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Monthly Archives: June 2017

Social Policy 2

My current social work course for my Masters in Social Work, is Social Policy 2. Social policy 1 was a history of social policies in the United States, from child protective laws to voting laws, to Medicare and Medicaid, to civil rights and food stamps. The current course, though, is about advocacy: learning how to advocate for changes in policy when you notice a problem in the system. First we have to choose a particular problem area, then we research endlessly, and articulate the problem and who is impacted by it, and then (we haven’t gotten to this part yet) we figure out who to badger to successfully make change.

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“I can badger! I’m a really good badgerer!”

I have been overwhelmed by the research part so far. In one week, I read thirty articles, wrote eighteen pages, and did at least ten drafts to whittle that down to a two (and a half) page proposal for my project. My focus: the gaps in Medicare, both as a result of the 80/20 split between what Medicare covers and what the beneficiary is responsible for, and in what is covered (not dental, vision, hearing aids, or long term care). Why is long term care designated to Medicaid (the health coverage meant for low-income individuals), rather than to Medicare (which is meant for the elderly and disabled)?

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“This is exhausting.”

This all led me into the weeds of Medicaid, which is one of the primary targets for budget cuts, both of the current presidential administration and the Republican House and Senate plans to replace Obamacare. Many of the billions of dollars they plan to cut from Medicaid will inevitably come from long term care services for the elderly and disabled.

This led me to the backdoor legal schemes people are allowed to use to hide their income and/or assets, in order to qualify for Medicaid, and the difficulty of those low income people, who are not low-income enough, to afford the elder care lawyers who can competently advise them on the different types of trusts available.

If you have absolutely nothing ($845 a month income, for 2017), Medicaid will catch you when you start to fall through the safety net. But if you have even a drop more than nothing, you are screwed. There is the option of a spend-down plan, where you must incur medical bills in the amount of the difference between your income and the Medicaid income cap every month, in order to get Medicaid coverage, a month at a time. But publicly financed advisors (AKA Free) are not allowed to advise you on the trusts that could hide your extra income, and don’t have enough hours in the day to help each person who needs help to organize a viable spend down plan.

This leaves a lot of seniors without dental, vision, hearing aids, long term care or medical transportation, and in fear of the 20% of any doctor visit or procedure that is not covered by Medicare. Which leads people to skip even the services that Medicare covers, because they can’t afford the fifteen dollars for a cab, or the fifty dollar copay for even routine appointments.

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“You mean I could skip going to the doctor?”

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“I really don’t want to go to the dentist, Mommy. Ever.”

There is a campaign slowly going around the United States called Medicare-For-All, with a version that passed in Vermont, and one that made it through the New York State Assembly three or four times now (but has not been able to pass the state senate), and one in California too. What interests me is that what they are calling Medicare-For-All is really not Medicare as we know it. Someone decided that in order to create universal health care, we’d have to fill in the gaps in Medicare as it is, adding dental, vision, and long term care, and limiting co-pays.

So my question is, even if we as a country are not ready to pursue universal health care for everyone in the form of Medicare for all (and it seems obvious that we are not there yet), could we be ready to fill the holes in the health care system that covers the elderly and disabled among us? Is that a step we could tolerate?

Once I fix Medicare and Medicaid, my next project will be to figure out how to add pets onto our existing health insurance plans. Because, really, my dogs are family members. If human children get to stay on their parents’ health insurance until age 26, to make sure they can earn a living on their own before they have to buy their own insurance, surely my puppies, who will never be allowed to work for a living (anti-puppy prejudice!), should be covered by their family’s health insurance too. No?

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Cricket is not excited by this idea.

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The Secret Keepers

 

One of the primary concerns in social work is confidentiality. It is important for clients to feel secure enough with their social worker to share difficult information, and many social workers make a point of telling clients, right away, that anything they say will be kept private, expect in cases of danger to self or others. In the case of a social work intern, though, confidentiality has to include a few more caveats: What you tell me is just between you and me, and my supervisor, and my coworkers, and my teachers, and my classmates. You don’t mind, do you?

I read instructions from a social work class, at another school, where they specifically told the students to camouflage not just the name of the client they were writing about, but also identifying details in their physicality, personality, and life circumstances. We were not told to be that thorough in our classes. My fellow classmates and I tend to use initials in our assignments, if identification of a client is necessary, under the assumption that since we do not work at the same agencies the initials will not be identifiable to fellow students. But some people choose to use false names instead, to make the prose flow more smoothly. I’ve been tempted to go whole hog and use “Cookie Monster” or “Voldemort” for some of my class assignments, just to see if people are actually paying attention, but I haven’t done that, yet.

