Insight

from hosp records:

"The patient stated that she was also worried about all the other patients, that they were given unhealthy food and carbohydrate loaded food."

In the doctors assessment notes and the referral we received for this client, she was presented as being a trouble maker, difficult and bothersome.  She called every hospital administrator she could track down to complain about the hospital food.

Sounds to me like she just knows what's going on!

Taking the Long View

I remember when I interviewed for my current job and was asked how I would handle transitioning to providing “long-term supports” - I was already working for this agency doing short term and crisis response work.  The director who was interviewing me stressed how challenging it can be for both worker and client to maintain hope, focus and direction over a long time.  I hadn’t really thought about it before, but must have come up with a reasonable answer, since here I am as a long term case manager.

I’ve now been in this role three, almost four years.  Some of my clients have been with me as long.  One of my very first clients has had problems with her housing situation since before I began working with her.  She also had mental health and physical health problems, family and financial issues amongst other challenges.  Basically, we both realized that until she had more suitable housing, it would be difficult to focus on her recovery, and I could basically only help her to “get by” in all the other areas mentioned.  Right from the get go I got heavily involved in working to address the housing problem.  There were family members, multiple agencies and her own issues to consider in this work.  What she needed was a first floor apartment (safety and accessibility issues) with three bedrooms (two kids of disparate ages and genders) in a particular area of town (so one child could attend a special needs school) with no carpet (severe allergy problems) and that would be eligible for the rent subsidy she receives (landlord would have to agree to work with that program, program would have to approve it and have the funds for it).  Like finding decent housing isn’t hard enough!

 

I won’t go into detail about all the ups and downs in this process over the past few years.  I will just say that a couple weeks ago, I got a call from a staff member at the housing agency.  I could hear excitement in her voice as she told me that she was looking at an apartment that she thought would fit all my client’s needs and criteria.  She could arrange a viewing in a couple days. 

The client came, kids in tow and looked around.  She couldn’t have been in the place more than 3 minutes.  It wasn’t going to work she said.  Why, I asked, as it had everything she wanted.  Did she want to take the kids to the park so we could sit and talk about it?  No, she wanted to catch the next bus, everyone was hot and she wanted to get home.

That was Friday, and on the Monday I met with her.  It went back and forth, she could see the advantage of the place, but there were certain problems…could she view it again?  I made the call and set this up.  My hopes were high, because I hadn’t even expected this much.  This time she came alone, left the kids at home.  Took a little more time looking around.  In my head I’m making plans about how to apply for grants to help cover the moving expenses, when I’m going to fit in an appointment to take her to get the key…the housing worker tells her she will need to know by the end of the day if she will take it.  I will call her in a couple hours to see what she has decided. 

When I do, she’s not ready.  Can I call later?  Of course I can.  This happens a couple times, until finally I tell her I can’t wait any longer and give her the housing worker’s number and tell her she will have to call directly.  I try to put it out of my mind as I go home that night.

Come the next morning, there are no messages for me.  It’s not until halfway through the day that the housing worker calls me to say that she will need a signed letter of refusal from the client, because she didn’t take the place.  The reason she ultimately gave was that the bedroom furniture wouldn’t fit.

I spent plenty of time that afternoon debriefing about this situation with my supervisor.  It’s times like these that it is difficult to remind myself of all those social work-y truisms – about client directed service, and individual right to determination and all that.  I will still be there to support this client either way, but I have to say I was mad.  As much as I can rationalize about her reasons, and empathize because of her history, I was mad.  Four years of work, for what?  I gave this woman my best and felt like it was totally disregarded that day. 

I know it’s not about me.  But this was one of those situations where BECAUSE I care, I couldn’t just forget about it.  It’s hard to think about possibly several more years of working with this client after this has happened.  This is where the long-term gets really tough.  This is where I start to feel tired and stuck.

The fact is, that what I need in order to keep going here are the same messages we use when talking about recovery.  Patience...hope...a willingness to fail in order to learn.  Finding the small successes that mark our progress.  Letting go of the things we cannot change.  Moving forward, because you can’t go back.  This is what will get me through the next four years of trying and trying again.  I can only hope that I will be able to inspire the same in my client.  After all, she is the one who must continue to live in her current situation.  And ultimately, she will be the one who determines when and how it changes.  Maybe I will even be there to cheer her on.

