gets you weird look. There's a few moments of silence as you wait for them to stop coughing. Maybe you offer a drink of water. There should be a word.

Tuesday, December 1, 2009

We Don’t Offer that Service

Except in those few occasions we do. We don’t help you move, but those one-two OK a few clients yeah I suppose we did help them move. Help with getting a new bed? Not really something we help with, except those couple of times last year.
 
It’s difficult to assess some requests (certainly lack of resources like money and time are a component of this). Rental requests are more straightforward: We find out the reason a person got behind. We do a budget to find out if she be able to pay rent on her own after she receives rental assistance. We also look at whether we have helped the client with rental assistance in the past. These types of questions

Other financial or otherwise large requests are discussed case by case. One increasingly common request is help with moving, i.e. physically help. I know a number of clients who would genuinely not have been able to move without external help, if because of mental/physical health conditions, lack of financial support/friends, lack of time. For these clients some staff members were able to fill in that gap in some capacity. But once an exception is made for one client it's harder to say no the next time when a client seems to be in particular high need. Not to mention that each project like this takes time -- while the inbox of other requests continues steadily fills up.

It's true, I'm not talking about tens of clients calling us about help with moving. But considering that helping one person may take from half a day to 2 days of help (in separate blocks of time) even helping 3 folks is a considerable time commitment if you have a caseload of over 40 folks.