Which yellow brick road to take?

The directions can be opaque, and never crystal clear. I am sure about not wanting to continue with the work that I do, yet I do continue to do so. 

The transition coordinating has its oddities and share of complications. You might think that I relish the challenge and have just enough ego to rise to said challenge - a conquering hero of sorts (a well-worn cliché). But it all seems tiring and a never ending challenge.

The cone as sundial - or is it a compass needle I am to follow?? Photo by Ralph

I am working with a person who was discharged recently. She has the PCA waiver, in which (unnamed) pays for the services of the assistants, while the discharged client acts as an employer. This is a tough task for many persons as in a nursing home, a dependency is fostered where someone shows up to do this or that for you. The longer one stays in a skilled nursing facility (the formal term in use that I would never use to describe these places...), the more dependent one becomes.

So this person has five PCAs in her schedule. Contrary to Independent Living preferred practice, I did a lot of the work for the consumer - advertising and locating potential, arranged for the interviews by the client and when approved, I created a schedule. Independent living really dictates that the client really do all the work - although the client needed help. so supergimp Ralph jumped into the hiring fray. 

The client can be demanding after being provided all services in the home. So far, one PCA has resigned, one more (I hear this in third person) may. Yet, I have to spring into action, the other day checking by geography potential recruits. Based on a phone call, and an e-mail of documents, there may be hope for another PCA. I hope...

Discharged clients who end up back in these facilities can make things difficult for the coordinators. As I work for a contractor the state (unnamed) cannot dictate  what constitutes an offense that can lead to dismissal. Yet, terminating my position could have a happy ending. I say could, because there is a lot of downside to being asked to leave, especially in a society that views the disabled as failures of sorts anyway. So failure is not an option. Yet, from many directions, outcomes are not guaranteed. So I ask as I have been, am I bold enough to resign and take my chances on income on my terms?

It’s not who you know, It’s what...

It has been a week since my last post. Yet I remain committed to a change while events keep me on the track I have been on and missing the switches that offer a spur line into change. The train metaphor is apt as the heavy locomotive moves along with inertia, and thus keeps on going despite the application of the brakes - what I need to at least consider.

Yet, during the past week , I see a bit of confidence in my approach, perhaps there is hope that I can use the bit of intellect that I possess. In this case, perhaps it is as (noted before) a disability consultant.

The non-profit I work for had its fund raiser this morning. Referred to as the 2010 Wheel-a-Thon, there were two obstacle courses whereby teams mounted manual wheelchairs, and team pledges were added up and team elapsed times were tallied for winners, and a cook-out lunch was provided. A fun time near Long Island Sound on a beautiful day.

Yet I had no real responsibilities for the day. I didn’t even receive the loud yellow Staff Member tee-shirt. So an observer I was. Yet there were two women who corralled me, perhaps as they had a few questions that a wheelchair driver could answer. Which was the case. It was an older mother and her younger daughter. The questions at first had to do with the power wheelchair for the husband of mom:

Q - How much did your (wheelchair) cost?

A - A basic power chair (Pride Jet) like mine is about $4000 new. I bought this chair like new through my company for $700

Q - Can you take your apart for travel

A - No, and I don’t think the units that can be broken down are ideal - you would probably get tired of trying to lift the heavy batteries every time you travel.

So, I asked a couple of questions that were pertinent: Does your husband have Medicare? If approved, it would be a 20% co-pay, so the $4000 would be a co-pay of $800

Next I asked if he could walk. Apparently he can stand and move for short distances with a walker - he needs a wheelchair. So then I mentioned that a van would be optimal. Would you like to see mine to get an idea? They would. I was able to explain how the wheelchair works well with this type of modified minivan. Except these are expensive. 

Q - Is there anybody that can help in getting one?

A - I suggested that Social Security maybe through Medicare, although I don’t think so. What about a used one? His wheelchair can be easily tied down in the van, so no battery lifting would be needed.

I suggested that they contact the place where my van was modified, Advanced Wheels in East Granby near the Hartford Airport. All they do is modify wheelchair vans, and ask for John, Christian or Jason to see if they have anything used or any ideas. I have their phone number committed to memory and the daughter took all the info down on her I-Phone (I am merely a satisfied customer of this company, not a paid shill. My 2008 Grand Caravan is the third vehicle I own that was modified by them, and they will get answers for you). They left satisfied with the answers.

The point I am trying to make is that I know these issues. Two people were apprehensive about their plight, and by my knowledge, experience and manner, I was able to take the edge off the women’s fears. Perhaps I was able to erase the answer we so often see - the easy to say words ‘No' or ‘Never' are often what we say. Hopefully I was able to allow them to see the possibilities, the harder to say ‘Maybe' or even ‘Yes' just might be the outcome. I spoke as naturally as I do, with a command of the facts and possibilities that were not considered. This is the third time in the past week where my knowledge of wheelchairs and egress answered questions that seemed daunting at first. I know what I speaketh, and can present it well.

A disability consultant? Why not??

