Wednesday, August 31, 2016

On being reported to Adult Protective Services

I have been reported to Adult Protective Services. I was reported by the same social worker who wanted me to leave the hospital with Louella under the care of hospice. The same social worker who said, I ought to “let her go.”

I have hesitated to write this post. For one thing I have been so angry that I could not write about it without using profanity and I try not to use profanity, especially in my blog. I have felt indignant and and outraged. I have just now calmed down enough to where I can write and report about what happened.

The other reason I have hesitated is because some people close to me advised me against writing about it saying some people would believe the charge simply because it was made and it would harm my reputation. After considering that I thought, “What the heck.” I don’t have a career to worry about. I am not climbing the latter of success; I am coasting toward retirement. I don’t hold public office and have no plans to seek public office. I blog but don’t get paid for it, so I won’t lose any money. I don’t believe people who know me personally would believe it anyway and for those who want to believe the worst, let them. I have nothing to lose and I don’t care. As Kris Kristofferson said, “Freedom’s just another word for nothing left to lose.” I am free to speak my mind.

The only people I would rather not know about this revelation are Louella’s children but I don’t really care that much about that either. In any event, they have most likely already been notified. Her children have not even contacted her or inquired about their mother in over five years, ever since I caught them “gifting” themselves her wealth and robbing her blind and I had to sue them. If they want to cause me some grief; bring it on. Not caring enough to call or send a Mother’s Day card or birthday card or Christmas greeting in five years, I don’t think they want custody of their mother and I don’t think they are in any position to cause me grief. If Louella had of been under her children’s care for the last five years, she would have been abandoned in a nursing home and be dead by now.

I decided to write this post; one to vent, two in hopes that it will help someone else avoid what has happened to me, and three to make the point that being accused of something does not mean you are guilty of it.

It is hard not to personalize my ordeal and blame the social worker who caused it. When I have not been referring to the social worker who caused me this grief with impolite profanities and vulgar pejoratives, I have been referring to her as “Nurse Ratched.” She is not really a nurse however; she is a social worker working in the Behavioral Health unit of St. Thomas Hospital. When I don’t think of her as “Nurse Ratched,” I think of her as the “Gestapo Social Worker.” No doubt that is unfair. She is just a cog in the wheel of a dysfunctional health care system. She is just one of those people who justify the evil they do as, “just doing my job.” I don’t know, but I would bet, that if she does not turn in a certain number of people a week, she will be considered to be under performing. It must have just been my unlucky week.

The last six weeks has felt like I have been a character in a Kafka novel. In addition to the difficulty of getting Louella the health care she needed and being forced to take her to the emergency room when that was not what she really needed, and being told by the Gestapo Social Worker that I should just “let her go,” and being turned into Adult Protective Services, there have been various other minor bureaucratic annoyances that tend to add up.

While Louella was in the hospital, every Tuesday morning there was a meeting with me and her health care team which included the doctor, the head nurse, the Gestapo Social Worker, recreation director and another person or two. We would set around the table and they would talk about our objectives and Louella’s treatment plan. During one of these meetings, they say that I said something to the effect that when Louella was raging and not sleeping that I did whatever I had to do to calm her down. I don’t even recall saying that. They took it to mean I gave her excess doses of medicine or that I gave her medicine that was not prescribed. I have never given Louella medicine for which she did not have a prescription and I have never given her more than the prescribed dosage.

During Louella’s first full week in the hospital, following the first Tuesday morning health team meeting, the Gestapo Social Worker came to Louella’s room to talk to me. We must have talked for over an hour. I did not know it was a fishing expedition. I did not know it was an interrogation. I thought it was just a friendly chat and she was a sympathetic person and she was trying to help figure out Louella’s needs.

After I learned I was being reported to Adult Protective Services, I reflected back on my conversation with Nurse Ratched and I should have picked up that she was probing. I have been told by knowledgeable people that in situations like this that the social worker probably has notified Louella’s children that I have been reported to APS. During our long “conversation,” she asked me the names of Louella’s children, their ages, where they worked and where they lived. It did not dawn on me she was compiling data with a purpose in mind. I was naïve and blindsided.

During the full second week of Louella’s hospital stay, Sue, Louella’s care giver for over the last five and half years, returned from a vacation on a Tuesday. The Gestapo Social Worker and another person pulled Sue aside and started questioning her. At first Sue did not think much about it and then Sue became uncomfortable and realized she was being grilled. Sue was upset and said it seemed they were trying to get her to say that I was somehow abusive to Louella. When Sue realized what was going on, she terminated the meeting.

