A Case Manager's Verse

Don't Say "I Know" to a Client

noreply@blogger.com (Anatolia) — Tue, 21 Feb 2012 21:04:00 +0000

Most of us know this, through advice from another case manager or through having said it to a client ourselves. "I know" being a response to a client talking about a personal and difficult situation, like living in an apartment that's in a poor condition. No, I don't completely know what it's like.

I have said "I understand" in the past but I've been told by a coworker that this may be tricky too because I don't really understand a situation. I mean it more as a I understand where (client) is coming from.

Really though, if I have been in a similar situation to a client, would it still make sense to say I know? Even if I do know what it feels like, would that be helpful? Apart from the fact that some of us may not respond to the same situation, i.e. crisis, in the same way. Though I do think to a degree it may make a client think that the person she's working with does know what she's going through and so respects her more, platitudes only go so far. It's important to acknowledge how a client is feeling, but I've spoken about how venting sessions eventually become unhelpful to a client too. It's also not what case management is about ultimately. We're not therapists. Our goal is to support the client to address her problem (and encourage this to do this on her own). Though the method may not always be a smooth one. (It wouldn't be as much fun if it was, right?)

Clients' Issues are Typically Complex

noreply@blogger.com (Anatolia) — Sun, 05 Feb 2012 05:39:00 +0000

I've been trying to practice more self-compassion, having realized that I'm fairly tough on myself when it comes to doing my job. See my pacing posts, most aptly the last one I wrote. I want to be able to support my clients and get frustrated at myself when I'm not able to help them solve their challenge as quickly as I would like or when I fail to have a straightforward solution. I thought about this recently and considered something -- the fact that clients' issues and challenges are often complex. If they were simple, my clients wouldn't need the degree of outside support they need. Complex issues may need a step by step approach. Clients need to follow through on the joint plan between them and the case manager. And in situations when, for example, a client shows up 3 months behind rent, and is already being taken to court, a case manager's approach is different (read support is more limited) than if the client showed up the first month he got behind. Our clients need to be accountable to a degree for their choices. As case managers we do the best we can, and at the same time hold our clients accountable for their choices (considering the circumstances they made the choices in, but it's ultimately positive to hold our clients accountable).

This post is to all case managers who set high standards of the support they provide to clients.

Pacing, a Success

noreply@blogger.com (Anatolia) — Sun, 01 Jan 2012 18:23:00 +0000

A client came in to see me earlier this week and laid out in length how things have been going with her and her mom for the past month. Benefit issues, housing challenges, legal questions. A lot may happen in a month. Most of the issues she brought up we would absolutely be able to collaborate on but not in one session. I need to fight back this impulse that still lurks in the back of my mind, tempting me to look into a pool of challenges and issues and look back at my client and say, OK, *deep breathe*, let's jump in. And swim around trying to grab at as many challenges as possible to tackle them in one session...... But it's just not practical. And this way it gets harder to remember how to prioritize what needs to get done first.

I listened and took down notes while my client talked. I asked her what she wanted to work with me on for our session. "I want to find a new doctor that accepts Medicare," she said, a topic that she interestingly had not brought up yet. We prioritized what she wanted to get done from what she had talked about. And talked about how to get her a doctor.

I was glad I that I was able to stay in the big picture mindset. My client and I knew what she wanted to get done and knew what the game plan was. Though the game plan may change and priorities may also, putting some structure keeps things organized.

To a happy, healthy, laughter filled new year and one where we challenge ourselves and one another. Throw some love in there too.

Rich People, Poor People All Got Dreams

noreply@blogger.com (Anatolia) — Thu, 17 Nov 2011 05:22:00 +0000

A line in a song made me think about this. Simple and true. I felt like I hadn't reflected on it in some time.

As I work with my clients day to day we don't often talk about their dreams. More frequently we're dealing with a crisis, navigating benefits programs, or discussing resources for basic needs, like food pantries. Dreams are still there but we're focusing on what needs to get done. Many times this does mean the basics: Benefits stopping, client getting behind on rent, food insecurity, issues with quality of housing.

I do discuss long term plans with clients and these may include aspirations. A common one is finding subsidized housing. Two important steps are usually needed, in some combination, to reach long term goals. Planning and meeting basic needs. It's easier to plan when your situation is fairly stable and this, for a variety of reasons, is challenging for clients who are in situations of ongoing crises or have physical or mental health challenges.

Occasionally a client mentions he wants to complete the GED or college. Learn to play an instrument or a new language. I enjoy having these conversations with clients to understand better what makes them tick and to eventually discuss how they want to pursue them.

