Saturday, July 26, 2014

Qualifying for Medi-Cal Due to Obamacare

          In other news, since I officially don't have any more unemployment benefits and don't know where and when my next income is going to come from, since you remember I've only been hired as a part time employee with no guaranteed working hours, I've re-qualified for Medi-Cal (Medicaid) insurance. (Did that sentence run on?) It was supposed to be effective June 1st, 2014 but due to government backlogs, I didn’t get it till mid July. In the meantime, I stopped paying Healthnet the monthly $135 I’ve been sending them since January. I thought that  I still have to continue paying Keenan Healthcare $45 a month for dental insurance thru COBRA from my previous employer but it turns out Denti-Cal was reinstated by California effective May 2014.
          Let me backtrack a little bit. In May, I had to call Covered California (the California Healthcare Exchange) to make the changes and was glad the wait time on hold wasn't as long as it was late last year. Charlie checked my eligibility and in a few minutes was transferred to the L.A. County Medi-Cal representative Lily who had me scan my last EDD unemployment check notice and upload it to the Covered California website. There are still some bugs in the system, but not as bad as it was before because the representatives have found workarounds to bypass the bugs. It also seems like the reps have more latitude to approve the changes based on the proof you upload. I thought that was it and that free Medi-Cal insurance would kick in on June 1st. I made a doctor’s appointment and the medical assistant confirmed my eligibility. However on May 27th, I got another call saying my Medi-Cal was deactivated. I called the L.A. County Medi-Cal office and was told that I had to wait for it to be reactivated again but without an approximate time. A few days later I got a letter in the mail informing me that a caseworker has been assigned to me at the local Department of Public Social Services (DPSS) office. I was also expecting another packet in the mail to pick a managed care plan.
          So I waited, and waited, then waited some more, and I called the DPSS every other week. Meanwhile I was getting tons of mail from Covered California which said I qualified for this and that federal subsidy which was basically what I was paying Healthnet for 5 months. It seemed that Covered California’s computer system finally caught up with the applications and the eligibility information I uploaded way back in October 2013.
          On the second week of July, I called the DPSS office again and my caseworker said that my Medi-Cal would be reactivated the next day, but to wait another day for me to make a doctor’s appointment. When the time came, I called the doctor’s office and they verified that my insurance coverage was again active. Hence, I made an appointment for the following week.
          So I finally made use of the free medical insurance last week  and went to see a doctor for a checkup almost a year since my last doctor's visit. Not just any doctor mind you, but one who accepted Medi-Cal and someone I used to work with as a mental health worker 20 years ago before he went to medical school and haven’t seen since. I went to the clinic 10 minutes early, filled out the necessary paperwork regarding my medical history, then waited in the examination room. When the doctor finally entered, he greeted me, then had to do a double take. He said "hey, I know you!". I was going to ask if he remembered me but it was too late for that. He asked me if I was in touch with any of our former co-workers, which I was not. So he mentioned a couple of nurses whom we used to work with and that they were his patients too. Hopefully, there was no HIPAA violation there since we were all friends way back when. So I had my checkup done, blood drawn for lab tests right there in the office, had my maintenance medications refilled, and experienced the advantages and joys of free Medi-Cal insurance: no doctor’s visits co-pay, no lab co-pay, and no pharmacy co-pay. All thanks to my much much lower income and Obamacare. I already addressed this in my blogpost way before Obamacare kicked in :

Seeking a Financial Sweet Spot
          Now I have this dilemma of finding a full time job with benefits or working part time (and semi-retired) to keep my income within the limits required to stay eligible for free Medi-Cal. I'm torn between staying semi-retired and earning less (with free coverage for medical,dental, vision, and most prescription meds) or getting full time employment and earning more while paying for regular medical insurance with all the co-pays. I was offered a full time job which starts in mid-August which more than doubles what I earn  now, but in exchange, I have to work longer hours. The decision has to be made soon on whether to stay poor and get free insurance as long as Obamacare is in effect, or earn more money and start paying for employer sponsored insurance with all its co-pays. And perhaps, not too far down the line, since my mortgage is already paid off, finally take vacations I never took in the past 34 years of working so much.

