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[personal profile] siderea
Today was the big day: we signed the contract with an assisted living facility and got the keys to her room. We can start moving things in immediately, she takes up residence July 12, two weeks from today.

Update re beds: D has decided she wants her full bed in there, at least to start, so it looks like we're not getting a temporary or new bed at this time. Thanks everyone for your suggestions! They were very helpful! Also, she has a week to change her mind about this plan.

After the signing, which was a 2+ hour process, we went out for lunch, then adjourned to her place and measured furniture.

Due to dealing with her move, I'm going to be somewhat hosed over the next two weeks. (If you have a favorite moving company that does small moves on the North Shore, feel free to mention in the comments. I have two recs already, but I could stand to get quotes from one or two more. Also, I feel nervous about trying to book movers in 14 days or less, so want a pool of leads at hand.)

I was hoping to get at least one post out this month, but right now I'm so exhausted I can't see straight, and I have lots of patients tomorrow and part of Friday, which is the last day of the month. We'll see.

The good news is that in the middle of July, whatever my availability had been, it (knock on wood) should be substantially improved. Not only will we be getting D settled, I have a bunch of patients all going on protracted vacations, so my clinical caseload will be temporarily lightened.

Once D is moved, we'll need to start worrying about what to do with her house, but there's no urgency on that. I think that while there's some minimal stuff that we'll get out of the way, G and I are planning on taking a nice break from Dealing With Things And Evacuating Houses for a little while.

Of course, all that goes out the window if D's health takes a turn for the worse – or for that matter if any other emergencies emerge. But right now I'm hopeful that later this coming month I'll be able to be around more and be shoving more posts out the door. Here's hoping.
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[personal profile] siderea
Constant readers will recall that I wrote a three-part post titled, "Why You Can't Find A Therapist, No, Really". I posted Part 1 on Sept 1st and Part 2 and Part 3 on Sept 30th of last year.

The clinic I work for as a contractor recently paid me, for my last pay period, an amount of money that was four times my typical earnings. Admittedly, how much I actually get paid fluctuates pretty wildly, but I figured I would have noticed having either 4x in arrears or having seen 4x as many patients as usual. But I'm paid via direct deposit, and the corresponding statement saying what I was getting paid for is put in my mail box at the clinic, so I had to wait till I was back in the clinic – today – to pick it up and find up why I was getting all this money.

The statement mystified me when I got it. It was two whole pages of pairs of canceled previous payments and replacement payments and at first I couldn't make heads or tails of it, and then I realized that I was looking at a statement where almost all the patient sessions listed had happened in 2016.

As I mentioned, last month, for the first time in decades, we got a raise. A big raise. Not big enough to be adequate, but big enough to be astounding. It was, we thought, effective starting May 1.

No. Turns out the raise was retroactive. To – apparently – Oct 1, 2016...

...The day after I posted the final sections of "Why You Can't Find A Therapist, No, Really".

Rumor has it that the raise – more properly, the increase in rate paid by at least two of the Medicaid providers – happened because MassHealth (Massachusetts Medicaid) leaned on them to do so, to fix the emergent strike.

Um.

MassHealth? Are... are you there? Are you reading my journal?

If so, thank you! (If not, still thank you!)

I have a few other suggestions for things you could fix!

For instance: I'm currently doing an amazing job (or so my chart reviewer wrote) doing care coordination with a big medical team involving four clinics, three hospitals, and family all involved in the care for a patient with an emergent psychotic illness. I can do that because the patient has MBHP, and MBHP pays for case coordination if it's extramural. I'd like to point out that it's insane that if I have a 15 minute conversation about the diagnostic formulation for a challenging and high-risk case with an in-house psychiatrist, I don't get paid for it (and neither do they), but if I do the same thing with a psychiatrist at a different clinic, I do. How wack is it that I literally wouldn't be able to afford to spend the sort of time on this case that I did (and continue to!) if the patient hadn't coincidentally decided he didn't like my clinic's available psychiatrist and went and found himself another one through his PCP. Surely this can't be the incentive system you want me or the patient (or the psychiatrist) to be functioning under – one where patients are incented to get their psychiatric care from an entirely different facility from their therapist.

And thank goodness that he had MBHP, as pretty much an amazing fluke. No other MassHealth payers pay for care coordination at all. If this guy had been on NHP or Tufts/BMC when he came down with schizophrenia... I shudder to think. Do you realize how much I've been on the phone with MGH's ER and APS and social workers and psychiatrists at local mental hospitals in the last six months?

Don't you think there should be some sort of provision for what happens when someone presents with a psychotic disorder? Like, when a provider slams the big red "R/o Schizophrenia" button, the payer has to start paying for some case coordination? (I'd also recommend that for substance abuse cases, where patients can manipulate providers around meds; and in mandated reporter cases, where you should probably have payers pay therapists for their time filling in DCF/DPPC/DES or whatever.)

