VENT: Managing Anger

LadyTexan

Since DH was discharged from the hospital, he has been receiving Physical Therapy, Occupational Therapy and Nursing from a Home Health Agency (HHA). The doctor also ordered speech therapy and a social worker. 

Earlier this week, the HHA informed me that the social worker would be coming on Saturday 7/10. Two other employees with the HHA confirmed the social worker (SW) would be coming Saturday. Usually with this HHA, the provider calls the night before to schedule the appointment. I was very eager for this appointment with the SW because I think the social worker was a critical part of the team. Especially because the emotional and mental dynamics in this situation were so significant (DH was suicidal).

Last night, I didn't get a call from the SW. At noon today, I still hadn't heard from the SW. I called the HHA, the nurse on call messaged the SW. Over two hours later, the nurse calls me back and explains that the SW is on medical leave and has been for a while. The nurse further states that because they (the HHA) cannot provide the SW as ordered, the HHA can discharge DH to another service. ARGH!

You may recall, 3 other agencies stated they could not provide services to DH. The current agency was my (almost) last hope. I passionately expressed my unhappiness, but was emphatic that I did NOT want DH discharged as he is already two weeks into the therapy and I was concerned about his continuity of care. I found the entire situation unbelievable.

I was so angry. 

I had a hard time calming down. The only thing that kept me from screaming out loud was the satisfaction of seeing the flies that were trapped by the fly paper on my patio. How sick is that?!

I am fortunate that I am still connected to a social worker in Austin. But I was hopeful to transition to one in our new community and connect to resources where we now live. Of course, crap like this happened over the weekend when the office is not fully staffed, although there is a nurse on call.

1. --Am I over reacting?
2. --Why does everything have to be SO HARD?
3. --What is your strategy for managing anger when things don't go as planned?...I have been saying the serenity prayer and YES it helps.....but it has taken quite a long while for me to simmer down.

janeymack

I would be livid. No, you are not over reacting. You are at their mercy, regardless, though, so it is best for you that you work on calming yourself. Try meditation for self-love or anxiety. I use Goodful on Youtube. The self love one is 15 minutes and is excellent. Breathe in, breathe out. There is not much else you can do except practice self-care. Hugs to you.

karwiy

Dearest Lady Texan - you are not over reacting. Everything is hard. I find the small moments of grace from some random source; a customer service rep on the phone who goes over and above, a clerk at a Verizon store who bends the rules for me, a neighbor who leaves me a small bouquet and note- this is what sustains me because the rest of the caretaking role and everything it entails is rough territory; thankless and winless. You are appreciated for your candor and grit. Know that others are inspired and strengthened by your words. You're in my thoughts and prayers. Keep being you - it's as good as it gets.

Quilting brings calm

You are not overreacting.  It’s yet another instance of feeling like you are on a desert island and the planes ignore your seaweed SOS.   It’s so hard being a caregiver of any sort to a PWD, and you’ve got a group  that are supposed to help and don’t bother to do their job.  There was no good reason that someone couldn’t touch base with the social worker or the dispatcher to confirm that appointment for you.  No reason why they didn’t know she was off on medical leave. But, as you’ve said, you are stuck.  

I know we are a country that prides ourself on our self sufficiency, but we really need to be assigned guides when we start this journey. Guides that are there every step of the way.  We are caring for people who don’t have the mental capacity to look out for themselves at all. We should not be left to flounder while doing it. 

Stuck in the middle

1.  No.  Hell, no.  They should have told you nobody was coming rather than standing you up and finally admitting they were failing in their mission after you called them.  They had a responsibility to start calling clients as soon as their employee called in sick, and they didn't do it.

2.  It just is.  I fought with special education departments et al. for years.  They did things like put children on year-long waiting lists for testing so they could delay providing special education services.

3.  Killing things helps with anger, with flypaper or by other means.  Some people will call that sick, but it's human.  We are people, not doves.  Even pulling weeds helps, so long as you think "Die, green scum!" while you do it.  A punching bag can provide excellent exercise and anger relief in only a few minutes.