I don’t think dogs care about confidentiality, but I’m not sure. I’m hoping my dogs don’t care, because I share an awful lot of their personal information online. Cricket doesn’t seem to experience shame when her behavioral quirks are uncovered, like pooping on the mat by the front door overnight, or peeing in the quilting area in the back of the living room (though that could be because she believes it is my fault, because I failed to get up when she asked for an outing at three o’clock in the morning). Butterfly is unconcerned with her missing teeth, or any leftover poopy on her butt, when she goes outside to meet new people.

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“The pee was up to my eyeballs, what did you expect me to do?”

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“What? I think I look great!”

Dogs are the ultimate secret keepers, actually. Cricket has never told anyone information she alone was privy to about me. And Butterfly lets people think that I am strong and confident and secure, even though she knows different. The dogs accept me as I am, with all of my facets intact. They’ve never suggested that I should be fired as a dog Mom because I have this or that imperfection, though they do expect me to make it up to them in extra chicken treats.

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“Secrets are yummy!”

Maybe we should all go to doggy therapists, instead of the human kind, and then we’d never have to worry about confidentiality (unless you believe that dogs are capable of speech, and are just barking to keep up the ruse that they are dependent on us, and there is actually a secret network of doggy spies collecting information about their humans to send to the doggy version of the NSA, or the real NSA).

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“You’ll never know.”

The fact is, humans are not built for unconditional positive regard, even though that’s what therapist’s try to offer to their clients. Even the most generous-hearted therapist will find herself looking askance at a client for one or two of his decisions. Most dogs, though, have unconditional positive regard down pat. Human therapists carefully guard their boundaries, conscious of how physical behaviors, and offers of support, can be misconstrued by people in desperate need. Dogs don’t do this. Human therapists are also taught to hide their own needs and vulnerabilities from their clients, both to protect themselves and to protect clients from feeling responsible for meeting the therapist’s needs. Dogs have no problem walking up to someone, even someone in deep and unrelenting pain, and asking for affection, and offering affection in return.

Dogs listen openly and without an agenda, whereas most human therapists have a goal in mind for each session: to find out the client’s story, to uncover the blocks in their life, and to offer healthy options for forward movement. Dogs don’t interrupt; they are more classically Freudian in their approach, allowing the client to free associate, and just know that someone is listening to them.

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“We’re listening.”

But, there are a few ways that human therapists can be more helpful than dogs, especially when you are ready to move past the venting stage of the work. It’s possible that, while the unconditional positive regard of a dog can be healing, you may take the positive regard of a human more seriously, because you know that their regard is conditional and you must have done something right to be winning their approval. Human therapists are also more knowledgeable about problem solving, unless the problem you need to solve is where to find the best place to pee, or how to fully appreciate the sounds of the backyard.

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“I can help with that!”

 

The fact is, human therapists are more than just secret keepers, or a safe place to confess the things you don’t want anyone else to know, they are bridges and teachers and support systems to help you make the connections to the life you really want to be living. A life in which, hopefully, you will have a faithful dog at your side to give you unconditional love.

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The Flight of the Baby Birds

So where did we leave off with the baby birds, in the rhododendron bush in the backyard?

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They really were in there.

First they were pink and a bit fluffy, and then they started the hard work of growing feathers, which meant they needed a lot of sleep, with short breaks for eating and nuzzling with Mom.

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The four babies slept in an undifferentiated pile, in a nest that became progressively smaller and smaller, or at least that’s how it seemed.

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One day, the oldest of the babies saw me coming with my camera and flew out of the nest. The next day, they all saw me coming and flew off in different directions. But not too far.

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And the following day, they were gone.

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A week or so later, I saw one of the baby birds, a teenager now, standing on top of Mom’s temporary greenhouse in the backyard. He had a speckled breast, alfalfa-like hair, and clumsy long feet. When I got too close, he decided to fly to a nearby window, where he saw his mirror image flapping desperately in the glass and lost his footing (winging?) and started to fall, barely catching one long toe on the window ledge below.

Clearly, flying is much harder than Mama Robin made it seem.

