The Twelve Days of Christmas - Social Work Edition

Like absolutely everyone else, those of us in social work often find the days leading up to Christmas to be particularly hectic.  It can be a hard time of year for many of our clients, so they may need additional support.  There are many charitable goings-on that we may be involved in, and most of us hope to get a couple days off with our own families.

Here's a little ditty to give you an idea of what the holiday rush looks like for us.  Feel free to sing along!  (I'm not typing out the verses over and over, you all know how it goes!)

Twelve grocery gift cards

Eleven overdue assessments  

Ten client Christmas parties  

Nine home visits 

Eight food hamper deliveries  

Seven flu shot clinics    

Six church hall turkey dinners  

Five volunteers!!!!!    (we love our volunteers)

Four donated toy drives     

Three office potlucks  

Two emergency room visits    

And one last minute crisis call!

  

Cleaning Out and Cleaning UP

A client of mine who has some, ah, let's call it "moderate" hoarding issues recently made it a goal of hers to clear out her kitchen enough that she could set up the table and chairs that she has.  I am helping her with this, and we began by tackling a corner where she had numerous plastic and paper shopping bags stacked about knee high.  In many of these bags were old empty prescription bottles she hadn't wanted to throw out due to her name and address being on the labels.  In all of the other bags were FULL prescription bottles of medication she hadn't taken, including some serious pain killers.  Apparently her doc has continued prescribing her 3xday when she only takes them as needed (maybe one a day a few days a week).  She had these from the past 4-5 years.  The mind boggles to think of what the street value of these things would be.

We just returned them to the pharmacy for proper disposal.

Thursday Morning Interrupted

I start most of my Thursdays in the same way.  I have a standing appointment with a long time client at 9:00.  Since my work day actually starts at 8:30, I usually pull up into a local parking lot, and drink tea from my thermos while I remotely check my voicemail and read emails on my blackberry.  At about 5 to 9 I drive on over to the client's building and we usually meet for the full hour.  This particular client likes to share, and always has lots to talk about.

The other day I followed said routine.  At about 5 to 9 I realized that I kinda needed to pee, but didn't have time to get to the McDonalds down the street (my preferred pit-stop location.  I won't eat there, but their bathrooms sure are nice and clean!) so not thinking much of it I went on to my meeting. 

As my client is launching into his weekly update, all I can think about is my need for the loo.  It's getting worse by the minute.  I've never used the toilet in a client's home (just my personal philosophy) and I'm not about to start in this particular one.  My client is extremely nice, but not the best housekeeper.  And let's just say that over the years this client has related many a charming tale about various bathroom "misses" (I'll leave that to the imagination).  Only 20 minutes into our appointment as I'm trying desperately not to wriggle and fidget, I had to make some really lame excuse - I'm sorry I have to cut this short today, I've over booked myself - and got out of there! 

Waiting for the elevator was agony.  As I got to the ground and dashed for my car, I quickly tried to come up with my best plan considering urgency/need to avoid any embarrassment.  In full on wiggle mode in the car, I drove down the street to my mother's house, as it's mercifully nearby.  I totally made it, and basked in the glory of this success for a few minutes before carrying on with my day.

This is remarkable only because how is this the first time ever this has happened?  I do the same bloody thing every week?!?  I guess I should be grateful, and just hope it never happens again.

Vehicle of DOOM!!!

Just exactly what you DON'T want to see when you pull into the parking lot at a client's building.

Social Work Summer Look Book

Summer provides a particular set of challenges for the housing worker dress code. As always, we must look professional enough for the office, but causal enough meet comfortably with clients in their homes.

Temperatures have been in the 30’s, and even hitting 40 with the humidity so we must try to stay cool. Getting in and out of the car is inevitably hot and sticky. Most clients do not have A/C at home. The office, on the other hand, as well as the many coffee shops, libraries and other public spaces we frequent are chilled to what I’m sure is minus 5 degrees, so layers are important. I’m toting cardigans with me in the middle of a July heat-wave.

We don’t get paid enough to maintain a particularly generous wardrobe which means I rotate the same 2 pairs of shorts and one skirt with great frequency. They are the only things that will allow me some relief from heat, while also allowing me to sit comfortably in some of the less than sparkling clean apartments and rooming houses I visit regularly.

And then there are the shoes.

I read with jealously when SocialJerk disparaged the social worker stereotype of wearing Birkenstocks, because frankly, I’d take any type of sandal right about now no matter how “social worky” they may make me look. But that’s a big no-no. Along with outlawing high heels (makes sense when we are entering all types of settings with a wide variety of health and safety disasters problems concerns) my agency has decided that a fully enclosed heel and closed toe are the only way to go. So the choices are sneakers and socks (which look AWESOME with my shorts and scrawny legs) or some type of flat dress shoes. Either of which leads to sweaty and stinky.