On the Thursday of Louella’s second full week in the hospital, the Gestapo Social Worker took me to a private office to go over several things related to Louella’s discharge. The first item of discussion was the arrangement that had been made for Louella to get under the care of a Psychiatrist when she left the hospital. The second was arrangements for home health care to serve Louella. The third item was the suggestion that I put Louella under the care of hospice and “let her go.” That is when it got tense and I told that that was not going to happened. I said, “Under hospice she could die from something as simple as a urinary tract infection. I am not going to let that happen.” She said, “Well you know she is dying, don't you?”

After that tense moment, she said, “The next thing is awkward to talk about, but I have referred Louella’s case to APS.” I did not know what APS was and asked what that was and she told me it was Adult Protective Services. I asked why, and she explained the suspicion that I was over sedating Louella and she said she had to report me to APS out of concern for Louella’s safety. Nurse Ratched apparently did not see the irony of point three being that it was time to “let her go,” and her trying to persuade me to do just let Louella die, and point four being that I had to be turned into Adult Protective Services because I may be endangering Louella’s safety.

APS has paid a surprise visit to my home. I let the young lady in and answered all her questions. She was respectful and pleasant. If however there is a follow up, I am not talking to anyone without my lawyer present. I have talked to my lawyer and he is standing by.

If you are ever in a group meeting of the kind I described or have a one-on-one conversation with a social worker, think about every single word you say before you say it. They can wait while you gather your thoughts. Think about how what you say could be misinterpreted and used against you. Choose your words carefully. If you must meet one-on-one with a social worker, keep in mind that it is not just a friendly chat to figure out how to best care for your loved one. The social worker is out to gather evidence to turn you in, in order to justify her job. The social worker is not your friend. The social worker is the enemy interrogator.

I have always had Louella’s best interest at heart. I would never do anything to harm her. If not for the care Sue and I have given her, she would have died on several occasions. I know her mind is mostly gone, but she is still “Louella,” an individual deserving of dignity and respect. She gets the best care possible and she is loved. It is the healthcare system that has failed Louella; not me.

I know that when one hears someone has been turned into Adult Protective Services or Child Protective Services or a woman has gotten an order of protection against her husband that many people assume the person reported must have something wrong. Many people think the person would not be accused if they had not. Often they have done nothing wrong. Being investigated or even being charged does not mean one is guilty of anything. Anyone can be investigated for or charged with anything.

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The Tennessean's Frank Daniels hits the nail on the head with, "it pays to be poor."

In Tennessee, of the 268,867 people who enrolled in plans for 2016, 85 percent received a tax credit. Per HHS data, the average monthly premium for people receiving tax credits increased $2, from $102 to $104 per month, in 2016.
So, in a perverse way, it pays to be poor, at least to access health insurance.
If you are one of the 15 percent who do not qualify for a tax credit, TDCI said the average “silver level” premium for a 35-year-old living in the greater Nashville area will be $518.34 per month; the average premium for a 45-year-old will be $612.50. (link)
Tennessean's Frank Daniels  acknowledges a modern truth with his recognition, "that it pays to be poor."  We have already seen the truth of this with low income people who are better off trapped in poverty than losing public housing, food stamps, medicaid, AFDC, and myriad other entitlements; now we will see this for those who get subsidized healthcare who have incomes above the medicaid level. It is bad social policy to incentivize people to be poor but that is what the Affordable Care Act does.

If you subsidize something you get more of it. When we subsidize poverty we should expect more poverty. A side effect of  Obamacare is less upward mobility and more people trapped in poverty. There is also an incentive for employers to not grow their company beyond 50 employees and to keep the number of hours some employees can work below 30 hours a week. The law also provides a motivation for a couple with children to avoid marriage and unstable families is known to be a contributor to poverty.

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Monday, August 29, 2016

RIP Betty Nixon

Betty Nixon
I served in the Metro Council with Betty Nixon in the decade of the eighties.  While she was a progressive Democrat and I a Republican, I had a great deal of respect for Betty Nixon. The Metro Council is a non-partisan body and most issues are  non-ideological so political ideology is only rarely a factor in determining who one aligns with.  Betty had been a leader of a neighborhood organization before serving in the Council and so had I, so we had that in common. We had both fought against the building of I-440.

I think Betty Nixon was one of the better Council member with whom I served.  She was smart, understood the complex issues, did her homework, had integrity, and she loved this city.  Betty Nixon was a good person and good public servant. RIP

To read the Tennessean article regarding Betty Nixon's passing, follow this link.