           A final note on free Medi-Cal: when you choose a managed care plan, they even supply a postage paid envelope. That's your tax dollars at work folks. No wonder a lot of people pretend to be permanently disabled like some of the psych patients I've worked with.
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Tuesday, July 8, 2014

A Freak Diaper Change Accident With Unforeseen Consequences

Stax Splint from Urgent Care
          No, it didn't happen while I was changing my own diaper, but this freak thing happened in the business of caregiving. In the annals of medicine, I challenge you to find anything close to what happened to me while changing a diaper (or continence care product, as my company wants it to be called). Sure, you can jam your finger at anytime or anywhere, but on a diaper or on bedsheets? Probably only I can experience that even though I don't consider myself accident prone. This happened at 3:00 a.m. While pushing a diaper under a residents' body to remove it and replace it with a clean and dry one, I heard a pop and thought it was just a sound made when you crack your knuckles. So I didn't think too much about it and continued to give care to the resident. It was only several minutes later when I finally took my gloves off that I noticed the topmost knuckle of my left middle finger was bent at a right angle. My first thought was that I broke my finger! I tried to straighten it back in place but it just returned to the bent position. So I went to my lead care manager, showed the finger to her and told her what happened. She went to find a tongue blade and some tape and fashioned a splint out of them (she is a nursing graduate from the Philippines).
Tongue blade splint
          I then filled out an employee incident report and asked her what I had to do next, like how to obtain a authorization for treatment form so I can be examined at the urgent care clinic that our facility uses. She didn't know and neither did the lead care manager a floor below, nor the maintenance/security person. The consensus was for me to go to the wellness office at 6:00 a.m. when the nurse arrives. In the meantime, I managed to finish my shift, being careful not to poke the residents with the stiff middle finger with the tongue blade splint, nor injure the finger any further. Fifteen minutes before the end of the shift, I called the acting coordinator for the unit or neighborhood I work in and left a voicemail message asking how I should proceed, since I'm not yet familiar about how they do things, having just started working there the month before. When I went to the wellness office, nobody there knew about obtaining the treatment authorization form and I was to call back at 8 or 9 a.m. to find out. So I clocked out and went home to get a few winks in. A couple of hours later, I got a call from the wellness nurse giving me a toll free number to the Nurse Hotline of Sedgwick, the company that handles workman's compensation claims. I was directed to go to an urgent care clinic closer to home. I had to wait for them to email me the authorization form (which was initially sent to the wrong email address) before proceeding to the clinic. The urgent care clinic was surprisingly empty and the doctor was trying to fix the TV antenna to get a better reception to the World Cup. Meanwhile the medical assistants were debating whether I actually got proper authorization since the place I work wasn't on their list, and they couldn't input my data on the computer. The doctor told them to just do it on paper and clear it up on Monday. Then he asked me to take off the makeshift splint and the moment he saw my finger, he said "Oh, that's a mallet finger". I spelled out m-a-l-l-e-t for him and asked, that kind of mallet? He said yes. I guess it's because the finger is shaped like a mallet (darn, I should have taken a picture of that!). Here is a pretty simple explanation of what it is: . X-rays were taken of my hand and there was no evident fracture other than the ruptured tendon. It appears like this is quite a common injury since there are prefabricated finger-shaped splints of different sizes in the urgent care clinic already, but I doubt that it's common in nursing or caregiving circles. So the doctor found one to fit my middle finger, attached the new brace, and recommended that I be on modified duty. Unfortunately, I found out later, he failed to specify what I'm allowed and not allowed to do on the release form.
          Meanwhile, I'm in trouble with my supervisor. In 34 years of working, I'm charged for the first time ever with a no call/no show at my job because the supervisor was not properly notified that I would not be at work on Sunday night. I never got a definitive answer whether they covered my shift or not after the injury. Apparently I called the wrong people, the incorrect number and left a message with the incorrect voicemail. My supervisor said I should have persistently called her cell phone until she answered. I didn't do that because I didn't want to pester her after thinking that one voicemail at her office phone was enough. Not wanting to be labeled as pushy or a pest, I didn't make repeated calls and just waited for a response that never came. I even called the unit a few hours before my scheduled time to check if the supervisor left any word about covering my shift. There was none. Now I know better. Because I didn't show up for work, I left my co-workers inconvenienced because they were short one person for the shift with more than 30 residents to look after in addition to their housekeeping, dining room, and laundry duties. In retrospect, I should have just shown up, did the work as best as I could, or gone home if someone was there to cover me. Let's just charge the miscommunication a result of the long 4th of July weekend.
          In any normal industry, when an occupational injury happens, the point person or department is Human Resources who coordinates with the supervisor, but in this job, things are different as I'm painfully learning now.
          I'm supposed to wear the finger splint for two months which is the amount of time needed for the tendon to reattach and heal. An initial follow up with the doctor is scheduled for July 14th. I'll be returning to work on the p.m. shift on July 10th and we will have to see what I'm be able to do without being too useless to my co-workers.