I have to think that the time demands of handling such a high-risk case are part of why some – maybe many – therapist are leary of working with psychotic or other high-risk patients. I've been there. I've twice spent four hours – half a work day – keeping a patient in crisis calm and coordinating with the BEST team and then the hospital, and never saw a dime for any of it. Who wants to bring a patient onto their caseload, for whom the total compensation divided across the total hours of work for that one patient come to less than minimum wage?

And I'm just talking about care coordination – I'm not even talking about CPT 90839 and 90840 which last I checked were still universally unfunded. Funding that would be way cool.

I have many other fine suggestions – I swear many of them even aren't just suggestions you pay me more money! I'm happy to talk more about reforms in mental health care.
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[personal profile] siderea
Oh god I didn't know it was possible to be this wet without actually wading into a body of water.

Hot Springs: Our First RV Trip!

Jun. 27th, 2017 12:53 pm
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[personal profile] hillarygayle
Thought I would share some photos of our trip to Hot Springs! Bryan spent his days at the Arkansas School for Math, Science & the Arts (ASMSA) while Ganon & I hung out at the RV, drove around Hot Springs hunting for things to improve the RV with, and played around on the free wifi (!) at KOA.

The Hot Springs KOA is an extremely nice place. It's built into the side of a hill and the campsites are terraced. There are several large pull-through sites, which is exactly what I wanted. They sent a person on a golf cart to pilot me into the spot & make sure we could reach the sewer/water/electricity hookups. The campground was super close to the downtown area; it only took 8 minutes to drive Bryan over to the school. Really it was QUITE awesome. I loved the whole experience & I feel like getting a KOA membership was a great idea.

Untitled
Where there was once a heavy, small-screened CRT television, there is now an empty cabinet with a nice flat screen mounted to it. All thanks to my incredibly creative parents and my dad who just sort of happens to carry a table saw in the back of his truck. Not a joke. The empty cabinet now contains wiring for the Apple TV and any video game systems we want to bring along. My mom said we're supposed to go on vacation to "get away from that stuff," but I disagree. You go to get away from work & stress!

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More pictures of the campground & our trip in here!
Read more... )

(no subject)

Jun. 27th, 2017 12:20 pm
hillarygayle: (Nurse Sakura)
[personal profile] hillarygayle
Boy did I have one of those days on Sunday! We saw a zillion people (I saw 24 people during my 12 hour shift) and they were either there for some complete garbage, non-emergent complaints or they were there for things that made my hair stand on end. No middle ground! It left me feeling incredibly introverted yesterday. The way I put it to Bryan was "If the entire world got mad and said it was no longer speaking to me, I'd probably say 'You promise?'" I wanted to hide under a blanket but I did the next best thing & went & got a massage instead. I felt somewhat better, but on the way home traffic turned into Mad Max Fury Road so I got a little crabby again.

I will say this, though: best way to become my favorite patient? I was in a room with a very nice lady I'd just diagnosed with a very annoying injury. She told the friend with her "Doesn't she look like someone?" Indicating me. "Not someone in particular, I don't think. I think she just looks like a 1940s movie star. She just has that kind of face." Oh yeah. INSTANT favorite patient. I was also told on Sunday that I looked like Adele (I've gotten that once before), Penelope Garcia from Criminal Minds (I've gotten that one A LOT and I've still never watched the show), and told that I was "kinda woke for a white lady" and "See, she's real. I told you she was cool." So it's not like it was all bad.

This morning there's no milk in the house, and while I can forego the sweetener in my coffee, I've got to have milk or cream. I really should start keeping a stash of those little shelf-stable creamers for just such occasions.

Tomorrow is going to be a hard day, I fear. As many of you know, we have 3 dogs: Pete, Sam, & Harry. Sam & Pete are quite old for rat terriers; they're 15 years old this year. Last year, a tumor began to show up in Sam's groin area. It didn't seem to bother him; it wasn't painful or bleeding, but recently it's gotten much, much larger. At this point it appears to cause him difficulty in movement, and while he doesn't help or cry, he doesn't move much and I think the sheer weight of it is causing him back pain. Bryan & I have long since come to terms with the mortality of our dogs; we've been feeling like they were living on borrowed time almost for the last 4-5 years. Ganon, though, bless him. Ganon is almost 11, and he has never lost anything that he's loved. This will be very much a first for him. He cries when we talk about it. Last night I asked if he wanted to go with us & said we were thinking of this afternoon, but he requested one more day. I imagine Sam will probably be fed bacon & be very petted & made over tonight. Hospice patient doggie & all that. :( In honor of Sam, have a pic of my doggos:

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Adventures in RVing!