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Saturday, August 27, 2016

A St. Thomas Social Worker wants to kill Louella

“Kill” may be a little strong. The St. Thomas social worker did not say “kill;” she said “let her go.”

Sue and Louella on May 6, 2016
They share the same birthday of May 6th

People don’t like to use harsh words. In polite company one certainly does not say a woman killed her unborn baby; one does not even say, “she had an abortion.” People are most likely to say “she terminated the pregnancy,” or “took care of the problem.” In war we do not like to say a lot of civilians got killed, we say “there was collateral damage.” We even say we put the family dog to sleep. It is so much easier to put harsh reality into pleasant terms, but we all know what we really mean.

 Louella is my wife and has been suffering from dementia since at least 2004 when she was mistakenly diagnosed with Alzheimer’s, but has probably had dementia since 2001. Louella went into St. Thomas hospital recently on a Thursday. The only reason we put her in the hospital is that her new primary care doctor said he did not prescribe psychotropic drugs and we needed to have Louella seen by a doctor who could. I don’t know if  her doctor could not prescribe the drugs she needed or was not comfortable doing so, but in any event, he would not.

Louella had been experiencing periods of absolute rage. She would fuss at the top of her voice for up to two hours at a time, with her face red. There was no placating her, no comforting her, or calming her. Finally exhausted, she would calm down. When not in the full-on rage mode, she was agitated and unhappy most of the time. She had also had some sleepless and restless nights. This had been going on for about six weeks.

After our GP told us he would not renew her medicine, which had been prescribed by another doctor, we began trying to get her an appointment with a psychiatrist. (The “us” and “we” are Sue, her caregiver for the last five and half years, and me.) We tried without success to get her an appointment. Some psychiatrists were cash-only, some did not accept Medicare, and some would see her but an appointment was six weeks to two months away. Her medicine was about to run out. The office of her doctor suggested we take her to Parthenon Pavilion but that is where we took her in August of 2014 where, when she was supposed to be on one-on-one supervision, they allowed her to fall and break her ankle in four places and she never walked again. I was not comfortable taking her back to Parthenon.

We were running out of options when her doctor’s office called and said St. Thomas had a Psyche unit and they had an opening and his office told us we needed to take her to the St. Thomas emergency room. We did and they discovered Louella had a severe urinary tract infection and she was hospitalized for that and by the time she was mostly cured of the UTI, the bed in “Behavioral Health” was taken so we had to wait another day or two before a bed in Behavioral Health opened up.

We took Louella to the emergency on a Thursday and sometime early the next week she was moved to Behavioral Health. During the end of the week in which she went to the hospital and all of the following week, Sue stayed with her during the day and I would come in the evening after work and stay with her. Sue was gone on a well-deserved vacation the second week of Louella’s stay and the weekends that bracket that week and the following Monday of the next week.

On Tuesday of Louella’s second full week in the hospital, Sue returned to work. On that Tuesday the social worker at St. Thomas pulled Sue aside and started asking her questions about Louella’s care. She then asked Sue, “Why does he not just let her go?” Sue, at first did not fully understand the question and said, “What do you mean?” And the social workers said, “Well, she has no quality of life and she is dying. Why don’t he just let her go?”

On Thursday of that week, the social worker pulled me into an office and went over several issues related to Louella’s release and future plans for Louella’s care. One of her items of discussion was what would I think, or would I agree to putting Louella back under hospice care. I said, “No, I would not.” She said, “Well, you know she is dying.”  I said, “She is not dying right now and while I know she could die at any time; she could have a stroke or a seizure that killed her, it is not like she has a terminal illness with only days to live.” I said, “Under hospice care, she could die from a urinary tract infection. I don’t want that.” Then she said, “She has no quality of life.” I didn’t say anything else and we moved on to the next topic on her list.

I know it is true that Louella is dying, just as we are all dying from the moment we are born. Louella could die tonight from a stroke or a seizure but I could die from a heart attack or an auto accident. While she cannot get well, she does not have a killer disease with only days or weeks to live. Her dementia could reach the point to where she cannot swallow or there could be other symptoms that end her life, but we are not experiencing those symptoms now. If “no quality of life” is the standard, well we should kill all babies who are colicky or are cutting teeth. We should kill all children born with severe mental disability. We should kill all prisoners. We should kill people who just went through a divorce, lost custody of their child, and lost their job and have a car that constantly break down.

