I stood at my kitchen counter yesterday afternoon. My eyes welled up with tears. It has been one frustration after another this week and it was only Tuesday. On top of that my paperwork is out of control. My case load is growing daily. Is there a limit? How much is one person expected to do? What the hell am I doing? This job, it’s not me. It’s not what I want to do with my life. I slammed my computer shut, changed into my running clothes and drove to Skinner Mountain. I had to pick up Carlos in an hour, but it was just enough time to get there, run up and down. I stood at the top of the mountain looking down. I felt small and so did my problems from that vantage point. Sure in the grand scheme of things I have it great. I do and I am grateful for all the goodness in my life. As I tore down the mountain at a rapid speed my thoughts turned over as quickly as my feet. I’m destined for something more, I’m sure of it, but what and how do I get there? I have so many more questions than I have answers.
Right now I work as a nurse case manager for the senior care options of a large insurance company. My case load is currently at 98 members and only going up. All of my members are senior citizens, a population I adore working with. I see them at least 2-4 times a year and my job it to assess their need for services, safety concerns as well as assist in coordinating their often complex medical care. I do not assess vital signs or participate in any hands on care. I order shower chairs, canes, incontinence products, etc. I arrange home delivered meals for home bound members. I communicate with primary care physicians to report my concerns about a patient who is confused about how to take their medications. I set up visiting nurse services for a variety of issues. I connect with members after a hospital stay to ensure they have the support required to continue the recovery process.
The reality is the bulk of my work is assessing members who are interested in what is called the PCA or Personal Care Assistant program. If a member requires assist with 2 or more activities of daily living (ADLs) they may qualify for this program. ADLs are essentially personal care – bathing, dressing, grooming, feeding, ambulating, toiling and taking medication. If approved for this service the member may select a family member, relative or friend to be their PCA. That person then receives compensation for the supposed care they provide to the member. In nearly every case of a member requiring assist with ADLs they also require assist with IADLs or Instrumental Activities of Daily Living. These are things such as cleaning, cooking and laundry. It is assumed that the PCA will also assist with those needs as well.
In my experience the PCA are almost never fulfilling their role and responsibilities. I don’t manage the program. Outside agencies provide support for billing and training. The program operates more like an employment agency for patients to employ an out of work family member or friend. More often than not the member is not receiving the extra care they require, but the PCA is receiving a paycheck. It’s maddening.
What qualifies a person as in need of assist with 2 or more ADLs are symptoms such as pain, shortness of breath on exertion, unsteady gait, balance impairment and dizziness, all of which put the patient at a high risk for falls or induce fatigue. It’s a slippery slope. People know these programs exist. They know what to say to get into the programs. A member in need of assist with 2 or more ADLs yields more money for my company, a considerable amount. How I word my assessments can demonstrate a member’s need for services. This is what I hate most about my job.
Then why do it? I won’t do it forever. I will do it for a little while because I need to work and right now it is my job. There is another side to the job that I love. On Friday I received a call from a very sweet 89 year old member. At my last home visit with her she asked if I could get her a hospital bedside table for her bedroom. I told her truthfully I wasn’t sure if that was possible, but I would look into it. There are so many details of this job and you can’t possibly know everything. I have an amazing group of colleagues that I am able to tap into for absolutely any question that comes up. So I reached out and was given information on how to go about ordering the hospital bedside table. When I answered the phone last Friday the first words I heard were “I love you Aimee. You’re my angel.” I knew the voice and I knew why she was calling. After nearly 5 weeks she had received her hospital table. It was a simple request yet it will truly make a difference in this woman’s life.
I’m not really an angel, but it is moments like these when I am proud of what I do and grateful to be in a position to help. It is those moments, though far and few between, that make all the frustrations of this job almost worthwhile. I haven’t quite figured out “what I want to be when I grow up,” but I know for sure insurance nurse is not it. However, I will use the opportunity I have been given (and yes it is an opportunity) to learn, grow and move in a direction that is more suitable for me. I was taught you never leave a job until you have another and when you commit to something you give it your all. That is what I will continue to do for now.
I really envy people who are doing something that they are passionate about and I am genuinely curious to know how they pursued their dreams. Work has always been an obligation for me, a paycheck if you will. I am an incredibly hard working dedicated employee and I give every job 110%. I want to feel excited and energized by my work. I want to do something that moves others as much as it moves me. I want to give back. I want to feel alive in every aspect of my life.
Are you pursuing your dreams? Are you doing a job you love? What is it and how did you get there?