Jun. 19th, 2017 09:38 am
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[personal profile] hillarygayle
 Well it's day #1 of our RV vacation in Hot Springs! It's sort of a working vacation, since Bryan is actually at a training at the school of math & science here (it's the curriculum organization training for his programming class). Anyway, we've learned a few things so far: 

Have a longer sewer hose than you need. We went out & bought a 15' with an elbow joint and all threaded connections. SO NICE.

Wanna bring out the ultimate stupid in other drivers? Drive an RV. Had a dummy almost cause a head on accident with oncoming traffic yesterday. It was on a very winding highway between the main interstate and Hot Springs. I was driving 55 in the right lane at an area that's meant to let people pass the slower moving traffic for a short distance. This goober waited until the left lane had already ended, AND THEN decided to swing out and pass me. This of course DIDN'T WORK because there was no more lane, and there were cars in the oncoming. If this accident had happened it would've involved at least 4 vehicles including my RV, and would've happened right at my left front bumper. All this to try & pass someone technically driving the speed limit. It's not worth it, whoever you are in the white Tacoma.

KOA campgrounds have wifi! This is how I'm currently coming to you from an RV. It's not the BEST wifi connection (it is certainly not up to Ganon's standards) but as Leslie said: "Wifi at a campground! Living in the future!" It's enough for Ganon & I to be watching Breath of the Wild YouTube videos.

Haven't tried showering yet, but that's next up. 

Looking at all the other RVs. Some are super stripped and plain; some of them are ULTRA FANCY. There's an incredible one up the hill with this outdoor entertainment system...holy cow. Right now I'm looking at the cutest little teardrop camper. They're cute & cleverly laid out, but boy do I love my much bigger motorhome with all the nice amenities.

[domesticity, MA] Renting a Bed?

Jun. 16th, 2017 01:06 am
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[personal profile] siderea
I keep having bright ideas that seem very plausible, but which then seem to not work in reality. I'm wondering if any of you can advise me about the following.

D, who will be moving into an assisted living facility shortly, is undecided about what size of bed she wants. The room she will have is quite small, so on one hand, she wants to maximize floor space. On the other hand, she's used to sleeping in a full size bed, and not sure she can handle downsizing to a twin.

So I had the brainwave that maybe we could use one of the rent-to-buy furniture places to rent a twin bed for her to try out. While we'd pay a premium for doing this, it would allow her to change her mind and have her full bed moved in if she didn't like the twin, without having to pay the full price for the twin if she didn't like it.

Now, I thought my question would be whether rent-to-own furniture places would even rent mattresses in MA given our laws about reusing mattresses – it turns out they do – or whether rent-to-own furniture places, having the reputation they do of being skeezy, are too disreputable to contract with or would have terms unfavorable to doing what I want – it turns out their model and rules seems ideal to our purpose.

But no. The problem seems to be whether rent-to-own furniture places on the North Shore will rent an entire twin bed.

There only seem to be two furniture rental places that serve the North Shore, Rent-a-Center and Aaron's. Both seem to be convinced that only children use twin beds. Aarons, at least, will allegedly (per website) rent a twin mattress and boxspring set, but none of their bedsets or electric adjustable bed bases are compatable. Rent-a-Center has no twin mattress sets at all; all their twin beds are for children, and either bunk beds, or platform beds (no place for boxspring), all of which are strangely inaccessible with things like elaborate superstructures (e.g. to make the bed look like a car, or a Cindarella coach) or higher than usual bed surfaces for under-bed storage (Captain's beds).

Does anybody have any suggestions about this? I can call the stores and ask if they have things available not on the website, but I figured I should stop and ask if there's things I should know that I don't. Like does anybody know of a local alternative? Has anybody done this?

[tech, soc] if \t then --$salary

Jun. 15th, 2017 05:01 pm
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[personal profile] siderea
Via Metafilter: Developers Who Use Spaces Make More Money Than Developers Who Use Tabs

Apparently, a suprisingly robust finding, even after controlling for absolutely everything obvious, and a lot of clever non-obvious things, too.

While correlation does not imply causation, in case you were wondering: 8.6% higher, on average.

Question thread #53

Jun. 15th, 2017 08:32 pm
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[personal profile] pauamma posting in [site community profile] dw_dev
It's time for another question thread!

The rules:

- You may ask any dev-related question you have in a comment. (It doesn't even need to be about Dreamwidth, although if it involves a language/library/framework/database Dreamwidth doesn't use, you will probably get answers pointing that out and suggesting a better place to ask.)
- You may also answer any question, using the guidelines given in To Answer, Or Not To Answer and in this comment thread.
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