Let's See that Happen

noreply@blogger.com (Anatolia) — Wed, 19 Oct 2011 02:30:00 +0000

"Anatolia, I'm going to stop by Empoder. When can I see you?"

I have a couple of prospective clients who occasionally stop me outside of Empoder and 'threaten' to stop by and set up an appointment with me. Each came in and set up an intake appointments with me multiple times and didn't show up. After finding myself in my office, third or fourth time around, wondering where oh where has my resident gone, I realized perhaps it wasn't the right time for them and I to meet.

Finally I said to each, "Let me know when you're ready to see me." It's not that people always make their intake appointments. Some people come in to Empoder and I set up an initial appointment with them and don't see them again. Others miss the first appointment, perhaps even miss two, but after they'll likely follow up fairly quickly (if only for the initial appointment).

With these rare folks it seems they don't want case management services though they get something from our short exchanges. How are you, how's it going. Knowing they have an option for case management in the future.

Explore a Client's Network of Support

noreply@blogger.com (Anatolia) — Sat, 01 Oct 2011 01:07:00 +0000

Having even just one family member or friend in a person's corner, when that person doesn't have other support, may have make an astounding difference. It may mean a person has a temporary place to stay after she loses her housing. She has help filling out a prescription. Or it may mean just having a listening ear. A mini community. It's good practice. I'll support you and you'll support me.

I want to encourage myself to remember to delve deeper into a client's network of support. Make certain to have this conversation with clients. Sure, sometimes clients have already tapped into their personal network before coming to Empoder but this isn't always the case. Along with family and friends' support are the more formal options. Is the client a veteran? Does she have support specific to her situation? Is she eligible for assistance through mental health resources?

This is for case managers who want to fill in gaps in a client's lack of support and moreso, those who who are tempted to do this a great deal by themselves. Earlier on as a case manager I approached my work like with a few intensive clients. While I did reach out to other providers I learned later in how many situations it would've benefited several clients and myself to reach out for additional support sooner.

I've already spoken about limitations of case managers. Some of us may have a holistic approach but on our own we can't be family, friends, legal, and medical advocates. We're a resource at Empoder. We do provide guidance in regards to life skills and offer support but it is exhausting and professionally not possible (until I get the legal and medical degree in the mail) to do it all.

Also see Struggling with Limitations of My Work

The Challenge of Breadth of Case Management

A Few Requests for Home Visits

noreply@blogger.com (Anatolia) — Tue, 27 Sep 2011 02:38:00 +0000

It's good to do home visits. Suddenly you're in the clients' territory where they're comfortable. You learn a lot from doing home visits, including some things you would not know from only having a client visit you. Like how many people actually live in the apartment. What condition it's in. Glimpse into what their home life looks like. It's a pretty intimate view, really.

I do appreciate clients taking a few steps in making you, the case manager, comfortable.

1. To the question is (wearing) my towel enough ... The answer would be a no.

2. Try and make space for the case manager to sit somewhere. It doesn't have to be furniture if this is an issue, of course. But it's great when there's a clear area to sit.

3. Try not to be surprised when your case manager shows up at the time you had scheduled to meet (also known as I can hear you in there...).

Though I don't expect the following by any means, I'm grateful when a client offers me something to drink. Not sure why -- it's the symbolism of it more than anything.

Are There Enough Jobs?

noreply@blogger.com (Anatolia) — Fri, 26 Aug 2011 02:18:00 +0000

If folks who have SSI or SSDI* would all decide they want to work would there be available jobs for all of them?

* SSI/SSDI: Payments from Social Security Administration that people receive due to a disability.

Yes, a very short post for quite a long pause in writing. Moving forward I plan to write 2 posts per month. If I end up posting more, great. But I plan for this to be the minimum.

Checking in on Goals with Clients

noreply@blogger.com (Anatolia) — Sat, 13 Aug 2011 16:42:00 +0000

When I start to feel overwhelmed as I think about all the challenges a client is dealing with,* unsure where to begin and what to work on, I think about one thing that makes it easier -- where is the client? What does the client want to work on?

It helps to remind myself that the work is about the client.

As I continue working with the client I check in after a few weeks and ask myself are we still working on the same goals? Originally my client said he wanted to resolve issues with his landlord but now he's talking about moving out. Time to reassess. Is my client changed aim realistic? It's true goals may change. Maybe a client doesn't want to commit to one after all. I found that some of my difficult cases were this way because I was still working on an original goal while my client was working on another. This is one reason why it's important to check in on this on occasion.

