Sunday, December 14, 2014

Retired Social Worker Perspectives: The HMO Experience

Retired social workers see things from a different perspective... a perspective of understanding and navigating systems. Throughout our careers we have helped OTHERS navigate these systems. Once retired, we'll encounter a system or two ourselves. It can be a shocking experience or just another social work challenge.

So here is my recent experience signing up with a major healthcare HMO. I'll enjoy reading comments from others who have had similar experiences.

It was Medicare open enrollment period. Choices were to be made based on quality, cost and convenience. I decided to go to a meeting held by a local healthcare HMO, a very well-regarded HMO. The slick marketing team explained the "products," but I had already circled the one I thought would benefit me the most in my booklet. I had carefully compared the program to the one I was on. The one I was on was costing more and more money. With cataract surgery looming, I thought I'd like to save some money.

Besides. I thought, change can be good  for the most part. I perked up when the HMO reps talked about the dental program and the free health club membership. I had considered returning to swimming and free sounded like a very good price. And now I paid $45 per month for dental insurance. And I still didn't like going to the dentist!

But mostly, I wanted to experience the continuity of care and health promotion aspects of this HMO. In my working life I had known a couple of physicians associated with the company and was impressed with their holistic approach.

I signed on the dotted line and looked forward to seeing what the HMO could do to help me with health issues (and, financial issues). I sent in the application and headed out for my last visit with a gynecologist I had been seeing for a scary condition I won't discuss here! The main thing to know is that she could handle my anxiety without belittling my feelings. A welcome talent!

Once in the office, face to face with my physician, I realized that changing insurance meant leaving the person before me who had taken time to understand me and researched my rare condition. Suddenly I realized I was giving up something important, not just gaining a new health care system which sounded really good on paper. 

My physician helped me tremendously when she made personal recommendations for gyn docs in who practiced with my new HMO. These were physicians she had worked with and personally recommended. Again, she had calmed my nerves. I realized how much I would miss her. As I drove home the thought of cancelling the new program went through my mind... but I didn't.

The membership card came in the mail and I called the new member phone number. I dreaded the thought of a call center employee (probably who had experience with a cable TV company call center or something) helping me with appointments and the transition. I was pleasantly surprised when an educated-sounding, skilled person helped me with appointments and even gave me tips on navigating their system (call the dental office at 6:30 am and ask if there were open appointments to get in fast). 

I was in "the system." With appointments made, I filled the rest of my calendar with recreation and social events. I had to do this to balance out the dreaded medical appointments and reassure myself that I wasn't getting old.. not me!

Thursday, September 04, 2014

Joan Rivers: Reminding us of planning for the tough end-of-life decisions

I’ve been following the Joan Rivers health crisis. I am not sure why. I am not a follower of the stars. But this issue really hits home for two reasons.

First Joan Rivers has shown us that she defies stereotypes of the aging woman. She’s 81 and up until her hospitalization was a real go-getter… appearing on several TV shows and promoting her lines of clothing and jewelry on QVC. There was no card-playing, rocking chair sitting in her life! I saw her as a role model of what 81 could look like. Bright, energetic, vibrant.

But things changed in an instant. Apparently she had a routine procedure. Her heart stopped and she stopped breathing. She was rushed to the hospital and put on life support. She was then placed under a medically-induced coma. It was not known what the damage to her brain had been after the period of time without oxygen. Family stood by. It was certain they were in crisis despite their carefully worded press releases. What a shock!

So now we hear she has been moved to a private room, still on life support, and is “being kept comfortable.”

This brings me to the second reason I am following her situation. I am a former Ethics Service member and have managed an ethics program in a hospital. I have seen what can happen when a person is on life support and the future is not clear. I also have seen what can happen at junctures like this so that a person’s wishes are not respected.

Family, friends (and even fans) can have trouble letting go. Physicians can want to offer hope of recovery at all odds. Sometimes a pulmonologist, for example, can be working toward restoring natural breathing in a patient. But what if the neurologist says there is significant brain damage. What if the cardiologist believes that the patient’s heart can go on beating strongly. What if a considered legal suit takes the forefront?

Should the patient be on life support even when it is only prolonging the patient’s dying? This happens all too often. We don’t know what the situation is with Joan Rivers. But we hope that her values and wishes are being respected. Sometimes that takes a full-blown meeting with the Ethics Service leading a discussion among the family, all physicians, key healthcare team members and even the patient’s attorney. These meetings are well worth it. Information is heard, questions are asked and documents are examined.

Documents? We hope that Joan Rivers and people like her draft documents such as a Living Will and a Durable Power of Attorney for Health Care. The former lays out the patient’s wishes should they have a life threatening incident in their lives (do they want to be on life support should there be no hope of returning to a previous quality of life… or, do they wish their life prolonged at all costs).