And the cherry on top of this sweaty, sweater-toting, scrawny legged mess? There are some clients who do keep a very neat and tidy home and want me to take my shoes off when I come inside. I’m not allowed to do this, and it’s too bulky to bring along “indoor shoes” so I end up popping on these babies:

Who ever said social work isn’t sexy, hmm?

NOTICE

Please put underwear on before your case manager comes over.  Please!

The Long Haul

How do you help a client who has been the recipient of case management supports for 14 years, and does not yet understand why she is receiving the service and what is its purpose? She can tell me exactly the number of visits she’s had (108 from me over the past 2.5 years, 784 total from all CM’s) but not why they are happening.

Careful of becoming frustrated, I go into empathetic mode. “You seem to have some questions…” “I hear that this is distressing you…” “Is there help you would like that you don’t feel you are getting…”

I’m not sure she hears what I say, as she would like to reinforce her previous statements, and repeats what she’s said before I am finished. Then repeats it again. We are testing the limits of the “recovery model” profoundly here.

So I call in the reinforcements. Her “natural supports” (dad) to keep him in the loop. He really wants to help, but doesn’t always know how. The “formal supports” (housing provider) to give a heads up and some background on the angry and frustrated phone call(s) they will inevitably be receiving. My supervisor so I can check my feelings about the situation, and get the help I need to figure out clinical solutions that may work here.

I really do believe in recovery. A situation like this makes me wonder if there was a failure in the system along the way, something early on perhaps that did not help this person gain understanding and a sense of control over their life situation (answer=probably). Perhaps it’s the set up, the fact that by accepting a rent supplement, she is bound to the “support” aspect of supportive housing. This policy has always troubled me as it is so far from “recovery” based.

On the other hand, maybe this is what recovery looks like for her. She’s been able to live in a place she likes for all those years. She has hobbies and things she likes to do, however sporadically she does them. She tells me she never wants to return to work, and does not want anything drastically different in her life.

Or instead, that could mean we haven’t done a good enough job of instilling hope and conveying a sense of what is possible.

Perhaps her journey is just a painstakingly slow long one. Maybe 14 years has just not been enough to create a new sense of self and new way of living after (what I understand to be) many years of neglect, abuse, illness and loss.

Sometimes it is just too hard to know.

