social work

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Five Advocacy Tips For Living In Skilled Nursing Facilities

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Adjusting to a new environment can be difficult. Adjusting to an environment that is typically seen as a higher level of care from an independent life can be even more challenging. As older adults are requiring more dependence in self-care, it is important to be mindful of how individuals and families can advocate for needed care. There can be many factors that can affect how care is delivered in skilled nursing facilities. As a telehealth therapist who works more often with rural facilities, I have compiled a list of the top five tips for addressing advocacy concerns.

  1. Know your rights: Familiarize yourself with the rights you have as a nursing home resident, such as the right to privacy, to be treated with respect, and to make decisions about your care. This means that staff should be knocking on doors before they enter private rooms. If you are in a meeting (like a therapy session) where you expect privacy, there should be some type of sign on the door making notice of a private conversation taking place. If there is a care plan meeting, sufficient notice of the meeting needs to be given to residents and their guardians/power of attorneys as well as any parties they wish to invite. Skilled nursing facilities are most often privately owned businesses although they still have to adhere to state and federal regulations. There are state ombudsmen who will inform on rights as well as county aging and disability resource centers (ADRC) that can assist with knowing rights.
  2. Speak up: If you have concerns about your care, don’t be afraid to speak up and let your caregivers and nursing home staff know. You have the right to have your concerns addressed and to have your needs met. As a therapist, I encourage my patients to speak up, often their voices are the last bit of control they have in their lives. One needs to understand the difference between addressing concerns with CNA’s, LPN’s or aides versus nurses and administrators. If the issue is smaller, then the aides may be able to assist in correcting things quickly. If there are larger concerns, nurses and administrators may be a better option to listen and respond.
  3. Keep a record: Keep a journal or log of any issues or concerns you have, including dates, times, and the names of any staff involved. This can be helpful if you need to report a problem or issue to the nursing home administration or to a regulatory agency. What I will say instead of writing things down (people often cannot write due to sight and arthritis or neuropathy) is to keep track of how often a concern is verbalized and to whom it was verbalized. Often, a concern will be lost at the doorway when the staff move on to addressing the immediate needs of another resident. As a therapist, I have found that staff will often listen and respond in a way that keeps the resident calm in the moment and then there is no further action taken. These situations are more difficult when residents have isolated contact with family members or if they require corporate guardians (non-family guardians/POA). In Wisconsin, a guardian is only required to be in communication every three to six months (sooner if needed) and to see individuals once per year face to face.
  4. Use the nursing home’s grievance process: If you have a problem or concern that cannot be resolved through casual conversation, use the nursing home’s grievance process to report the issue. The grievance process is probably the most effective way to get issues resolved or to get some accountability and action. Issues or complaints related to direct interactions with staff are usually handled through the grievance process. The facility’s social worker (who sometimes isn’t even a social worker) can assist in explaining the grievance process.
  5. Be assertive and keep family or friends informed. It is important to be firm and clear about your needs and concerns, but it is also important to be respectful of the staff and caregivers who are working to meet your needs. Staff have a lot to deal with during their shifts and a lot of different personalities to connect with when assisting residents with their personal needs. Keep your family informed about your care and any concerns. They can be a valuable source of support and can help you advocate. Know where to go for help: If you feel that your rights are being violated or that you are not receiving the care you need, don’t be afraid to seek help from facility management teams, ombudsmen, facility social workers, and county human service departments.

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The Red List: Developing a Spotlight on Policies and Initiatives Affecting People

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Previously, I created a separate website specifically for my therapy clients. That website was called, “The Rebellion Clause.” Now, The Rebellion Clause redirects to this website.

The idea of the Red List grew out of the idea of policy changes affecting the livelihoods of the people they were supposed to protect. Before my start in the world of social work, I wrote about gaps in the community related to crisis intervention services and how agencies dealt with children who had higher level behavioral health needs. I turned my photography website into an advocacy website and was eventually able to land a job addressing those themes and topics in direct practice every day. I went from a made up job title to Clinical Director in a few years.

Now I find myself at the top of the social work field, essentially doing private practice telehealth therapy for the various populations. I conduct telehealth therapy with patients in four states. I’ve gotten the itch to continue my written advocacy work after working with clients in skilled nursing facilities.