Anyway, it is not true that Louella has “no quality of life.” For about the six weeks prior to going to the emergency room during her awake hours she was agitated a lot and had those periods of real rage. That extreme rage may have been due to having a urinary tract infection. She cannot tell you what is wrong. She may have been in pain.

For about a month prior to the period of the extreme agitation, Louella was a delight and joy. Louella is “total care,” and cannot talk, but during the month period prior to the weeks of agitation she was engaged. She laughed, she smiled and she was sweet. She noticed things and made eye contact. Her mumbling of nonsense syllables had words mixed in and she was not just chanting syllable; if you did not know, you would have thought she was speaking a foreign language. She spoke with inflection and punctuation, and she said some complete sentences and phrases. She enjoyed “talking” to people. She was happy. She had “quality of life.” I hope those times can return.

Even when having periods of agitation, she enjoys eating. She will stop fussing to eat. Since she has difficulty swallowing, we have to feed her very slowly and it takes about and hour to feed her. She is happy when she eats. At night before bedtime, I always feed her ice cream and she loves ice cream and makes appreciative “uhumm” sounds as she eats. She at times enjoys watching the squirrels and birds at the bird feeder outside our front window. She loves Sue’s little dog, Beauty. She notices the dog. Louella can propel herself in her wheelchair, and she will try to go to the dog and will say, “Come her, you.” When she came home from the hospital, she was happy to see Beauty. Sue held Beauty up to Louella and Louella kissed her.

Louella's mind may be gone for the most part, but she still has worth and she still has personality. Even when she is mad, she is sometimes cute.  She will fuss in non-sense syllables and and then emphatically say, "And, I don't like it!"  She also has a since of humor.  She will rapidly babble a series of syllables, "bing, bing, bing, bing, binb, bing, bing, bing, bing, kaboom!" She will then rare back proudly and then have a mischievous smile on her face and then laugh and we laugh with her.  She has a couple variation on this. The social worker only saw her in the hospital when she was sick. How dare her suggest Louella's life is not worth living!

We had a really good night recently since she has been out of the hospital. She smiled a lot and leaned toward me and put her head on my shoulders and nuzzled me and kept given me kisses. She was happy.  It was sweet and romantic.  She has  “quality of life.”

Louella was under hospice care from March 13th 2015 until December 5th 2015. She was put on hospice because while in the hospital with pneumonia she failed three swallow tests on three consecutive days. A palliative counselor told me, Sue, and my sister Kathleen, that the choice was to put a feeding tube down her throat or send her home with hospice care to die. I opted for hospice care. They said she had days or weeks to live and that she would die of starvation if something else did not kill her first. At first we gave her just thickened liquid like water or juice but we then started giving Ensure and chicken broth and other liquids with nutrition and she got stronger. After a couple weeks we started giving soups and pureed food such as mashed potatoes or pureed veggies and she kept getting stronger, then we moved to soft but solid foods such as hamburger or shredded chicken and then to regular solid foods. On December 15th 2015 she was dismissed from hospice care.

I know hospice care has been a blessing and comfort to many people. My father who died about 26 years ago was under hospice care for a few days before he died. I am not against hospice care, but the goal of hospice is to keep the patient comfortable as they die, not to help them get well. While Louella was under hospice care, they did not even take her temperature telling me they just did not do that, that a fever was just part of the process of dying and could be a comfort to a dying person.

If a person was caring for a loved one on their own and was just worn out, or if they stood to inherit some money and needed it, it would be so easy to put their loved one under hospice care and just let her die from some mild aliment that could otherwise be treated, when hospice care was suggested by a social worker. One could just assume the social worker knows best. Social workers who suggest that someone like Louella be put under hospice care should be ashamed, should lose their job, and maybe go to prison where they would have no “quality of life.”

My anger has been directed at the particular social worker who tried to talk me into putting Louella under hospice care and "letting her go," but after reflection, she is probably just a cog in the wheel. The problem is most likely systemic and part of a societal disregard for human life, a disrespect for the elderly, and a dysfunctional healthcare system in which the patient does not come first.

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Thursday, August 25, 2016

Mayor Barry proposes expansion of the Urban Services District

While Nashville-Davidson County has a metropolitan form of government, we still have two taxing districts. Most of the counties population lives in the Urban Services District (USD) where they have a tax rate of $4.516 per $100 of assessed value.  In the more rural areas and some suburbs, people live in the General Services District (GSD) and have a tax rate of  $3.924 per $100 of assessed value. The only thing the people in the USD get that people in the GSD do not get is garbage pick-up and street lights. They still get the same library services, police services and fire services and of course we only have one school system for the county.  Mayor Barry is attempting to annex into the USD some of the developed suburbs.