The serenity prayer and meditation are important and I use both.  I can't do either until the red haze of rage has passed.  Go hit something, and say "That which does not kill me has made a grave tactical error."

7/14/21   I have deleted the name-calling in this post.  I started to validate the OP's feelings, it reminded me of people who left me in the lurch, and I was angry too.

[Deleted User]

The user and all related content has been deleted.

Crushed

 

McCott

Victoria 2020 -- Did you get your Victory in 2020?

Let me correct your grammar in your statement that

"schooling is insanely priced, demographics - less babies"  should be FEWER BABIES

       "Fewer" is correctly used only with a plural noun, as in 'fewer babies,' or 'fewer posts'
       "Less" is used only with a collective noun, as in "less guilt," "less hope," "less truth" etc.

Somehow I doubt a PhD is needed for PT.  Something beyond a BA, but a 'doctorate'??

                         .

loveskitties

LadyTexan wrote:

Since DH was discharged from the hospital, he has been receiving Physical Therapy, Occupational Therapy and Nursing from a Home Health Agency (HHA). The doctor also ordered speech therapy and a social worker. 

1. --Am I over reacting?
2. --Why does everything have to be SO HARD?
3. --What is your strategy for managing anger when things don't go as planned?...I have been saying the serenity prayer and YES it helps.....but it has taken quite a long while for me to simmer down.

Dear Lady Texan,

          1) You are not over reacting in the least.  First off, this is care for a LO who is a human being and needs the HHA services...all of them.  We aren't talking about a failed appointment to mow the grass or service an appliance.

          2)  Everything is so hard because too many people today consider the work they do as just a place to earn a salary and not a career to help others.  They either have no concept or do not care that what they say or do can seriously impact others.

          3)  In this case, you were told by three employees of this agency that the SW would be there.  If they do try to cancel all services, I would push it to the top of the management chain at the HHA as well as your state board who manages such places.  If they can't or won't do their jobs they should not be in the business.  I have to wonder if they are canceling all patients requiring an SW....maybe...maybe not.  I guess in response to your question, it takes a while for me to get really angry over a situation, but once there...excalate when you feel necessary.  In the mean time, go buy some cheap throw pillows which won't be missed once you beat the stuffin' out of them!

Hope you are able to get issues with HHA to a satisfactory conclusion.

    

    

Cynbar

I am a longtime medical social worker for a home care agency, and yes, I do think you are overreacting.

No, this shouldn't have happened. It was a mistake, a communication error. I suspect the SW got sick unexpectedly, was navigating the channels of notifying her supervisor and filling out paperwork, and it wasn't fully entered in the system yet. A medical social worker is a master's-level clinician with extensive training and expertise --- you can't just find one quickly on the street. I would be annoyed too. But there are lots of steps between annoyed and very angry, as you describe yourself.

A home care agency can and will discharge you if they can't meet your needs or expectations , if you push it. In the same way, a doctor can discharge you from his practice, or a facility can give 30 days notice to leave. These services are not an entitlement. There are a lot of moving parts to home care, scheduling visits at the times you prefer with the staff you prefer, and juggling you along with their other patients. Sometimes staff gets sick, sometimes emergencies with others intervene. Vacations come up at this time of year. Bottom line, it's not always going to go smoothly. This doesn't mean people don't care, or aren't doing their jobs. No one is not treating your DH like a human being, sounds like they are giving good care overall. Please don't burn your bridges with them over this incident, it's not worth it.

Lady Texan, I have followed your story with interest and great admiration. But it doesn't sound like you are in crisis at this moment. The social work visit didn't have to be on July 10th. I know you are under a lot of stress, as we all are, and probably projected all your feelings onto this disappointment. They will send a social worker as soon as yours returns or they find a temporary one, sometimes retired employees come back to earn a little extra money. Someone from management will likely call you tomorrow to apologize, and I would accept it gracefully. This mixup wasn't intentional. You must have been very angry for them to mention discharge ----- a conciliatory approach will be much more productive in securing the services you and your DH need.