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Wednesday, July 2, 2014

P.M. Shift Duties and Responsibilities on the Memory Care Neighborhood

Selfie with Moxie :)
This cat has learned to open the door of her owner's suite. The first time she did this in the middle of the night, I thought it was a ghost. She jumps and turns the door handle, opens the door, and wanders around the TV room, dining room, and other resident's rooms. She has been eyeing the main door and trying to escape the neighborhood.

I've been working at this assisted living community for slightly over a month now and a few weeks ago I posted my duties and responsibilities for the overnight shift. This delayed post tells you about what caregivers do on the afternoon/evening shift. Although I'm starting to connect the names with the faces of the residents, I still have to find a better way to mesh or coordinate my duties with the other 3 care managers. Since I only work with them once a week, I'm finding it a little challenging to do that. They have to remind me what I have to do next like when I'm supposed to watch the residents in the TV room who are in risk for falls due to age and balance problems. I also sometimes miss what time I'm supposed to go on my lunch break. At times, I find myself doing what I'm not supposed to do like which type of laundry goes in which bin. Minor mistakes which may not necessarily imperil the residents, but mistakes just the same. I'm constantly learning as I go and I haven't minded being told what to do because my co-workers know much better than I do. Thanks for the help folks.

Here is the list:
*Get report and assignments, pick up walkie talkie, pager, and keys, then locate your residents.

*One care manager as assigned to monitor residents in Living Room at all times.

*Laundry and bath/showers as assigned. Also check dryer for clothes and table linens.

*Note 1: Don't mix soiled sheets, bath towels, clothes (i.e. pooped or peed on) with regular laundry which goes in a separate bin. Placemats and napkins also go in a separate container.

*Note 2: Do not wash female resident's hair during shower to retain the body done in the beauty parlor.

*Before 3 p.m. - pick up hydration supplies + 4 pitchers from 1st floor kitchen, fill with sugarless juice (1 with sugar for breakfast), pick up snacks for Social Activity. Bring up to the Memory Care neighborhood and the separate rear area where residents need more care.

*Offer hydration - i.e. watermelon, fruit cocktail, drinks, etc.

*Check on residents then move clothes from washer to dryer.

*Set up tables in Dining Room in preparation for dinner at 4:30 p.m. : Napkin in middle, 2 forks on left side, spoon, knife, and soup spoon on right side/ 2 glasses: 1 big and 1 small, fill big glass with water.

*Dinner: Inform residents of dinner time and usher them to the dining room/ Give them choice of soup or salad/Present main course choices of 2 hot dishes and 1 cold dish and serve/Present 2 choices for dessert/Serve on left side and pick up on right side of what's being served.

*One care manager fills bowls and plates, one tosses the salad, two serve the residents.

*Start clearing used plates and utensils as soon as the residents finish using them, bring to the sink for rinsing and place in automatic dishwasher. Clear tables with everything else after the meal and launder placemats and napkins. Sweep floor.

*Medications after dinner by medication technician / Lunch break as assigned by lead care manager.

*Check on residents / Continue laundry as assigned, wash, fold, and return to proper owners and hang in closets.

*Prepare residents for bed at approximately 7 p.m. Open up beds, close curtains, set out pajamas, nightgown, pull ups or wrap arounds (diapers). Assist with continence care, mouth care, remind to use bathroom. Needed products are inside locked cabinet. Return inside after use and lock cabinet again. Make sure bed wedge, body pillows, pillow between legs, portable rails are in place.

*Obtain hearing aids, remove battery, take dentures and lock them in resident's cabinet (some need to be kept in office).

*Place resident's dirty clothes in laundry bag behind bathroom door/Empty wastebaskets and replace plastic liners.

*Make sure cabinets in rooms are locked after providing night care.

*Pick up trash and do clean up in common areas and green door bathrooms. Take trash to outdoor dumpster.

*Check on residents (pull ups and wraparounds) to make sure they are clean and dry before shift ends.

*Monitor sundowners for safety and wandering.

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