Hello again reader,

Thank you for taking an interest in my blog. Sorry about the formatting on some of the entries. I'm still getting used to the blogger program.

So I promised that I would talk about a client experience today. Well, I'm going to do so, but this time I'm going to describe the experience of a social worker sitting on an Inter-Disciplinary Team (IDT) looking at other professionals and their re-actions to a client's situation.

Again this vignette is from the medical/hospice setting. Picture an elderly lady with mid-to-end-stage dementia and who is living in an assisted living environment. 

In simplified terms, "assisted living/supportive-living" is a residential setting that caters to the needs of the individual by offering for-fee services off of an "a la carte" menu (i.e.- care-giving, dressing, medication reminders, baths, meals, socialization groups, transportation, ect.). There is a movement in America to try to fill the gap between living in one's private home and the nursing home. Assisted living environments are just one option that the commercial marketplace has offered to our elders, and can sometime be as expensive as $2000-$4000+ per month. Obviously, this is not an option for everyone.

Over the last 5 or so years, in my opinion, assisted living providers have become more savvy to the idea of "aging in place". I also subscribe to this idea... why make an elder go through a major stressor, such as moving continuously, when they are feeling less and less control in their lives as it is  Especially, if routine and familiarity to one's own home is the only thing really grounding a person in his/her orientation or capacity to function. Also, I have heard quite a few of my clients grieve over the loss of their family house that they had lived in for 40 some years.

Back to my client. As I sat in the IDT meeting, I heard a nurse explain with frustration that there was a lack of communication/sensativity between the Hospice and the assisted living staff. It seems that the growing pains of the assisted living staff aren't keeping up with the needs of a frail/hospice resisdent. Roll-adjustment is a huge issue here. Let me give an example.

There are many different skill levels for care-givers/home health aids. Some are Certified Nursing Assistants (CNAs), some are more like companions/house-keepers, some have the nurturing experience of their own life experience to pull from. My point is that not every care-giver/home health aid has been introduced to the realities of what is considered abuse/neglect of an elder in the eyes of the state or the medical profession. For example, is the use of diapers on an elderly client. Are the diapers being used for the health of the client, or the convenience the care-giver. How often are the diapers changed? In my client's case, is proper attention being given to how the diapers may be contributing to skin breakdown....expecially when the care-giver thinks it's easier for her to change the client in the future when she puts two diapers on at the same time. *sigh* 

So this doubling-up of diapers pushed some buttons on the hospice team, and from my past experience in nursing homes also tends to push family buttons. It pushed my buttons too, when I saw patients enter a sub-acute floor for physical rehab and for the first time in their life they were put in diapers. These were people who were alert enough to ask for help going to the washroom with the nurse-call button. So seeing this type of decision to put someone in diapers is not new to me.... but two diapers at once.... I have never heard of such a thing. Think of how uncomfortable that must be, and how clamy a person's skin would get? Now imagine if you couldn't verbalize your discomfort?

The nurse presenting the case vented as I said in the meeting saying that she did the best she could at the time to educate the employeed care-giver, but wasn't sure if the instruction would be taken seriously.

I gathered from the feedback from others at the team meeting that a power struggle between the care-giver's supervisor and the nurse ensued and the situation was bumped up the chain of command. The transition of this assisted living environment to a medical environment had not gone as smoothly as was first portrayed.

Also, I think how long this care-giver had been "doubling up diapers" on clients. Was this an accepted care-giver practice in the assisted living enronment?  And since, I know for a fact that other medical agencies had had clients in the same assisted living environment, why hadn't they noticed this "abuse" in the past? Did the need for sustaining a "good" business relationship with the assisted living environment prevent the exposure of systemic deficits? 

Lastly, when one agency criticizes the actions of another agency, and they have to continue working together, how do you go about mending that realationship? My hopice agency advocated for the proper treatment of the client, but we had to basically shoot ourselves in the foot to do it. Don't get me wrong, the client's welfare is always the most important issue. 

Just something I was thinking about today.

Well, I think I'm ready to start this blog "for real" this time. I have a good solid start on the Social Work Cafe, and now it's time for me to have fun bloggin'.

I've kicked around a few ideas for this blog, and have settled for the "Day in the Life" format. I thought it might be interesting for social work students to see a personal journal of a social worker. Also, there is a therapuetic element to journaling, that will allow me to work-out my own stress. 

Just a little background about myself....

I just started a new job as a Hospice social worker, in the state of Illinois, USA. I'm 32 (well almost 33) years old, still a newly-wed, and have worked in the field of social work since 1998. Past job experience has focused on the geriatric and homeless/low-income populations. I am preparing to take the clinical social work licensing exam, and hope to sit for the boards by the summer of 2008.  

On the Job.... 

I was hired by a hospice company this past March. It is a national company that has just opened up it's first office in Illinois. I was hired on a PRN basis (meaning that I only work as needed), with the job title of Social Worker and Director of Volunteers. Once the agency has a caseload of 40 patients, I should be able to be hired as a full-time Social Worker. 

The first phase of my job has been filled with training, and building program protocols, more training, and building community linkages. I believe that part of any profession is continuing education, but I have also had to adjust my thinking of documentation and case management to fit the new Medicare Hospice requirements. Now all team member documentation needs to be written in the negative, which speaks to patient decline and the necessity of continued Hospice services. This has been a huge challenge for me.