A Day in the Life

Thursday February 3, 2011

8:30am – park a block away from first appointment and check messages on office phone and cell phone. Remarkably few, possibly due to yesterday being a “snow day”.
9:00 – pull up to client’s building for first appointment. He’s a big guy (with severe back, neck and knee problems) who struggles to get in my little car, but we make it. We head off to check out a new grocery store, a figure out a route for him to take the bus there on his own next time.
9:45 – take same client to coffee shop for a caffeine fix and quick chat about plans for next week’s meeting.
9:59 – return to client’s building, help him load his groceries in.
10:00 – back in the car, call the pharmacy to see if next client’s prescriptions can be made ready for pick up. Ah, crap – there are no more refills. The pharmacy offers to fax a request to the doctor’s office, and I call the client. He swears that he did see this doctor in the past few months (can’t remember exactly when, but…) and forgot to ask about those prescriptions.
10:10 – Call the pharmacy back, they say it might take awhile. Call the client again, tell him it might take awhile and is it okay if I drop his meds off this afternoon. Yes, that will be fine.
10:20 – Eat my lunch in the car trying to ignore the fact that it’s -10 Celsius outside but I’m dressed in several layers so that’s okay. Relish the fact that I have a few minutes to listen to Q on the radio.
10:45 – Head downtown to start searching for a parking spot.
11:00 – Find parking, dash across the street to the church to set up for the Outreach lunch program. My co-facilitator has beat me there, as have several of the clients, even though we don’t officially open until 11:30, but hey, it’s still -10 out!
11:30 – Serve chili, chips, and veggies to familiar faces, and some new ones. The attendees are mostly male, 40+ and kinda rough around the edges. They make loud conversation about politics, people they know, their plans if they won the lottery, and “the way things used to be”. They’re a good natured lot, and the lunch tends to run a lot more smoothly than its breakfast counterpart at the other church. Breakfast gets a bigger crowd, and there is sometimes “trouble”.
12:30 – start tidying up as people leave. Spend some time supporting an elderly couple whose son lives out east and was recently diagnosed with bipolar. They’re frustrated that “the system” out there isn’t giving him the support he needs, and they wish they could do more to help. They went to visit him last fall when he was in the hospital, but the motel was expensive, and it’s hard for them to travel.
1:08 – I realize that I’m late for my next appointment, and try to call but get the answering machine. The outgoing message wishes me a “happy new year” and remarks about the date 01/11/11 for several minutes before cutting me off, so I don’t get to leave a message.
1:15 – I arrive to my “happy new year” client’s building, but there’s no answer when I buzz the intercom. I wait inside the front door for several minutes then try again. I call her phone, and the answering machine seems to work this time so I leave a message asking her to call and reschedule.
1:30 – Back in the car, I drive to the neighbourhood of my next appointment, and park across the street to check messages again. One marked “urgent” from a new client whom I have met only twice telling me that he found a room to rent and is no longer living in the shelter, and he’ll call me later to set up an appointment, because he doesn’t have a phone. Another from a current “high needs” client crying and upset because she’s lost all her ID. This could be pressing, but I know if I call her back it’s possible I’ll get stuck on the phone for a long time so it will have to wait for a more opportune moment.
1:40 – I check my email and notice a message from a client I did an intake with a couple weeks ago. He let’s me know that his housing arrangements “didn’t work out” and he, his wife, and their two children are now in the family shelter. He sounds pretty desperate for help and is planning to rent a truck to go sleep in. I remember him as extremely depressed, anxious, and suicidal. I email him back quickly to ask if it would be okay for me to refer him on to our outreach program which can meet him right away.
1:55 – I call my 3:00 to see if we’re still on because he often cancels. He has schizophrenia, and is also going through cancer treatment so he’s not always in the best of shape to meet. He asks if I can come earlier than planned and I say we’ll see.
2:00 – I check in with my next client. It’s dark in her apartment as the balcony door is blocked by the snow and she never opens her curtains. She finally let her dad know that her cat died, so he’s not worried any more about why she’s acting out of sorts. She missed her psychiatrist appointment last week because she’s scared that if her taxi runs out of gas it’s winter and she’ll be stranded in the snow. She’s scared that no one will save her. I try to understand, and try to support as best I can.
2:30 – Back in the car, call Mr. 3:00 and let him know I can come now. He wants to go to the grocery store and has his list ready.
2:35 – I pick him up, and off we go.
2:50 – I’m getting a grocery cart while my client starts his shopping inside. An older gentleman is trying to light his cigarette with a burnt out lighter, and I suggest to him that he’s probably not allowed to smoke in here and needs to go outside. He asks me for a match, but I don’t have one. He goes back to trying the lighter.
3:45 – Groceries are done, and after a stop at the post office I take my client home. We make arrangements to meet next week if he feels up to it.
3:50 – In the car I call the pharmacy from this morning and learn they finally got the refills, they didn’t think they would cause this doc has said no before. I call my client to update him, message my boss to update her about the changes to my schedule/location (for safety purposes, understand) and head off to the pharmacy.
4:05 – At the pharmacy we commiserate for a minute, and they tell me my client called them about 20 times today, anxious about his medication. They’ve known him for years, since he was homeless down the street from their store, long before I came around. They want to know does he also need his foot cream, I call, he doesn’t, I take the bag of pills (these have got to be worth $$$ on the street!) and zip over to his place.
4:20 – I get there (just in time) hand over the drugs and apologize that I won’t be able to stay and chat. I’ll call you tomorrow to schedule a check-in appointment, okay?
4:30 – I finish my day on time somehow, and call home to let them know I’m on the way.

And watch the upholstery!

Community visit check list:

Sensible shoes with closed toe and flat soles? Check.

Comfortable clothes that can be stripped off and washed of all pet hair, lingering cigarette smoke and unidentified sticky substances IMMEDIATELY upon returning home? Check.

Hand sanitizer? Check.

Lint brush to remove endless tufts of cat hair from clothes and car seat? Check.

Bed bug spray? Check. (yes, apparently this exists and is supposed to protect me. Yeah right.)

Disinfecting wipes for hard surfaces in vehicle if transporting client? Check.

Well organized binder including notebook, client folders, pens and any standard forms client may need to sign? Check.

List of local resources for handy referrals? Check.

Contact information for supervisors, crisis line, and emergency responders? Check.

Business cards? Check.

Keys attached somewhere on my person with a karabiner? Check.

Left all valuables at home? Check.

Blackberry at the ready for any and all emergencies? Check.

Tim’s card for when self or client needs caffeine therapy? Check.

Purse securely locked in trunk? Check.

More hand sanitizer? Check.

Face masks left over from the H1N1 scare? Check.

Barf bags? BARF BAGS?!? Dude, get OUT OF MY CAR! You do NOT need to go to the drug store so badly that you can’t cancel your appointment when you’re HEAVING!

Keep your pants on!

A first today, although I'm surprised it hasn't happened before. I went to visit a client at his home, and he had left his porn out. DVD's on the coffee table, right in front of me. Also, he was wearing long underwear instead of pants.

It was a very short visit.

I could have said something to him, but didn't. Honestly, I expected he would go find some pants - this has happened before, that he answered the door in his long johns, and excused himself to his room before returning more properly dressed. As for the porn? I guess I could have said something about the appropriateness of exposing guests to this sort of thing, but I didn't want to get into it. He's a quiet, middle aged man who is only semi-fluent in English, mostly keeps to himself and is generally very polite and agreeable. He's an adult, and it's his house. That said, if it happens again, I will likely speak up.

And no, it was not a surprise visit. He knew I was coming.
*sigh*