What it's worth, will it work?

Sometimes (often) we feel we just can't do as much as we'd like for clients.

One client of mine was facing particularly difficult financial straits this month for reasons outside of her control.  I offered to provide some grocery gift cards to help bridge the gap.  I was only able to get a $25 card, and felt a little sheepish giving it to her - I mean, you have a $0 bank account balance and need to eat for a whole month - how far is $25 bucks gonna go?  When we met again she told me she really appreciated my help and the card.  The day she went to the grocery store with it they had a "dollar sale".  How perfect!

Sometimes we worry that the situations our clients are facing are too difficult, and we worry about the barriers they face.

I helped this same client make a call for emergency rent bank help.  We were both surprised to find out how long it would take to complete the assessment and get help approved and processed.  She let them know the homeless deadline she was facing and they actually called her back really quickly.  She got in for an interview and to receive her money.  She called me several times that day distraught because it was a very dehumanizing experience for her.  But she got the money.  Got it to the landlord and secured new housing.

The next day the workers who called her back so quickly and processed her request went on strike.  If someone had not deigned to give her priority, what would have happened?  Sometimes when we think we face the impossible, the improbable happens.

When we work hard, sometimes it just might work out.

Mini-rant of the day

Why why WHY doesn't ODSP cover more dental expenses?

My client has three teeth left.  THREE.  We found a clinic that will waive their fee for extraction, but dentures have to be made elsewhere and would cost him about $500 each (upper and lower).

I guess it's not "emergency dental care" but does this ensure an acceptable standard of living?  From what I understand some outside agency determines eligibility for dentures.  Crap, now I have to get on the phone and figure out if he can appeal or something.  I probably should have known this too, before I got his hopes up that he could get some teeth.

Bleg.  /endRant

System Shock

The thing that never happens HAPPENED. The system saved the day!

Allow me to explain.

My client is on long-term disability from his job due to his mental illness. His wife works full-time at a fast food restaurant. They have had subsidized daycare for their 6 year old daughter for the past two years.

They received notice recently that their subsidy would end as of September, as their daughter will begin attending full day school. They asked me to call Children’s Services to advocate keeping the subsidy, as they can’t afford the full rates. Children’s Services explained to me that once a child is past the preschool age, and in full day school it is presumed that they do not require the same level of care, and the parent should be able to manage this. Apparently, this is policy. She said she had never heard of any exceptions being made. I kinda see their point, but have these people never heard of P.D. days? Winter and spring break? Summer vacation???? There are many days when the little one will not be in school.

My client is doing well in his recovery, but is not yet able to take care of his daughter by himself for extended periods. He has appointments with various therapists, doctors, clinics pretty much daily, and has difficulty staying awake for long periods of time and handling stressful situations.

So today, 3 days before they are to be cut off the Children’s Services worker calls me back. Apparently the department has just finished approving a new policy which states that approved disability leaves will continue to qualify for supports beyond preschool age, and this already applies to this family.

Hallelujah! We must have saved up some good karma or something. I was all set to do battle with the higher-ups if need be, but they pre-empted me! Any of you readers who work in or receive social services will know just how rare an event this is indeed.

Not bad for a Monday morning.

Extremely Cold Attitudes (Toward Homeless)

It's -27 celcius today, and snowing. Many of my client's find it difficult to get out of the house much at this time of year. I find myself less and less enthused about bundling up to get in the car and head out to see them.

My thoughts mostly are with the group I used to work with - the homeless and underhoused. An extreme cold weather alert has been called, but we know that some will still be outside.

An older gentleman that I support was distraught last year after his brother died on the steets of Calgary. He was found in a snowbank.

At least that city seems to have a plan in place to address the issue of homelessness, a plan that seems to be making progress.

Calgary's 10 Year Plan seems to be simple and straightforward. First, create permenant affordable housing for individuals and families. Provide support for mental health and addictions. Recognize the systemic issues that create homelessness, and acknowledge the economic toll that it takes on a community. It's great to see such an honest discussion of the problem occuring at a civic level. Several cities in the U.S. have similar plans and report largely positive changes so far.