Having worked in this field for several years my brain takes what a client is sharing with me during intake or conversation and puts it in categories of issues to address. However, after hearing six different issues my client is dealing with, it's not uncommon that she wants to focus on only one area. It's challenging for me to hold myself from my holistic approach that thinks: Let's rock, let's address all your concerns. But I need to listen deeper to what my client needs through her statements and life situation.

* See earlier this week.

See also: Let's pace this collaboration

A Secret Client

noreply@blogger.com (Anatolia) — Sun, 31 Jul 2011 02:11:00 +0000

Sometimes I wonder what it would be like if social services were visited by secret clients, similarly to how secret shoppers assess businesses' quality.* I picture a secret client eyeing me suspiciously, taking notes as I sit with him and fill out the intake forms.

Assessing case managers' services isn't quite like evaluating a business though. At a social service agency, a client isn't receiving a straightforward good like food or hotel accommodations. Also, a case manager/client relationship is ongoing and collaborative, calling for a client's commitment to work on goals. At a certain level case managers have their own style as well.** This influences how well they work with different clients.

Assessing service during intake though is fairly straightforward. How's the case manager approach? Is she working on developing rapport with the client? Treating the client as a person, not as answers to a set of questions? Giving the client time to answer, asking very personal questions sensitively?

Though the secret shopper system may not work in this field this isn't to say case managers can't and shouldn't be assessed on a regular basis. It's only that criteria of doing this is layered due to nature of the job. Typically it's staff evaluating case managers' work, namely supervisors. At Empoder, colleagues offer their insights informally and sometimes even without being asked.

Still, it's valuable to know from the point of view of clients how you're doing your job. Case managers may learn this through confidential surveys from clients. One good indication that you're doing something right may be that majority of your clients come back or follow up.

* For the record, in regards to the concept behind secret shoppers: I don't think the customer is always right.

** Still, it's important within an agency that some uniformity exists in how case managers work with their clients. And clients do talk with each other.

Not a Therapist -- When Boundaries Make My Job Easier

noreply@blogger.com (Anatolia) — Thu, 28 Jul 2011 03:19:00 +0000

A client of mine, Betty, lost a close relative. Betty and I had worked together for a fairly short time but more intensively in the past couple of weeks as the health of the relative she cared for declined.

Betty came in to talk with me and as she sat down she shared the news her relative passed away a day earlier at the hospital. She looked to the side while she talked about some of the details of what happened. I offered my condolences and asked if she wanted to talk with me about how she was feeling and she said no. I answered OK, adding an offer to look into supportive services with her if she'd like in the future, and our conversation turned to working on case management issues. What did she need help with? Burial plans, navigating insurance. Logistics. Betty has a sister but they were on difficult terms and she asked I help mediate between both of them. We did a conference call that went better than anticipated and Betty and her sister made plans to follow up later.

Towards the end of our appointment Betty asked about mental health services. We agreed to follow up to look into different options. After she left I thought that it's sometimes a relief that my job doesn't involve therapy. It may be helpful to focus on one area, particularly when a lot of practical work needs to get done.

It is important to let folks know that support exists beyond case managerial support. Therapy may not be appealing for all but the idea that it's accessible is comforting. Offering support, even in the shape of other agencies that offer more specialized support, also let's the people you're working with know you're thinking about how they may be feeling.

And as important: While it's helpful to review options, it's equally important to let the client lead. What s/he wants to focus on leads the professional collaboration.* This is something I continue and remind myself.

* With some caveats sure, but at its basic level a professional relationship is fruitful when a client's goals align with a case manager's goals.

Drawback of Stuff Swap Community Events

noreply@blogger.com (Anatolia) — Sat, 16 Jul 2011 20:10:00 +0000

I was at a stuff swap community gathering a few days ago. For folks not familiar with this idea, people bring items they don't need (hopefully still in usable if not good condition) and take other items for free. Terrific concept. Reuse, recycle. Giving away items you don't need instead of throwing them away. I loved that it was on a larger scale level too, that people who didn't know each other took party in it. I've been to clothes swapping parties before, for example, but with friends.

I couldn't help but think though, while I was perusing the booths, of folks who aren't throwing items away but only adding more. That several people are coming away from the event with more items to apartments already overrun with belongings. I wondered if having a system would be helpful. For example, that for bringing a certain number of items to the event you may take away that same number of items. You bring 6 items and may take up to 6 items home. I wonder if this would help.