A Durable Power of Attorney for Health Care lets the health care team know who you designate to make decisions for you should you be incapable of making them for yourself. It clears the air if there are differing opinions among family members. You can designate anyone you wish (except a person on the healthcare team) to make a decision to withdraw, or continue life support, for example.
Everyone should have these documents. It makes things so much clearer because… these end-of-life decisions should be made with the patient’s wishes, values and directions respected, above all else. And no one knows what you want more than you do.

I hope Joan Rivers’ care is being handled with her wishes and values at the forefront. Moreover, I hope Joan can be restored to the vibrant life she had been leading. And, if that is not in the cards, I hope that whatever her wishes are.... will be followed.

Note: Shortly after this was written, sadly, Joan Rivers died... peacefully per her daughter.

Wednesday, August 20, 2014

Wild: From Lost to Found on the Pacific Crest Trail – Should you see the movie?

The Bridge of the Gods, Cheryl Strayed's destination on her PCT hike.
Why would a woman hike the Pacific Crest Trail (PCT) from California to the Washington border fairly unprepared and alone? The movie, Wild, about a woman who did just that, is coming out in December.

Many are eagerly anticipating the film including those who read Cheryl Strayed’s  book. I can only superficially relate to the hike. I walked just a little of the Pacific Crest Trail myself and hung out around The Bridge of the Gods on a sunny afternoon.  But the book is about so much more. It is about personal struggles and a journey of healing. I CAN relate to that.

But I am wary. I am wary because I can’t figure out if I want to see the movie. After all, I enjoyed the book, the story and Cheryl’s writing style. After reading Wendy Bumgardner’s review (she read the book a couple of years ago), I realize more than ever how an author’s words can lead us to self-reflection. 

We overlay so much of ourselves and our own personal stories as we read. Wendy’s reaction, for the most part was negative. She just didn’t like much of Cheryl’s fringy behavior and she didn’t like Cheryl’s lack of preparation for her journey. Wendy is a walking expert and writes tons of articles on walking, hiking and how to be prepared. So I can see where she is coming from.

I just saw Cheryl Strayed as troubled. Well, maybe, tortured. I thought of those I had encountered in my personal and professional social work life who were equally as troubled.

As I read Wild, I thought about my life. As Cheryl pounded her way along the PCT, I reflected on walking parts of the trail in the Lake Tahoe area and, recently, in Oregon. I remembered dragging along after a hot, six mile hike wishing it would end and looking forward to a cool Diet Coke when I returned to my car. Multiply that feeling by a hundred and I might only begin to empathize with Cheryl’s pain.

Throughout Cheryl’s accounting of her PCT backpacking experience, I said to myself over and over, “I would never do that… I would have quit.” But I am not carrying the personal pain that Cheryl carried. And, I am not feeling the need to endure the suffering that Cheryl brought upon herself.

It was through the lens of my own life experience that I interpreted Cheryl’s writings and her struggle. I believe that is why she is a highly acclaimed author. She makes us think, to feel her pain through our life experiences and, make comparisons and try to understand those with different life journeys.

So should we see the movie? A movie may just remove most of the personal interpretations from the experience. They will show us what Cheryl’s toes looked like after hiking in too-small boots. They will show us what her encounter with a fox felt like and show us what happened when she ran out of water. We won’t need to use our own minds and creativity to picture her experiences.

I believe that what I saw in my mind when I read the book has to be more powerful than any actress and director can portray on the screen for us. What I experienced was highly personal and what I experienced of Cheryl as I read was very subjective. When I put the book down each night, I reflected on the strong feelings the author had led me through. While it was her journey, the feelings were mine.

Black letters on white pages make us do that. We are forced to use our own creativity and to color the story with our own box of paints. I may or may not see the movie. Haven’t decided yet!

Thursday, August 07, 2014

Social Group in Turmoil: Dealing with a Personality Disorder in a Social Setting

There are many articles written for professionals who diagnose and treat people with Personality Disorders but very few for those in social settings where the dynamics surrounding a person who may have a disorder such as Borderline Personality Disorder, are ripping apart a social group. This article is written for those who find themselves in this confusing, sometimes enraging, social situation.

Here's An Example
Mary belongs to a women's group at her church. It's always been a supportive place for her and she's gained much from the Bible studies. Everyone seems to get along and easily accepts newcomers. It was one of these times, after a long summer, when several new people joined the group and they began a new Bible study.

All went well through the Fall. Newcomers made new friends and the group selected Bible studies and activities for the upcoming months.