While I generally oppose tax increases, I do not oppose this effort to bring into the USD those highly developed suburban areas.  I think it makes sense.  I see it as an equity issue. It appears the GSD area gets services they do not pay for subsidized by the USD ratepayers.  I would like this proposal better if it was revenue neutral and if tax rates were rolled back so that after paying for expanding street lighting and trash pick up in the annexed areas there was no net increase in revenue to Metro government.

For many living in the suburban communities to be annexed, the increase in taxes will be less than the cost they currently pay for private trash collection. To learn more about this issue see this link and this link to Tennessean stories.  For those who want to delve deep into the issue, here is a link to a Metro Planning Commission staff report beginning on page 156.
Below is the mayor's letter to the Planning Commission requesting the annexation be deferred to the first meeting in October.


Below is the map showing the proposed expansion of the USD. The light brown areas are the areas of the proposed expansion.

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Ketron: Voter fraud compromises the electoral process

Sen. Bill Ketron
by Tenn. Sen. Bill Ketron, The Tennessean Op-ed, Aug. 23, 2016 - In 2005, I sat in a Memphis courtroom with many of my Senate colleagues to hear a case of voter fraud regarding the election of Ophelia Ford to the 29th senatorial district of Tennessee.  .... The returns indicated that Ford won the election by only 13 votes over opponent Terry Roland out of the 8,653 cast for the Democrat and Republican candidates. ...investigation that showed voting by felons and nonresidents of the district, as well as ballots cast by dead voters. ... I was astounded that this kind of fraud existed and took action to put measures into place to protect the integrity of Tennessee’s elections by introducing and passing a voter ID (identification) law. ....

Voting, however, should be conducted according to our laws and our Constitution so that is not compromised by those who would cheat and suppress the vote of another. (link)

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Shelby County Democratic Party "decertified"

Memphis Flyer - ...the Shelby County Democratic Party has ceased to exist, having been formally decertified last Friday by state Democratic Party chair Mary Mancini of Nashville. .... one of the known factors in forcing Mancini's hand, and likely the precipitating one, has been the Shelby County party's months-long impasse over what to do about the case of former local party chair Bryan Carson, who resigned last year after an audit turned up evidence of unexplained shortages in the party treasury. (link)

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Tuesday, August 23, 2016

Tim Kaine’s ObamaCare is Collapsing in Tennessee

Press release, NASHVILLE, Tenn.-August 23, 2016--Democratic Vice Presidential Nominee Tim Kaine comes to Tennessee this evening where the latest damaging development about ObamaCare is reverberating throughout Tennessee. This is the the law Kaine has called a "great achievement."

Tennessee's Insurance Commissioner Julie McPeak has said the ObamaCare exchange is 'very near collapse', as reported by the Nashville Tennessean. On a related note, the Chattanooga Times Free Press reports ObamaCare rates are set to skyrocket by the "biggest amount since the program began three years ago." U.S. Senator Lamar Alexander told the newspaper these rate hikes are "only the most recent proof that Obamacare is spiraling out of control."

Tennessee Republican Party Chairman Ryan Haynes discussed the Virginia Senator's woefully-timed fundraising visit to the Volunteer State. "While the Democrat Vice Presidential nominee is here to prospect for checks, Tennesseans are dealing with headlines that ObamaCare's exchange in Tennessee is near total collapse. This isn't a 'great achievement'--it's a failure. Democrats passed this law based on false promises and now it's hurting our citizens who deserve better than government mandates and higher taxes. Yet, as part of the Clinton campaign, Tim Kaine wants to double down on this disaster. That can't happen," stated Haynes. "Republicans are ready with an alternative that allows for higher quality care, more choices, and lower costs. It's time to put patients back in charge of healthcare, not the government."

Online: ObamaCare will be known as a ‘Great Achievement’: During an interview with CNN's State of the Union, Sen. Kaine remarked about ObamaCare: "I think health care reform is going to go down in history as one of the great achievements of this president." (1/2/11)

On Health Care, Kaine said when the American people “Immediately see the benefits,” then Health Care would be “a great thing politically for the Dems.” AMANPOUR: “You mentioned health care. I want to say something that you, yourself, said about this issue when it comes to elections.” KAINE: “OK, great.” KAINE: “When make this happen, and people immediately see the benefits that are going to come their way, I think this is going to be a great thing politically for the Dems. And we’re trying to show members that they’ve got their constituents behind them if they vote with the president.” (ABC’s “This Week,” 10/24/10)

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