Joys of Running a Benefits Program Onsite

noreply@blogger.com (Anatolia) — Tue, 05 Jul 2011 02:29:00 +0000

My agency hosted a benefits program a couple of weeks ago. Federal reps came in to process the applications and Empoder's job was to advertise the event and mediate traffic the day of the event.

An important conclusion if we choose to do this again: Be as specific as possible when advertising what documentats clients need to bring.

As.

Specific.

As possible.

Make sure all case managers know so they could review them with their clients. Now, I did make fairly detailed flyers that were fairly detailed and that asked clients bring the most recent copy of their income.

"But Social Security Administration didn't raise disability benefits in the past 2 years so what does it matter?"

The answer is the rules I do not make.* This answer is profoundly less joyous the day of the event.

Though I'm the most detail oriented person in the world even I didn't provide such detail in my written handouts. I know now how I would improve it but on the other hand, no handout covers everything. Even with an organized list of eligibility requirements there are several possible what ifs. What if a person has an expired ID? Or has a rent receipt but not a lease? Or no income this month but will starting from next month but right now her aunt is paying towards household expenses and her cousin isn't really staying with her but for most days out of the month she does da da da da da.

One good thing, it helps to run a benefit's program with familiar clients because some needed paperwork may already be available in a client's file. It's also easier to deescalate a situation when you or another case manager knows the upset person (aka client) who has been waiting for an hour and a half and found she's missing a document.

Important side notes: Keep a clear sign in sheet showing order of people who came in. Also, it certainly helps to check in with waiting clients occasionally and let them know how long wait will be. Or, since it may be hard to assess exact time, estimate how many more people may be seen.

* Technically Social Security Administration is supposed to mail you an awards letter (document that states how much you receive in disability benefits each month) each year but not everyone gets them. Or places them in a memorable place. Or knows what they are exactly.

Anti Bullying Status Response

noreply@blogger.com (Anatolia) — Fri, 01 Jul 2011 02:56:00 +0000

I came across Facebook's anti bullying status a few times. Goes along the lines of: "People look down at a girl who has a baby at age 14 not realizing she was raped. People hassle a person who's overweight not knowing his obesity is due to illness."

In other words, don't judge and perhaps more importantly, don't assume. Two values I appreciate though admittedly the judging part, well, I'm working on that in my personal life. Professionally I do a pretty good job of keeping myself in check (and have coworkers who volunteer to do that).

On the other hand, something about this status doesn't quite work. Perhaps it's because a short message may sometimes be misunderstood. Or maybe due to my social work mindset I think, what about...

Let's say there's a 14 year old girl who's pregnant because she had sex with multiple partners without protection. She was trying to get pregnant. Or a person is obese because he eats a lot. Let's say he enjoys it too. Are these folks less deserving of kindness or understanding?

I do get the status' deeper meaning: Don't judge. Presume that people's situation is not as simple as it seems. Yet it also implies that one behavior is more rewarding of compassion than another. Granted we do that all the time -- we make judgments based on context. But it seems to defeat the purpose of this message which is to act compassionately.

An Orangutan's Compassion

noreply@blogger.com (Anatolia) — Sun, 19 Jun 2011 00:56:00 +0000

Something quite touching about this video (BBC):

Orangutan tries to help a baby bird

When US Paid off its National Debt and Why it Didn't Last

noreply@blogger.com (Anatolia) — Wed, 15 Jun 2011 04:18:00 +0000

I wanted to recommend NPR's Planet Money. Economics explained in easier to understand terms.

Wanted to share this show:

When the US Paid off its National Debt and Why it Didn't Last

Also see Financial Crisis Readings

Apprehension that Things May Get Better

noreply@blogger.com (Anatolia) — Thu, 09 Jun 2011 05:34:00 +0000

It took me some time to appreciate... An unlikely challenge to achieving a goal: It's scary to think things may get better (more so when it involves making a new healthy or otherwise positive choice). It's scary to step outside a pattern, even if that pattern causes chaos or anxiety. Going through a similar cycle brings a sense of comfort. It may be painful but it's familiar. The idea that things may get better may actually cause anxiety.

I've observed this in clients and others as well as in myself. Apprehension about things improving adds another layer of struggle when trying to work towards a goal. It is funny because it sounds so illogical.Why wouldn't you want something to get better? Yet we are creatures of patterns and years of habit, even the way in which we grew up may set the stage to certain types of behavior. These may be changed but it's not unusual for this to be a process.

I plan to write more about goal setting in a future post.