Substituting fact for...fact

It is obvious that October 1 is going to pass with me still in my position As much as I want to, events are conspiring against my moving out. As I have written, the income I require to make a move (with the Social Security disability and income limits) is quite low. So my minimal $ requirements shouldn’t preclude a move.

In fact, the state vocational high school in our area is literally around the corner from our house (800 or so feet) and they are looking for substitute teachers. The per-diem is wonderful. Around twice what it when I subbed three years ago.

Why would I want to sub again after my stint with this is a middle school? This could be more lucrative, but still…Being broke and unemployed and with no disability payments at the time, anything that paid anything was an option that was becoming closer to acceptable.

So I applied at Kelly Educational who handles the sub duties in a number of local districts around here and nationwide. After the fingerprints were taken and the background check performed ($49 out of my pocket) I was ready. Ready being a relative term here.

I generally ended up in a music classroom. Why there, when I cannot

• Read music
• Play an instrument
• Sing or act

The reason was that the teacher in question was embroiled in a termination issue that may be recounted here soon. At any rate, with few lesson plans and 6-8 grade students bored, itching for action and a sub with no authority (the past as prologue – how odd that jobs in 2007 and 2010 have the same issues…). I got used to saying to any challenges to the lesson by any student: Hey, it’s not my ‘F’

I had had enough at this middle school. Without too many specifics, let’s just say that I lost my cool with the most disruptive seventh grade class one day to the point that I was asked to not come back as a sub.

I offer no alibi no excuses as to why I was asked to leave. The oddity here is that I had decided to give this assignment up after the previous day’s assignment, but when the assignment call/e-mail arrived this morning, I blindly accepted it and that led to my undoing. Not that the mere $75.00 made the middle-school maelstrom worth it all. As strange as it seems, these situations sometimes have to end in the worst possible way to make sure that it has ended for sure, slay the dragon for real.

So despite the bump in pay and general dissatisfaction with my current employ, could this be worse? Yet any and all issues remain moot until I decide to stay or to go

If I only had the authority

Authority - what a concept. I'd like to have some...I worked with a consumer in a discharge. The care plan person (from unnamed) had a plan approved with a discharge for a particular date. It was apparent that nothing would get in the way.

Given my use of a power chair I know ramps – and this consumer can live without it but would be better off if a ramp were installed. However, I deferred to the care planner – the one with the authority, so no ramp…

Let’s move ahead several months. I received a message from (unnamed). The consumer needs a ramp I am told – have you obtained the bids yet??

Given my schedule I have visited the consumer and owner to see how substantial the work might be, and it will be. However, more referrals were thrown at me (with ASAP written all over). So I haven’t yet contacted the list of approved contractors. Although the care planner contacted me the other day – can assistance be offered to get this going? Nice that I was asked. My 18-hour workweek will be exhausted by Wednesday - my workdays are very full.

I will contact the planner with the list of approved contractors (today is Labor Day, a day to labor, right?) and a list of days the owner will be available. Major changes ought to get the owner’s approval IMO…

I am of the opinion that the care planner needed to have the ramp specified in the beginning. Not to whine, and it was nice that I was asked for help, but I am waiting for the fallout should the bids not received soon. I have had it with finger pointing and blame, and would be happy to take any of that – if I only had the authority…

Finger pointing exercise

The term ‘transition coordinator’ seems innocuous enough, you coordinate others who perform the duties that they are assigned, and all works out in the end, a safe discharge the result.

Pointing the way??

That’s the theory, anyway. 

The ‘responsibility vs. authority’ argument seems pretty clear here. I am the point person, the visible one who has to be certain the care plan is adhered to by the various care planners. I am merely an administrator. So the discharge on Monday occurred, with an interesting mix of problems that indicate a lack of focus by others - that I have to address and hopefully fix. Not my job? So there!

Lets start with the facility person who arranges the discharge. As medications will be needed, an appointment with the consumer’s physician is needed. Given that this person doesn’t drive, a method of transport to the doctor’s office is to be determined.

So the  appointment was made for the following day at 3:45 PM. I set up the PCA schedule, and can you guess - there was not a PCA scheduled who could drive the consumer then! Call it a mistake, but hey, why ask me what a good day might have been since I only created the schedules. Thanks...

Exit stage left??

The bigger issue is that after a call to the doctor, there were no other times available this week and there is a finite supply of meds. The transport for Title XIX (Medicaid) requires 48 hour notice. A fabulous sales job by me (30 minutes) convinced them to schedule a pickup for the appointment in <24 hours.

Let’s follow the what-ifs:

• the meds run out
• the consumer was unable to get to the doctor to get a new supply

Who has the ultimate responsibility here? You’d think the nursing home personnel, who have to provide a safe discharge, might have sweated the details a tiny bit. Au contraire! Any problems fall onto me. I am not averse to work, but where ought the blame ultimately be placed? There are a few other sidebars to this story I’ll ignore, but you get the idea...

Let’s not be silly Ralph - the blame is to fall on you! Responsibility vs. authority. It is a simple enough concept that I get it. What about the other players?


So much behavior here seems so old. Change can be good for the soul, my mantra should be change is good, change is good, etc. Wheelchair or not...