Tuesday, March 18, 2014

Evil Computer




System Evil
Americans are constantly bombarded by blather regarding public assistance funding. The noise takes precedence over the dismal performance of the states in administering programs such as SNAP and Medicaid. I'll avoid the term, "broken system." It would just fall on deaf ears. In any event, broken implies reparable (not to mention, the will to repair.)

     Let's begin with Colorado, my state of residence.  A March 3, 2014 headline in "The Denver Post" read: OFFICIALS WANT MILLIONS TO KEEP UPGRADING TROUBLED COMPUTER SYSTEM. The Colorado Benefits Management System has been and remains, faulty, per Colorado Human Services Executive Director, Reggie Bicha. I'll give him that and, oh, so much more. 
     Here are the findings of the most recent state audit, which found Department of Human Services errors on the rise. The errors include: 1) inappropriate approval of approximately $26 million in food assistance benefits (2012 fiscal year;) 2) Erroneous denial of $11 million in food assistance to deserving applicants/clients, during the same period. This translates to erroneous denial, termination or suspension of benefits to 68.7% of Colorado households found ineligible for food assistance, beginning in fiscal year 2012.
     Here's the bottom line with regard to CMBS and the training to use it. It has cost the State of Colorado $300 million to operate, repair and update CMBS. The most recent state investment of $11 million (coupled with federal funds) resulted in increased system efficiency. This is according to the Governor's Information Technology expert, Kristin Russell. (In the interests of fairness, part of the states investment was used to prepare the State for Affordable Health Care and the associated Connect for Health Colorado.) Meanwhile errors continue to plague the system. More important these errors result in suffering, even, death.
     There is a concept in computer technology about faulty systems. Backdoor repairs do not work. In other words, to repair and update a fundamentally bad system is considered by most computer scientists to be futile. This is particularly true in government. California, for example, has been forced to examine the issue of chronic failures of government information technology projects. http://www.pe.com/opinion/editorials-headlines/20130212-editorial-determine-why-state-computer-projects-fail-routinely.ece   


Failure is not an option. -Confucius 


     Considering the audit error outcomes for the State of Colorado Department of Human services, the problem must go deeper than CMBS. I'll back this statement with personal experience as a client of the Denver Department of Human Services over a decade of misery. I do not use the term consumer, because beneficiaries are not treated as either "underserved" or "consumers." 
     From experience, it is impossible to reach a caseworker at DDHS. Supervisory personnel do not respond to calls from clients. It is nearly impossible, with wait times of an hour, to reach the Customer Service Call Center. There is no telephone number or e-mail listing, by means of which the client may communicate directly with a caseworker. Everything and everyone goes through the overburdened central system. 
The Department requires routine paperwork from clients. I have sent certified mail via USPS that failed to be acknowledged, resulting in the denial of benefits. Faxes have failed. Hand delivered documents with the DDHS date stamp prominently displayed, have gone astray. The most recent hand delivery resulted in February 2014 denials and the disappearance of a SNAP (EBT) distribution February 7. 
     By now, you're wondering whether I saved the documentation with receipts. Yes, without fail. DDHS has reluctantly rectified its errors, in my case, for a decade. Herein lies the second part of the problem. Outgoing mail from the Department is not merely slow; it often reaches recipients after the appeal window has closed, denying the household's right to appeal. Next benefits are seemingly cut forthwith.
     If I sound like a whiner, here's what happened following last year's fiasco. I was denied SNAP benefits, admittedly, due to my own error. I received the letter after my benefits were cut. The appeal window had closed by the time I received the notice. Unaware of the cancelation, got to the cashier at a local Safeway store, could not pay for my groceries with food stamps, nor by another means. A friend bailed me out, and, subsequently waived the debt. Anyone for a dose of extreme humiliation and angst? The popular term is "food insecure."  
This year it has happened again. I walked, waited and took a bus and train to DDHS, to hand-deliver my recertification documents in a blizzard. After I obtained a date stamp, I submitted the documents.
     A week later I receive the accusation and denial. In checking my SNAP benefits, I'd been cut off, before the letter arrived. The issue was subsequently resolved online. When I received a demand for yet another change report in March, I made corrections to some ancient expense information, and noted a $4.00 reduction in my rent, due to a reduction in the energy costs for the tax credit building, where I live. Within another week or so, I received a drastic reduction in food stamps and denial of my Medicaid program. Now I am scheduled to make the commute to DDHS and wait three or four hours to, hopefully meet with a case worker. 
     I lost my medical coverage on a similar occasion. The ground is constantly shifting under my feet, and, I must turn either to family or friends occasionally to cover bare essentials. American citizens and politicians actually believe food banks are the place to turn. That's another myth altogether, one I will not try to rectify today. Add this to a persistent attitude on the part of DDHS management and staff that beneficiaries are cheating, unworthy, ungrateful ... undeserving.
     Fix the attitudes and train people to do more than operate their computers. From the tonnage of paper I receive, generated by DDHS computers, the button pushers are certainly winning the paper war. Make the entire system accessible to clients, not just online, Mr. Bicha! Otherwise, even slaying your computer monster will not help. 
      If the latest round of funding is not approved, will Coloradans be worse off? It is hard to conceive, but we know what runs downhill. As for me, I intend to file a federal complaint for five years of denials relating to Medicaid SHIP.  For me, Colorado SHIP repairs have sailed.