I also have to say I am appalled by some of the comments in this thread. I don't see any signs that this agency consists of a bunch of  "Useless SOBs", as Stuck said.  I also don't see any signs that agency employees see their jobs as "just a place to earn a salary", as loves kitties says. And I won't even touch on the efforts to correct our grammar. Lady Texan, I'm sorry this happened. Let's accept it as upsetting but not cataclysmic, and move on.

LadyTexan

Thank you everyone. Your kind words, prayers, love, and humor helped me more than you can imagine. 

You all are saints and heroes. I am grateful for you.

White Crane

Dear Lady Texan,  first of all, I admire you so much.  You have done and are doing a wonderful job of caring for your DH even through such difficult times.

No, you didn't overreact.  I would have been very angry!  They could have and should have told you the social worker was out on medical leave. 

When I am very, very angry, it's usually best for me to leave the house and walk...even a short walk around the block helps.  While walking, I am praying and shouting at God and venting my anger.  Then I usually call someone while I'm walking and tell them how I am feeling.  This helps.  Another thing I do, besides the Serenity Prayer is to do "the next right thing."  Whatever it is I need to be doing right then whether I want to do it or not.  If all else fails, I grab the vacuum cleaner and "attack" the house.

 Blessings to you dear Lady.  Sending prayers.

M1

LT I'm late to this thread. I think I posted elsewhere about how disrupted home health agencies have been by the pandemic, most are having significant staffing issues. So disruptions of all kinds are to be expected. I would also point out that your husband has practically everything ordered that can possibly be given by an agency-PT, OT, speech therapy, nursing, social work, AND an aide? No wonder they are threatening discharge, there are few that could meet all of that. That number of services makes me wonder why they didn't send him for inpatient rehab or keep him longer.    I wonder if it would help to reassess what is essential for you to be able to manage him at home over the long term, and what isnt-for example, can a stage 6 dementia patient really benefit from physical or occasional therapy? If you pare it down you may have more success.

Like Cynbar, I think the miscommunication was unfortunate but not critical. But I am sure every disruption resonates when you're under as much stress as you have been. Hoping you have a peaceful Sunday.

Ed1937

Lady, I'm so sorry this happened. Your emotions are certainly understandable. Until this thing gets straightened out, I think you should try revisiting what has always seemed to work for you. Counting your blessings has been huge for you, and that's something we all need to do. I hope things work out for you quickly.

LadyTexan

Thank you for the reminder Ed. I do have so much to be grateful for.

I would like to clarify that the SW's missed appointment was an annoyance. It was neither a crisis nor cataclysmic. My apologies for giving that impression. It was the straw that broke me yesterday AND I was angry. Hence the VENT. 

I do recall the conversations about the staff shortage for HHA. I further understand the services are not an entitlement. The services were ordered by a health care professional and I do not doubt his judgment. Although I was passionate during my phone call with the nurse on call. I was not disrespectful. I let him know that I understood it was not his fault and that I was frustrated. I definitely respect the providers that have been coming.

I understand the discharge policy if our needs or expectations cannot be met. This was explained earlier in the process, after the initial assessment, when the HHA realized they were unable to provide the speech therapy. 

The aide that is coming in 4 hours per week is not part of the post hospital discharge HHA. She is private pay through a separate company. I engaged the aide's service to allow me to have a break for 4 hours during the week.

My anger and frustration probably caused my post to come across as extreme and severe. I felt the need to check myself about my reaction. I meant no disrespect to anyone.  

I do value and appreciate the responses. It is a reminder that on any given day, at any given moment, we are each riding a roller coaster of emotions and have varied perspectives. Our feelings are real. How we respond in the midst of those feelings is important.

ps. I am not a grammar master. That's why I became a CPA. Now I am a caregiver. My remedial grammar and spelling don't affect my care giving abilities (yet). Seriously - we are all in rocky and unpredictable seas. Let's not be distracted by the small stuff. Yesterday, my small annoyance felt like a really big deal to me. Thank you for allowing me to vent.

I love you all and did not intend to offend anyone. I am grateful for each of you.

loveskitties

Cynbar,

You posted that perhaps the SW was out unexpectedly, however, Lady Texan wrote that the nurse who returned her call indicated that the SW had been out for some time.  I feel certain Lady Texan would have been far more understanding if 3 different representatives had not confirmed the appointment within days of the appointment.