But by November, the dynamics of the group were changing. Gossiping was going on via text and phone calls between meetings. Hurt feelings ensued. One of the members challenged the group leader, loudly, emotionally, and some of her closer friends rallied around her. It seemed like some of the group got along well and enjoyed social events outside the women's group while others expressed anger and hurt at not being included.

The group couldn't agree on much of anything, including the Christmas party planning. During one meeting two women stormed out of the room, red in the face... seething at what the group leader had suggested they do for the holiday. Some of the group members couldn't believe the level of anger they were feeling. Where was this coming from?

The group just wasn't that supportive, encouraging place anymore. There were factions, cliques and lots of "drama," especially around one of the newer women. Several women eventually quit. Others threatened to start their own group... and maybe even quit the church!

Mary's reaction was to just stay home from the group. She made excuses for not attending their weekly meetings.  It was just plain uncomfortable to be there.

What is Borderline Personality Disorder and Why is it Important in a Social Group?
Borderline Personality Disorder (BPD) is a mental health diagnosis. Individuals with this disorder, have had problems since childhood, life-long patterns of stormy relationships, and difficulty managing their emotions.

The National Institute of Mental Health describes the disorder ... A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation). The person is also described as having a distorted and unstable self-image or sense of self.

It is a much more complex disorder than this of course. One of the dynamics of BPD is termed, "splitting," and this can affect social groups. Splitting describes the way that people with BPD may see themselves and others. People can be perceived as "good" and "bad." All good or all bad. The person with BPD often cannot see that an individual is both good and bad, and can be right some of the time and wrong some of the time. This can affect the group as the person with BPD is often persuasive and downright seductive. They can engage others in this "splitting" behavior. They can pit one person against the other.

People with BPD can also easily and unrealistically have feelings of abandonment, express very strong emotions and sabotage relationships. This is not an easy person to have in a group, although they may, initially, develop what looks like some strong positive relationships (remember, they can be seductive).

What Mary experienced in her Bible group is not unusual for a group that includes a person with untreated BPD. Things can get very chaotic, disagreements are not unusual and the level of anger expressed is not easy to take. The divisiveness can tear a group apart.

What to Do?
If you have access to a human services professional like a clergy person, counselor or human resources person, it is handy to get some perspective by talking with a person outside the group who may have some knowledge of group dynamics and mental health issues. They might be helpful to the group in getting some distance from the issues and returning to the original purpose of the group... their common goals.

First, realize that this is a social situation and not a mental health setting. You can't diagnose or treat the problem. You can, however, set some limits on behavior in the group and you can suggest that a person who seems to be spiraling out of control, emotionally and behaviorally, gets some help.

Second, feel free to set some ground rules for your group, with their input. Ground rules, which apply equally to everyone, often cover showing respect, how to communicate, and how to handle disagreements.

Third, you may have to ask a person who consistently challenges or disobeys the ground rules and is disruptive,  to leave the group or you may suggest an alternative for them.

Not all negative group dynamics can be attributed to a person suffering from a personality disorder such as BPD. External change, stressors such as financial limitations, change of leadership, etc. can also bring on some difficult group dynamics.

And not all people suffering from BPD are going to be disruptive. Many are in treatment and can lead fairly normal lives. People with mental health disorders can be helped, of course, and it is important not to jump to conclusions just because a person is living with a mental health condition.

But if you have looked at all possible causes and still have divisiveness, high levels of anger and the feeling of being torn apart by a tornado in what was once a peaceful, supportive social group, please consider how a person's pathology can negatively affect those around them.

More Information
National Institute of Health Borderline Personality Disorder

Tuesday, April 08, 2014

Social Work Job in Alabama - NASW Executive Director

NASW Alabama Chapter Seeks an Executive Director

The National Association of Social Workers (NASW) - Alabama Chapter, a professional association with over 1,000 members, is seeking a dynamic and energetic leader to serve as its part-time (.75 FTE) Executive Director. 

The successful candidate will be responsible for all aspects of administering and leading a nonprofit association. Qualified candidates will possess a minimum of two years of managerial experience and a bachelor’s degree, MSW preferred. Proficiency in communications, financial management, MS Office, conference and event planning, member services, and volunteer management is required. 

Additionally, the ideal candidate should have experience in membership marketing, social media and website maintenance, nonprofit board development, and public policy advocacy. Our executive director must demonstrate a strong commitment to the NASW mission and social work values. 

The position requires a self-directed executive who is capable of being actively involved in the day to day operations as well as all executive management functions. Some travel is required. Salary range is $35,000 to $38,000, with an excellent benefit package. There is a strong potential for growth in salary and full-time status with success in this position. 

NASW- Alabama is an equal opportunity employer. Qualified applicants should e-mail their cover letter and resume by April 28, 2014 to Nancy Francisco Stewart, Search Chair, at Please direct any question to us via this e-mail address.