Sometimes I'm Not Sure How to Respond

noreply@blogger.com (Anatolia) — Thu, 02 Jun 2011 04:40:00 +0000

Sometimes clients make side statements that are difficult to respond to. "Oh, things aren't that bad." No, I'm not going to offer that reply. "I'm sure it'll get better." A platitude helpful with its empty meaning.

What's an example of a difficult side statement? A meaningful comment made, either as an afterthought or matter of fact, like "Don't grow old, Anatolia." A few clients have told me this in a context of illness or challenge that growing older brings. Sometimes these comments are meant in humor but not always. Sure, it may be a comment that could be delved into during a future session but sometimes it is just a passing comment. A client may not want a response too. Yet I have this instinct to want to be reassuring in some way.

I envy case managers who just know what to say and whose responses are genuine. Certainly a skill.

Advice for New Case Managers

noreply@blogger.com (Anatolia) — Sun, 29 May 2011 04:02:00 +0000

Though I wrote this post a couple of years ago about how advice may have not helped me when I started at Empoder, I changed my mind. I do have advice. Maybe it won't make much sense the first day or week, but at the end, I think knowing this early on helps:

Initially sit in as many appointments between clients and different social workers/case managers in your agency as possible. Each case manager and dynamic may teach you something.

Connect with the client's providers to learn more about the client, coordinate his service plan, and find out what services and (this one's sometimes my favorite) goods he's getting from another agency. Particularly relevant for clients who you'll work with more intensively or clients who ask for a lot of assistance.

Get into the habit of staying organized early. As organized as possible. File papers right away. Trust me.

If you must have post it notes or handwritten notes for a short time, and these should be sparse, date them. Date them all. It may be helpful to have a notebook to keep info in one place.

If you're not able to help a client with an item (like a dresser) always give another option. Like offering to budget with her to save money to get one or refer her to a resource that may help.

Make sure you're able to read the doctor's handwriting (on prescription) before you leave her office.

Find support in a coworker or professional in your agency or field. If you're unable to find support this way, be open to seeing a therapist. This gig is difficult enough with support.

Please feel free to share your suggestions.

Refocusing Speaker Also Needed

noreply@blogger.com (Anatolia) — Wed, 25 May 2011 03:49:00 +0000

Workshop at Empoder. 45 minutes in. The speaker still has quite a bit to go through in her presentation about legal rights to do with immigration and a client rises his hand and starts going into a very detailed and specific question. The kind that has an answer that would really only be relevant to him. I speak up after the question goes into minute 3 of explanation and say: "I'm so sorry to interrupt but we have a lot to cover and I'm sure the speaker could answer individual questions later." Speaker speaks up and says "No, it's OK" and nods for guest to continue. Aaaaah, I'm trying to help you here speaker! And the rest of us who want to get all the information you were planning to share with us before allotted time is up...

Let's Pace this Collaboration

noreply@blogger.com (Anatolia) — Sun, 22 May 2011 02:33:00 +0000

I'm not going to get it all done in a few meetings. Surprise! Yet it took me a long while to truly accept this. I won't be able to resolve 5 issues (may no be able to resolve one if it's complex) a client is dealing with in two sessions.

Some issues are straightforward. People just need help filling out redetermination forms for food stamps. Easy. A referral for a dentist in your neighborhood? OK, well you have Medicaid, so yes, it may take time but we could find a few dentist options. Yet some situations need more than one session to solve. A client gets behind on rent again due to money mismanagement. A client doesn't follow through on referrals yet comes back and says she still needs help. There's a larger issue here and it relates to the client's behavior and choices.

It's unlikely that after decades and decades of habits and lifestyle a client's behavior will change immensely thus guiding us to collaborate smoothly, at the end each of us skipping along on her merry way.

How can I expect people to change their lifestyle quickly when I see how in myself and people close to me that this is difficult to do? This bearing in mind that I and many of my loved ones grew up in a stable household and supportive environment.

Client's established behavior is not the only reason issues take time to resolve. Bureaucracy is part of it. Lack of resources, like when a client asks me about a legal matter but his income is just above the limit for free legal advice. Providers may not be reliable. It's tough being the mediating party between the client and a targeted service.

Not to mention also that clients may not necessarily come to a case manager with one issue. Three or four is not uncommon and each may be related to the other one in some way. Untangling each and working with it independently may be challenging as well. Like, perhaps if a client received mental health services other issues would be easier to deal with. It may not always be quite that simple but sometimes tackling one overarching issue paves the way for dealing with other challenges.