There is no doubt that COVID had a massive impact on social service delivery and staffing changes. It almost seems like we’re back in the 1970’s after de-institutionalization began and we’re finding ways to either keep people in new forms of institutional care or fighting against the current to get people back to the level of independence they had before the pandemic.

After watching ‘The Black List’ on Netflix, I had the idea of creating a ‘Red List’ for agencies and policies that keep individuals stuck in new forms of institutional care. I also want to focus on state and federal initiatives that are not effectual in their goals. A lot of taxpayer dollars are wasted on awareness campaigns. Awareness campaigns only reach the people who are already aware of the issues. I hope to give a platform for real people negatively effected by policies and initiatives or do not go far enough to be fiscally beneficial.

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Craniofacial Kid Revisits the Past As A Clinical Director

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At the tail end of a four-day trauma-informed ‘Train the Trainer’, I stopped to contemplate and reflect on my biggest trauma response trigger, Children’s Hospital of Wisconsin in Milwaukee. In the flood of Milwaukee’s afternoon traffic, I ventured into the now conglomerate of an area that has sprung up incorporating Froedert Hospital and the Milwaukee Mental Health Hospital.

Initially I was nervous that someone was going to catch my uneasiness from the anxiety and trauma triggers. I’ve lived enough years to figure out how to settle myself enough to continue functioning physically in spite of a mental fog. I do not go all to pieces mostly due to the human connections in my life that were barriers (resilience) to even more detrimental effects.

Assisting my ability to remain calm was that nothing visually is the same as is burned into my memories of childhood except for the logo of two blue children. In fact, I began writing this article in the hospital lobby, sitting at a table next to Cafe West. Quite possibly I might have also been in the wrong building, as there are two structures with the same name and the same logo with Froedert being between them. I am not sure, but I’m pretty sure I was one of the few adults who continued to have surgeries at Children’s due to their ICU capabilities.

It has been too many years to remember everything about this place and yet not too long to erase the seared in memories of everyday appointments for so many years and countless surgeries. When I was a kid, we would get ice cream from the cafe in this lobby as a reward for handling another day of appointments or procedures. Gone is the archway of white toy blocks that I used to refer to as the ‘Archway to Hell’. The efforts of appealing to children was something that used to strike a negative chord with me, like the hospital was trying to hide their true purpose.

In college, I took Environmental Psychology and love it, so I have a different appreciation for safe, inviting spaces. What really helps being back in this environment is that I have the emotional maturity to know that the past cannot come back to harm me. The men who operated on me, lied to me, never explained things to me or forced the gas mask on my face are either retired or are long since deceased.

Intellectually, I have nothing to blame on this place or the people that work here. I was but a child caught up in the trials and errors of advancing techniques to better assist kids and families dealing with craniofacial differences. Combine that with an age where kids with disabilities were still being institutionalized and separated from family and community. My parents refused to institutionalize me or put me in special education. I think about whether the idea of complex medical trauma was around in the late 80’s and early 90’s. But then I think about my parents who saw it and made changes to assist in buffering the practices and recommendations of medical professionals.

At home, I had a normal life or what I saw as a normal life with the ability to do normal things. In the hospital, the outside world was seen as an ever-present danger. Two parents taking a child to appointments every day started leading to isolation, so it became a good cop bad cop situation. When my parents took me out of the team environment of the craniofacial team at Children’s Hospital, I stopped simply surviving and started thriving.

Unfortunately, I have seen the present day outcome of other kids I once knew who were not so lucky in that all encompassing realm. Ultimately, I believe that an external surgeon gave me back power and control over my own body and my existence. I didn’t have to suffer through things without being told what was happening to me. This is where I believe my indifference to self-torture began. In so many instances, I had to give up control and disassociate in order to deal. So I became a social worker to advocate for children that didn’t have the ability to communicate their needs in similar atmospheres.

I’ve never been negatively vocal about Children’s Hospital, and I don’t intend to do so in the future. I just choose not to contribute any of my resources to the charity aspect of an organization that attempted multiple times in court to take my parents’ house away to pay for medical bills. I still get triggered, unfortunately most often due to radio ads for the hospital’s foster care services. Being involved professionally in social services, I get triggered more often.

I still have night terrors and I still go back and relive moments that shouldn’t have happened. These days, I am able to deal with what comes from exposure or response in the moment. I hope I can be a beacon of hope for others who have experienced trauma. I still hold on to a lot of anger and it used to fuel my drive to succeed. I don’t know if I will ever get rid of the anger, nor do I know if I want to release it. I’ve become so used to anger leading to passion and then action.