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P.S. Miss Butterfly has healed so well from her surgery that she was up to a visit to the groomer.

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“Now that I look beautiful, don’t you want to give me a chicken treat?”

 

A Stubborn Butterfly

 

Two weeks ago, on Thursday, I came home after five PM and noticed Butterfly standing by the door and panting. When she tried to sit down, she yelped. I checked for the bump on her lower belly that usually causes these symptoms, and it was not only there, it was bigger and harder than usual. These attacks make me nervous because Butterfly’s health is already fragile, with diabetes, and heart trouble, and a persistent cough keeping us perpetually on alert. But most of the time the panting and discomfort, and even the hernia/bump on her lower belly, passes in a few hours. We watched her carefully and gave her extra cuddles, but when we took the dogs out for their late evening walk, Butterfly threw up three times, in purple. I brought her back inside and put her on my bed so I could keep an eye on her, but she couldn’t find a comfortable position. I sat with her and scratched her back as she drooled a river on my bed, and after a while she calmed down enough to decide she wanted to walk down her doggy steps and search for a sip of water and a more interesting place to sleep. I thought that was a good sign.

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“I’m fine, Mommy, this is just how I breathe.”

When I woke up in the morning, I expected her to be back to her healthy-ish self, but instead she was listlessly resting her head on her paws, facing the front door of the apartment, next to a drying puddle of pee. Both dogs were scheduled to go to the groomer that morning, and Cricket was blinded by hair and smelled awful, so we dropped Cricket off for her haircut, and took Butterfly directly to the vet for an emergency visit. The people at the front desk were a little snotty with us for not calling ahead, until an hour later when the doctor did an ultrasound on Butterfly’s bump and it became clear that her intestines were compromised and she needed immediate surgery.

We were very lucky that Butterfly’s vet was still there. We had assumed that she would already be gone, and we had said our final goodbyes at Butterfly’s last regular appointment, but it turned out that Butterfly had her emergency just in time, on her doctor’s second to last day at the clinic. In the past, the doctor had discouraged even dental cleanings because Butterfly’s oversized heart would be too vulnerable under anesthesia, but this time she said it was worth the risk. Without surgery, part of Butterfly’s intestines could die and that would kill her just as surely as the anesthesia could.

I held Butterfly in my arms and sang her the Misheberach song, a Jewish prayer for healing, and then I handed her to her doctor. I used up a box full of tissues at the front desk and in the car on the way home, trying not to think that I might never see my baby again.

The doctor called within the hour to tell us that Butterfly was doing well on the anesthesia, but they would need to do a second incision so she would be under longer.

Mom went out to pick up Cricket from the groomer while I did busy work to keep my mind as blank as possible. Cricket returned looking skinny and clean and confused. She was still recovering from her anti-anxiety medication, and the trauma of grooming, but I think the worst part was that her sister wasn’t home to sniff her butt and listen to her plight.

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“What is going on?!”

The second call from the doctor came an hour and a half later. Butterfly had survived her surgery and was waking up from the anesthesia, and they wanted advice on what to try and feed her, because her blood sugar was low and she was refusing all of their treats. Even chicken. The relief was extraordinary. The numbness that had taken over my whole body started to recede and instead of crying or something else more reasonable, I started laughing. My baby had survived!

I felt like there was a GPS muttering in my head all that day, “Recalculating, recalculating.” The relief that Butterfly had actually survived the anesthesia was replaced with anxiety when the doctor called again later to say that she wanted Butterfly to spend the night at an emergency veterinary hospital, where a doctor could keep an eye on her, and her breathing. The clinic would only have a technician on duty overnight and the doctor was concerned that if something went wrong, no one would be there to help. She didn’t specify what might go wrong, and she made it clear that the night at the hospital would be very expensive, but she didn’t leave much doubt about the right course of action.

The doctor brought Butterfly out to us, drugged and blurry, and gave us directions to the emergency veterinary hospital twenty minutes away. I held Butterfly in my arms in the front passenger seat of the car while Mom drove, and I listened to Butterfly’s raspy breathing, trying to buffer each bump of the road (she lifted her sleepy head once or twice to let me know that I wasn’t doing a good enough job with that). I could still hear the GPS voice in my head, “recalculating, recalculating.”