Pacing is crucial when you have a caseload of 40-50 people. Even back when I had a caseload of 30 people I would be quick to schedule a follow up appointment in a week's time even when an issue could wait. I prioritize much better now which gives me a bit more space to breathe. I also continue being better in encouraging clients to try advocating for themselves (perhaps with some coaching) before I step in.

Pacing is something I need to keep working on. I think I need to start thinking realistically about what I may accomplish in a week. There's a set amount of time to work with and typically a few surprises (in varying shades of crises) that come up as well.

Financial Crisis Readings

noreply@blogger.com (Anatolia) — Sat, 14 May 2011 00:37:00 +0000

In my search for some light reading I started researching information about USA's financial crisis. Though I stay pretty updated with what's happening now I wanted to understand its roots better.

As a side note, I strongly believe all case managers and social workers should have a fundamental understanding of economics. Frankly, it benefits us all to understand it as well as causes of financial crisis in educating ourselves on viable solutions.

During my search I came across this video:

Crisis of Credit Visualized

Indeed gives a pretty clear explanation. But were the causes this straightforward? Lending money to folks to buy a house when they weren't realistically going to be able to make payments was certainly irresponsible and unsustainable. But was something else at play? I'm usually not quick to believe simple explanations.

A friend recommended I listen to American Life which I had a chance to peruse a little and I recommend it. Here are two particular shows I enjoyed:

The Giant Pool of Money -- Housing Crisis and its Relation to Financial Crisis

Collapse of Banking System

I'm not saying they give all the answers but they do give food for thought.

As for readings: Through New York Times I found a link to Books for Understanding. That site links to a list of books and academic papers examining financial crisis. Gonna take some time to wade through this list. If you have any recommendations or thoughts about this topic please share. To be continued.

Now I need to Advocate for Myself.. Hold Up..

noreply@blogger.com (Anatolia) — Tue, 10 May 2011 01:47:00 +0000

It's going to be easy for me to plead, speak assertively, and demand to speak to a supervisor if my insurance issue doesn't get resolved/apartment maintenance issue isn't dealt with (OK fine, that one doesn't involve a supervisor exactly). I do that every other day with a client. I'm ready to go!!

Hmmm. It's not quite the same to advocate for myself though. It feels challenging (though it depends on how complicated the issue is as well). Not because I don't think I'm deserving of fair treatment. Somehow it's easier to do if I imagine I'm doing it for someone else. Perhaps in a similar way to it being difficult to ask for a promotion for myself. Maybe also because in case manager mode I speak with certain authority that's good to apply in some personal situations as well..

9 Phrases from Clients that Illicit a Long Inward Sigh

noreply@blogger.com (Anatolia) — Tue, 03 May 2011 03:00:00 +0000

1. "You look shorter/wider/more perpendicular today."

2. "I mailed out the original and only copy I had of my birth certificate/receipts/some document that took us 6 months to obtain."

3. "What else you (Empoder) got?" (Meaning, items/goods. Gift cards? A dresser under my desk perhaps?)

4. "I lost my check--"

5. "I won $15,000,000 in the lottery and all I had to do was pay $100 to take part in it!"*

6. (Exasperated) "I've been trying to reach you for two days!! You didn't return my call!"

7. "Want to hear a (joke that I will soon find out is inappropriate for some reason or other)?" Granted, at the end of which I may want to sigh or make a brave attempt not to laugh.

8. Leaving a doctor's office with client, client says "I wanted to tell Dr. Adams that I _______________________. You don't think that was important do you?"

I will be quick to admit I've certainly been in that situation before with my own doctors.

9. "Yeah, (provider's rep) said he was going to get this done!! I don't know, his name was Steve or Barry, something like that."

* I hate scams.

Also see

No Put Downs about My Appearance Please

Practical Life Skills Workshop

Photos of Elderly Animals

noreply@blogger.com (Empty) — Sun, 24 Apr 2011 01:49:00 +0000

I was intrigued when I came across an article sharing photographer Isa Leshko's photos of elderly animals or animals at the end of their lives. I was intrigued by this project and the concept behind it. It's absolutely true that photos of ducklings, puppies, and baby ferrets are found all over as well as animals in their prime, as Leshko states. I liked the spotlight being turned on elderly animals. Her photos are touching and I get a sense of gentleness through them.

The back-story of the project: Leshko cared for her mom, who has Alzheimer's disease, for a year. She started taking the photos as a way of dealing with her feelings from that time.

More photos may be found on her site.