Tuesday, March 11, 2014

Sex Talk

With so many Baby Boomers single again, do you wonder how (or whether) we should approach dating and marriage? I am, personally, neither elderly nor a female boomer. My elder daughter is too young to be a Boomer, but, in her fifties, she is an extraordinary woman, a ferocious, hard-working single mother. My daughter has raised a handsome, gifted, loyal man without support. So, when she met a nice man recently, I thought, "What a joy. She will have a little light-hearted company." Her newfound friend, however, made classic errors. He rushed her into romance. He began to demand her full attention. He insisted she would learn to change, and accommodate his lifestyle. Three proved to be the charm. She wished him the best, while wishing him gone.

I am profoundly relieved by my daughter's astute reaction. Dating and marriage are distinctly tempting at any age. However, divorce and domestic violence are on the rise among Baby Boomers. Later in life domestic violence is closely related to other potential elder abuse, and the question is one of cooperation among entities that address domestic and elder abuse. In any event, thinking about the potential for things to go right in a relationship goes hand-in-glove with considering the chances things will go amiss.
http://www.ncea.aoa.gov/Resources/Publication/docs/nceaissuebrief.agingnetworkguideDV.pdf

“Impertinent submissive,” Raoul snapped, and his dark brown eyes turned mean. “Nothing new for this one. You're doing a lousy job of bringing her to heel, Marcus.”
“Bring me to heel? Like I'm a dog?” Without thinking, Gabi instinctively yanked away and snapped out, “Bite me.”
--Cherise Sinclair, Make Me, Sir


Let me be clear. Sexually transmitted disease is also a significant, growing, issue among people who should know better than to have multiple partners or unprotected sex. Absent the fear of pregnancy, however, many older Americans have multiple partners, and are ignoring the dangers. Have we forgotten about HIV/AIDS and treatment-resistant strains of Syphilis and Gonorrhea? Or, do we choose to believe these are unlikely outcomes among people ostensibly sadder and wiser? Boy, do I have news: http://www.nytimes.com/2014/01/19/opinion/sunday/emanuel-sex-and-the-single-senior.html?_r=0

Spring is here, my dear, so be smart. Most boomers are too smart to participate in the club scene, unless I'm mistaken. If not, it goes without saying; remember the harsh lessons of youth. Do not think about online dating or personal ads. Take your time; meet people in correct contexts, and know who people are. Be extremely cautious about social media. Never trade personal information from the get go ... no exchanging personal addresses. Agree to a luncheon, a cup of coffee. Meet at a public event, by all means, but meet there. See a person long enough to become actual, not virtual, friends, before dating. Once you are dating, take a long think, before taking steps toward combining your life with a partner's life, whether or not this means rushing toward the altar. There is absolutely no such thing as Internet privacy. Everything you post or write online (including your personal e-mails) is public information. We don't have to talk about sexting, I'm reasonably confident, but anything at all you don't want public, do not share in the name of love and romance.