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Trauma-Informed Care in Action

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My hope is to create a series on Trauma Informed Care (TIC) in Action. Rather than wasting everyone’s time with a multitude of awareness campaigns that only serve to cater to those already aware of the issues. When I was in graduate school, TIC became a hot button issue/training opportunity. Hopefully this was sparked by the new wave of combat veterans and research on adverse childhood experiences. The hope of this series is to highlight people and projects contributing to real changes in trauma-informed care not necessarily where federal, state, and local money flow.

I didn’t fully confront my own medical trauma until graduate school, when out from the end of first semester I wrote a dark and honest performance piece called, “Gods and Monsters.” A piece that opens with, “As a child my teddy bear wasn’t allowed to have eyes.” Memorized, engraved somewhere in the lizard part of my brain. 

My talents in social services are my abilities to write, my high attention to detail/excellent memory, and my desire to advocate for others. As a writer, I write professionally/clinically as well as creatively. I write performance pieces or poems meant to be performed and I have been fortunate to be published by other change agents. Cathy Plourde formed Add Verb Productions (The Thin Line, Major Medical Breakthrough, You the Man, Out & Allied Project Volume I & II) and later Animal Mineral Press (Making Out Like a Virgin). Both ventures have focused on sharing the experiences of others in subjects meant to educate and respond to social justice issues most professionals will not or do not know how to approach. I prime example of taking action rather than wasting time and money on another awareness campaign. A feel-good project accessorized with brightly colored bracelets. Never mind the stigmas that victims and survivors carry with them and others are walking around with look-at-me bracelets.

Mistakenly, I thought social workers were a profession of trauma survivors, a field of flowers that was once a minefield, showing others how to plant the seeds of change. We aren’t even fully aware of the trauma we continue to inflict on others. I went to a TIC training hosted by Brown County by Disability Rights Wisconsin. It changed how I interacted with clients, especially those who are not able to verbalize their needs. Environmental psychology taught me that children who have experienced trauma have a larger personal space bubble. My bubble requires much more space than others I interact with on a daily basis. I am not a hugger, not even with family. “To hug me is to hold a collection of bones mummified for self-preservation.” Give people their space. Take some action and start planting the seeds of change rather than advertising the seed package.

Links associated with this post:

Addverbproductions.org
Animalmineralpress.com
Disabilityrightswi.org

Advocacy for Aging Adults

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This article in the Guardian struck my interest today. When you identify yourself as a social worker, people generally automatically assume you work with children.  Also, I see a lot of continuing education training targeted towards child issues and not so much for adults.

The baby boomer generation is aging and what I see are social service agencies looking for Direct Support Professionals over social workers or clinicians who have no certifications or specialized training requirements. A lot of elderly care services are taken up by private agencies. The real heartache is that service towards the elderly is not more of a platform for social workers and social advocates.

I get uneasy when I walk into a retirement community that is below ground and covered in artificial light. I get uneasy when an agency decides to put their hospice in the basement of their sprawling facility. People are unaware that retirement facilities are the new community-based institutions. I am glad though that more and more people are allowed to get care in their private homes, especially when it comes to hospice. Hospice definitely comes with challenges but to deliver services to people in a very stressful time, must be very rewarding.

I hope that more social workers will move towards aging client populations. I suspect when they have experienced the aging process of their families, they will have a better understanding of what is needed out in the community. As someone who has a lot of elderly neighbors, I keep an eye out. Some of them are stuck as shut-ins because of their mobility and their children come by every day or two to assist them and keep them social in the community.

http://www.theguardian.com/social-care-network/social-life-blog/2016/jan/13/social-work-with-older-people-is-as-important-as-child-protection?CMP=share_btn_link

Children’s Mental Health Campaign

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A network of newspapers across Wisconsin are creating a multi-faceted awareness campaign for Children’s mental health. The newspaper network for USA Today will be conducting several townhall meetings to provide awareness but also get feedback from local agencies and professionals.