I only wish that this was a conversation that City Hall in Toronto would have ears for. Instead, we have new Mayor Rob Ford's recent suggestion that social workers should be made security guards of the steets and force homeless people into shelters during extreme cold. Mayor Ford made no comments regarding plans for these folks once the weather warms (to greater than -15). As a city councillor, Ford made his feelings on the matter quite clear stating "People do not want government housing built in the city of Toronto. They want roads fixed, more police presence, but they don't want more government housing that will depreciate the value of their property."
He also cried that it would be "an insult" to his constituents to even discuss having a homeless shelter built in his ward.

So I guess it's up to us - front line agencies, community activists, and the people who need the housing around here to keep up the fight. To find the allies we undoubtedly have in city hall and elsewhere. Not that that is anything new.

Please, just go

I’m crossing all my fingers and toes today. A client of mine has been on a housing transfer list since 2006. She has been in supportive housing since 2004, when the housing agency made an “in situ” arrangement for a family member to rent to her, as he was going to let her live in the first and second floor of a semi-detached that he owns. This seemed ideal at the time (I’m told) because she has two children of disparate ages and three bedroom housing stock is low.

The situation has not worked out. He constantly asks her for money over and above the rent to pay for household bills, utilities, and improvements. She frequently gives in because, hey: she doesn’t want the lights to go out of the heat turned off. She has multiple complex health issues, and is on disability so she has funded this largely through a line of credit and credit cards. She is in DEEP debt. And majorly stressed. The effects on her mental health and family life have been devastating. I would go so far as to say there has been financial and emotional abuse happening.

About one year ago I started calling the housing agency to get an update on her transfer. Somewhat understandably, these things are not always a priority compared to new client’s who haven’t even been housed yet. The agency was able to show her one unit, but she didn’t take it. It was in a neighbourhood far removed from just about everything, and her daughter would not be able to get to her high school (she attends a special program). Understandable, but frustrating for all that it didn’t work out.

Fast forward one year. She’s been doing relatively well given the circumstances, and we’ve been working a lot on goal plans. We realized together that the housing issue is creating a huge obstacle to most of her other goals and aspirations. Since it’s been a year, I call the housing agency for updates, and to impress on them how urgent this situation has become. I do an email follow up and cc: the manager just to make sure we aren’t forgotten about.

Well that did the trick!

Two days later a unit has been found for her to view. We went to see it yesterday. It’s in a great neighbourhood, near the schools, nicely kept building and clean, good sized unit. She seemed to like it, but had one major concern which I’m really hoping will not sabotage the whole venture. If she says no to this one, she only gets one more chance.

Our work is supposed to be client driven, but I admit I was not unbiased with my client yesterday. I talked up what I thought were the good points, I printed out a map for her of the area, highlighting access to services, routes to school etc. I suggested ways that I thought we could work around her ONE concern.

She has to decide today. I hope she takes it.

Soapbox pt. 2

So I figured if I could blog about it, I could also do something more productive. Write a letter. This is what I have written to the premier:*

April 23, 2010

Dear Premier,

I was very encouraged when I heard the recent announcement of the changes being introduced to Ontario’s curriculum regarding sex education. I understand that this is a sensitive and therefore particularly challenging subject matter, and I felt that your plan did a good job reflecting the diverse experiences of children and families in Ontario. It was disappointing then when you decided to place these changes on hold.

I am the parent of a six year old who attends public school. As a mother, I have a great responsibility to impart my knowledge and values to my child, but I also recognize that she is constantly being influenced by other sources. Between sexist and homophobic messages in popular culture, hyper-sexualized images in the media, and often misguided information from her peers, I would like to trust that the education system is a place where she and other children can receive sound knowledge and resources. It is not helpful to her or the other students to continue using language in the classroom that is vague or non-inclusive.

I sincerely hope that the government of Ontario will proceed with the proposed changes to the elementary curriculum. Cultural attitudes and information available about sex and relationships are always changing, and the curriculum needs to keep pace. Our schools provide a safe environment for children to hear these messages.

Sincerely,

(Nectarine)

Also, I tried to find some groups or articles supporting the change, but have come up short so far. I did find this informative comparison.

*feel free to copy/paste/share/plagirize!