Luckily, I have the support of a wonderful team, and supervisors who are also facing their own struggles to adjust to new rules and job roles. It's a unique way of being introduced to a new company, and uplifting to think that we are all building something together. my superiors are from the nursing profession, yet they have worked for over 20 years in the hospice field and they all respect the work of social workers. Healthcare is the one realm that I have felt this respect on a consistent basis from my peers. Being part of an inter-disciplinary team is something that I strongly suggest that every new social worker looks for in a job.

Because this is a new agency we rely on the principle of "mentorship". This is probably why the Social Work Cafe has a new "Mentor Match" program. I find having mentors, I like to call them my "touch-stones", an invaluable resource for the questions that arise that I feel can't be answered without a lengthy discussion. For example, my whole question of how to write progress notes in the negative. For a social worker who has been trained to use a "strengths perspective" and help clients set their own goals, this is very weird. I also, tend to see the positive in a situation, like....

"Client is Alert and dis-oriented. Client seems to be able to recognize when a new person comes into the room and seeks interaction."

To me this is not a contrary statement. But to a nurse it seems to be. We must have different definitions of the word "dis-oriented". So I strive to breakdown my statements to mostly observations instead of statements, the exception would be when I have a client who I could do counseling with. Then I can say the goals of the counseling session.

Anyway this, "re-programming" of my mind is worth it because it doesn't change my inter-actions with the clients or their families, and as my supervisor said "it allows the client to stay in the program since Medicare will approve of payments". I know this sounds a little strange, almost like it is fishing for clients by stating the negatives as a constant, but I'm sure there is a way that physical decline can be shown with goals being completed at the same time.

All in all, it has been an interesting journey so far in this new job, and I'm sure it will continue being a rewarding experience.

In the next blog entry, I hope to write about a client experience.

Dear Reader,

I haven't had much time these days to write on this blog. With the hot weather here is Chicago the last few weeks, my Internet connection has not been the most reliable. Last night, we even had a blackout! So when I am lucky enough to get a solid hour online, I tend to edit the other areas of the Social Work Cafe. I'll surely get back on the quest for links about children with chronically ill parents, when the weather breaks.

For now, I want to thank the Social Work Cafe users who I have had the pleasure of chatting with through chat utilities like MSN Messenger and MySpace IM. (On both services I can be found by searching for my e-mail address, bshane@hotmail.com). I was thinking of incorporating SWC user's chat nicknames on the global e-mail list. 

Another way I plan to help SWC users make connections is to publish a quarterly newsletter. I hope to have the first issue written and sent out by the end of this week. It will introduce new features on the SWC, and have commentary on the expanding SWC community.

Oh, and the official rollout of the Mentor Match program is just around the corner! I'm so lucky to have almost 20 volunteer mentors to help fulfill requests from new social workers and college students!

Well, I better go and continue my work! Have fun exploring the Social Work Cafe!

Okay, you caught me. I am writing these blog entries, because I feel that I really have very little occupying my time these days. Of course, I'm sure this down time is just the proverbial "lull before the storm".

Since my wedding day in March 2007, I have been patiently waiting to start my new job as a hospice social work. Oh, I have been doing some administrative work, going to trainings and such, but I haven't seen my first client yet in this new position. As the new "Mrs. Pace" I tried very hard to get interested in the whole housewife role. That wasn't really challenging enough, or maybe the house is just too quiet. (No kidlets yet). So I had to jump on the Internet again.

At first, I thought.... "Maybe I should get a job that I could work from home?" I had been updating the Cafe and found a member's web page that had links to jobs for at-home mothers. But after reading through about 5 different websites on the topic, I realized that in many of the cases I had to spend money on mail-lists for jobs in order to start making money. Ack! I didn't want to spend money.... heck I'm a humble newly wed living in a basement apartment trying to scrape together $20,000 to buy our first house. 

Then my new husband, Timothy, asked if I could use the Social Work Cafe to make a little extra money. I had seen other social work websites charging for ad space, but after thinking about the concept, I said no. The Cafe had always been FREE and that is how it should remain. Besides, I wanted the Cafe to remain a "fun" activity for me.

Next, I decided to try my hand at writing; hence, this blog. I thought, maybe practicing my creative writing again would spark a new ambition of sorts. There's just one little itsy-bitsy problem. A blog is a one-way form of communication! Seems unnatural for my social work identity to be the "talker".  But maybe there is something to say - if I focus on one topic and some research to my blog.

So this is what I am going to try from here on out. I have picked a personal topic, that when I was in college about 5 years ago, I hadn't found much information on. The topic is children who grow up with chronically ill parents. Maybe a journal written by an adult, reflecting on childhood experiences will add something new to the knowledge base! 

Yes, I too hate the description of people as "Needy". But is there another description for what a social worker might see in his or her neighbor or family or friends? Sometimes, I forget that when I am home, away from work, that people watching is only a sport and is not my job to worry about the outcomes of their actions.

For example, in my neighborhood there is a continuing confrontation between various people about cleaning up after our dogs. One neighbor sets up a camera in the alleyway to catch the culprits. Another screams at anyone passing by a 20-yard radius of her house. And finally, there's the neighbor that dive bombs a courtyard with 10 bags of collected feces at 1 am in the morning. What do I see?

I feel a need to bring everyone together to discuss the issue, and at the same time feel too exhausted at the end of the workweek to negotiate between these sociopathic characters. Is my ambition to help my own community lacking? YES! Call me apathetic, silly me thinks that when I am no longer wearing my social work hat, that life should be easy-going. *sigh*  Or am I just acting out by saying that it's some one else's problem, like the alderman's or the community police?

Not very social worky of me? But I guess that's my point. I am still a person, not totally defined by my job roll, not always the helpful soul. And you know what.... While the guilt is there, I can not be a social worker 24/7!