As soon as we reached the emergency veterinary hospital, a technician took Butterfly from us, and we had to sit in the waiting room and wait to hear from the doctor on duty. We’d assumed we would just be dropping her off, so the long wait was one more surprise. We finally saw a doctor after eleven PM, and she said that she could hear a crackling sound in Butterfly’s lungs, and wanted to do an x-ray. More waiting. I tried to read the books they had around the room (dog books, of course), but I was worried about Cricket sitting at home alone, needing to pee, barely recovered from her day of anti-anxiety medication and grooming and loneliness.

The x-rays turned out okay, thank God, and then we had to pay the exorbitant estimated bill in order to have the right to visit Butterfly one more time and say goodnight. They led us to a roomful of kennels, set up like high rise apartments, filled with sleepy dogs attached to IVs. As soon as the technician opened the door of her first floor kennel, Butterfly walked out, still attached to her IVs but ready to go home. I tried to explain to her that she needed to stay overnight, but she did not believe me. The technician had to put her back in the kennel for us, because Mom and I were both afraid to risk pulling out one of the tubes she was attached to. And then we finally left, after midnight.

Once again, I had to take deep breaths and tell myself not to think too far ahead. It was a long ride home. Cricket, as predicted, was losing her mind and full of pee. We took her out for a late walk and then we all tried to settle down and get some semblance of a night’s sleep, but even Cricket found the No-Butterfly feeling of the apartment disconcerting.

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“I have nothing to say.”

The next day, we paid the rest of the exorbitant emergency vet hospital bill and took a seriously drugged Butterfly (they put her on Methadone!) back to her doctor at the clinic.

Not only did we have to say good bye to Butterfly, again, we had to say goodbye to her doctor, who really was leaving this time.

We had a second night of no Butterfly at home, but at least we knew she was healthy enough to stay at the clinic overnight. The next morning, a new doctor called to tell us that we could pick Butterfly up that afternoon, because she had been taken out for a walk and managed a soft poop. The only trouble was that she still wasn’t eating, and they hoped coming home would reduce her anxiety enough so she would eat.

As soon as the technician brought her out and put her paws on the floor, Butterfly led the way to the exit, even with the Elizabethan collar making the walls hard to spot. We had a bagful of medications to give her and a list of things to do and not do: do not give her kibble; do not give her a bath; do not let her walk up and down the stairs; do give her chicken and rice; pick her up carefully so as not to press on the staples closing her incisions; keep her belly away from magnets (okay, maybe they left that one out, but I really think they should have mentioned it).

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“I can walk myself.”

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“Where have you been and did you get extra treats that I didn’t get?”

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“I do not like this hat, Mommy.”

 

She still wasn’t ready to eat by the time her nighttime meds were needed, so we crushed the pills in peanut butter, and then spread the mixture, bit by bit, on to her lips. An hour later, her face and my clothes (and the couch and the rug) were covered in peanut butter, but it’s possible that some of the medicine actually got into her system.

 

 

 

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Oy.

She started eating chicken and rice the next morning, and took the pills that I broke up and hid clumsily in her food. Then I had to cut off the peanut butter hair left on her chin (whatever she hadn’t managed to rub on the floor herself), and some of the hair around her hygienic areas as well, because she was getting a bit stinky.

Butterfly still had two rows of staples on her belly, and this funny hairless ring on her right front ankle, where they’d put in the IV, and she was a bit slow moving and still on pain medication, but she made the most of my unwillingness to pull on the leash of an invalid. Out on her walks, she started a new habit of walking ten steps in one direction, stopping short, looking around, and then taking ten or fifteen steps in the other direction, just to see if she could get away with it. She could.

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This anklet is the height of fashion. Really.

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Ouch.

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She’s Home.

 

Within a few days, she was off her pain meds and back to licking the hand that petted her, and spreading her food in ever widening circles from her bowl (which is much messier with soft rice than it is with hard kibble). She started to walk faster, and then to jog, but she still didn’t think I had any right to control her leash and she made that very clear.

 

On Wednesday of this past week, not quite two weeks after her surgery, Butterfly went to the doctor and had her staples removed, and celebrated by trying to run all the way home. She’s still not allowed to climb the stairs, and bath time has to be put off for another week, but she thinks she’s all better. She also thinks that now that her belly has been reinforced with extra stitches, she should be allowed to widen her diet to include French fries and pizza, but this is unlikely. I can be stubborn too. She’s a very good teacher.

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“Mommy, you learned the wrong thing.”