Date for months, not days, before being intimate. Have "the talk" about sexual histories and protection, beforehand. You knew all this as a dating greenhorn, so how come you don't know it now? If you are a woman who finds it awkward to carry, offer and apply condoms get over it! Broach the subjects of sexual history and protection without hemming and hawing. It is a brave new world, ladies and gentlemen. Nobody will care for us, if we do not care for ourselves.

Shared responsibility is a good thing. Individual Responsibility is everything.











Tuesday, March 4, 2014

Dangerous, Dangerous Places

Empty Too Soon?
     Patient safety, as much as it is discussed in this country, appears to be foundering. What is your take on the progress and enforcement of patient rights? What is working and what is not working? Personally the possibility of surgery does not frighten me nearly much as the possibility of a hospital stay. It is a grim prospect to have even more federal support for hospital services disappear: http://www.mcclatchydc.com/2013/02/28/184476/looming-federal-spending-cuts.html 
The price tag will be preventable deaths, a disproportionate number of which will be deaths of elder patients. Three years ago the HHS Inspector General estimated 180,000 patients per year die as a result of poor hospital care; this estimate is three years old and was conservative in 2010. 
      However, if a close friend or family member requires skilled care outside of home, the risk is magnified by receiving care in a skilled nursing facility. One out of every three of patients will be injured or will die in such a facility. The number is staggering, considering there are 15,000 skilled nursing facilities in this country. Here is a link to the Pro Publica website. The following article concerns skilled nursing facilities. By all accounts, including the estimate of Medicare's Inspector General, 22, 000 injuries per month will occur (more than 1,500 fatal.) According to Medicare nearly sixty per cent of these cases could be prevented:
http://www.propublica.org/article/one-third-of-skilled-nursing-patients-harmed-in-treatment
     Predictably representatives of America's huge, growing, nursing home industry answer by protesting any suggestion that insufficient light shines on the quality of care patients receive in their facilities. They claim government inspection is vigorous. Clearly annual inspections, however vigorous, are ineffectual. One suggestion by Johns Hopkins makes sense. It is to develop metrics to track improvement, as an adjunct or alternative to annual inspection.

 "...a system of long-term care that’s trying to retrofit to be a system for post-acute care. The resources to care for (these patients) and commitment from those sending them from one facility to another haven’t kept pace." -Dr. Jonathan Evans, president of the American Medical Directors Association

     Consumers know nursing facilities have to deal with Medicare itself; it is a given. Medicare payment is a significant part of the problem; it is both insufficient and slow. However, this has not slowed industry growth, so skilled nursing facilities must be profitable. Are nursing homes beleaguered by underpay and overwork? I believe it is likely. Are they places where people work purely for love and concern for their patients? I think this is a gross exaggeration. In any event, it is no consolation to injured or dead patients or their loved ones.
     In addition industry representatives decry abbreviated hospital stays, alluding to the original intent of nursing homes. Their facilities were intended to provide care for medically stable patients, but they currently admit many patients whose hospital stays have been cut short, too short. Assuming this is not buck-passing, the healthcare system is failing miserably to assign joint accountability in what it calls the continuum of care.
      Richard Mallot, Executive Director of New York’s Long Term Care Community Coalition characterizes skilled nursing facilities as "dangerous, dangerous places. " He believes the industry entirely capable of addressing the staggering numbers of medication errors, bedsores (infections) and falls experienced by patients. He does not fault Medicare's standards of care, stating standards of care are poorly enforced.

     As families and friends of patients, we are on our own, left to advocate for people we love. To begin be certain the condition of the patient warrants dismissal from the hospital. Before choosing a care facility, check Pro Publica's Nursing Home Inspect, for information about available skilled nursing facilities: http://projects.propublica.org/nursing-homes/
Once a patient has been admitted to a skilled nursing facility, keep a close watch on the patient, If necessary, enlist a team to be present randomly and regularly for the patient. Never dismiss anything a patient says. Advocate with medical staff, the patient's primary care physician, and nursing home management. Promptly contact an ombudsman, as well as your state's oversight agency, if you deem a problem to be ongoing.