Having worked with teenagers for over 5 years, mental health and suicide-ideation are very big issues in their lives. A number of years ago, various programs and agencies were created to assist in addressing mental health in youth. There is a PATH program implemented by United Way and Family Services which brings mental health services into the schools. There is also Catalpa Health which has been the main resource for children’s mental health since it’s creation in 2012. It was created through a collaboration between the three main private healthcare companies in the area. I tried to get a graduate internship there, to be at the forefront of a dire community need. But instead I have had various email contacts with the Director Greg Blume. They don’t hire APSWs, only people with clinical licenses which has its pros and cons. But Wisconsin is in dire need of more psychiatrists to be employed in these community partnership ventures.

In 2014, Wisconsin was awarded a grant from SAMHSA for $1 million for the next 5 years. Project YES was/is supposed to help fund mental health services for young adults in need of mental health and substance abuse services initially in Jefferson and Outagamie counties and then expanding to other counties. From what I have researched, Project YES is more of an awareness campaign state-wide. I have asked the local newspaper to highlight any details about Project YES’s financial contributions to community services.

I will follow the awareness campaign and townhall schedule and relay information that I think is pertinent to social work and advocacy for youth.

Disclosing Disability During an Interview?

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I had an interview for a great job opportunity today. Before I walked into the agency, I thought about whether I should try mentioning my disability. It’s fairly obvious when talking with me in person. However I did some research on disclosure and found that most people get jobs when they decline to speak about their disabilities during the interview.
I waited for the end of my interview and as part of my final message, I disclosed that my nasal voice and speech stem from birth defects as a physical disability. I did however try to explain that my speech is like an accent; I find that coworkers understand me better as time goes on.
I disclosed in response to someone suggesting that I be upfront and not let people make assumptions. One of my goals this year is to stop making assumptions and asking for further clarification.
Would you or have you disclosed a specific disability during a job interview? Do you think it hurts people’s chances to disclose to possible employers? I would love to know your opinions.

Find the Need

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It takes more than passion to be an effective social worker.  You need to have vision, you need to seek out people who have been successful, and you need to keep up to date with professional development.

In all of the books I have read on being an entrepreneur, they always talk about finding mentors and learning from other successful people.

One goal for this blog is to go out and interview leaders in the community and discover their biggest needs while also highlighting the needs they address. I have started a list of topics relevant to social work advocacy and a list of community leaders. I hope to highlight agencies and services that the general public may not know exist in the community or their need with their client populations.

http://www.socialworker.com/feature-articles/career-jobs/3_Components_of_Turning_Passion_Into_a_Successful_Social_Work_Career/

Professionalism and Ethics

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In Wisconsin, the social work profession is one of the most highly regulated job fields. After earning my MSW from an accredited university, i was required to obtain licensure with the state. I first had to pass a state codes exam and then apply, study, and pass the national ASWB Masters exam. Also to maintain my license, I need 30 continuing education hours. For me, still in the job market, I must pay for all of my trainings myself, without any agency funding assistance.  I do know however, that substance abuse counselors are required to complete 40 hours of training per biennial.
I am glad that other states are making licensing requirements more strict. As social workers we work with protected populations. It is imperative that professionals be held to a high standard and remain conscious of their professional standards, practices, and behaviors in and out of the office.
I very much take professionalism seriously in all aspects of my life. I have a very small group of Facebook friends and everything I post is for friends. Most of my Facebook posts are nature photos or workout/physique updates.
Unfortunately I see a lot of professionals who are not conscious about what they post or what privacy setting their posts are under.
Let’s be mindful of what our profession requires and the limits or sacrifices that are made for practicing in this field.
https://www.bostonglobe.com/metro/2015/12/17/dcf-fires-workers-who-failed-get-licenses/KMfgcEdkfEkHyD5yjNBw2M/story.html

Police and Social Workers Team Up

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In the area that I live, there is a volunteer crisis response team. They work in partnership with the county’s crisis hotline and also the police. This is a prime example of how crisis response should be handled.
I also like that the crisis team of police and social workers in the linked story below primarily focus their efforts on community outreach and establishing relationships with people in need of services.
Not enough agencies do proactive community outreach with the client populations they serve. And sometimes, crisis services are disconnected from each other or only select clients qualify for certain services.
There is still institutionalization in this country. Clients with aggressive behaviors are not served in community-based agencies, rather they go to hospitals or institutions. I believe that needs to change. I believe trained, licensed professionals need to stand up for these clients and attempt to prevent institutional crisis responses.
What are your thoughts? Does your community respond to crisis in a collaborative and professional way?

Source: Police and Social Workers Team To Help The Troubled

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