I agree with Lady Texan.  the SW is the primary coordinator of all these services and options available.  Key person.  Granted, the HHA has the ability to cancel their services if they so desire, but hopefully they will make an effort to fix the issue rather than opting out since I feel certain they knew of the service needs when they opted in.

I have a family member who has worked in the HHA arena, including MC, and unfortunately has found that many of co-workers see it is just a job.  If you have found it differently in your area, you are blessed.  I am sure in your own experience you felt differently about your work.  Your clients were fortunate.  We all see the world differently based on our experiences.

Lady Texan was venting her frustration here...an appropriate place to let it all out.  My own experiences have proved that venting to others helps me better handle a situation with the ones who caused the upset.  Hopefully, Lady Texan finds it the same.

French

Yes ladytexan, I can understand why you vent.

We need a robust organization. You were waiting, he didn’t came. It was important for you so you are disappointed. And when life is difficult, this kind of disappointment is difficult to manage.

It is a reason why I will not continue caregiving at home. I don’t like to depend on others. I will have to travel. What if the caregiver isn’t available at the last moment ?

It’s already the case this summer. I can’t go to work on Tuesday morning because the caregiver I hired can’t stay till the adult daycare time. I have to go 2 days per week to the office now (we progressively go back to the office), and as I can’t go the whole Tuesday, I have to go 4 half days. I lose a lot of time in moving and the morning, during my work, I have to manage the departure to the daycare. The bus stop at home but I still have to have my partner put is mask, his shoes, his jacket…sometimes in the middle of a meeting. 

I still consider I have chance because this caregiver is a very good one… when she announced me she wouldn’t be able to come till 10pm I was very disappointed. As I have to stay at home when she comes now, I could have asked her not to come. But one day without managing the shower and dressing is already a blessing.

Crushed

McCott wrote:

Somehow I doubt a PhD is needed for PT.  Something beyond a BA, but a 'doctorate'??

       

Physical Therapist Education and Licensure

To practice as a physical therapist in the U.S., you must earn a doctor of physical therapy degree from a Commission on Accreditation in Physical Therapy Education-accredited physical therapist education program and pass a state licensure exam.

The length of professional DPT programs is typically three years. Primary content areas in the curriculum may include, but are not limited to, biology/anatomy, cellular histology, physiology, exercise physiology, biomechanics, kinesiology, neuroscience, pharmacology, pathology, behavioral sciences, communication, ethics/values, management sciences, finance, sociology, clinical reasoning, evidence-based practice, cardiovascular and pulmonary, endocrine and metabolic, and musculoskeletal

 
https://www.apta.org/your-career/careers-in-physical-therapy/becoming-a-pt
  
Since DPT programs are unknown in Europe   This always causes very interesting issues.
In Germany it is a "Fachhochshule"  study for a Bachelor or masters degree similar to accounting or other professional areas.  

Rescue mom

I’m wrestling with a similar situation, that also goes to what M1 wrote. My DH with mid-stage Alzheimer’s doctors suggested (with some hesitation) and approved him for PT.

Finding a PT who would take a person with midstage Alzheimer’s was much harder than  I expected. Cost/pay was not an issue. Most quickly and flatly refused, saying a PWD like that rarely gets any real benefit. They are short-staffed like everywhere,  and demand  is huge.

Finally found one PT group took him with the understanding that if he did not follow the program, they would discharge him. The fact is, he cannot/will not follow the program. They just gave me notice they will stop next week.

He seemed to enjoy the attention and some aspects of it, so I wanted it,  but it is a hard fact he cannot do what it takes to get their benefits. I get they have other duties than to “babysit” or entertain, and failures can make them look bad. But I did think he got some benefit, and of course it was nice to have somebody else helping. 

But there seems to be serious issues around getting such therapies for mid/late stage Alzheimer’s. Anybody who plans or hopes to get these services for their PWD should know that like everything else, it’s not as simple as it may sound.

Arrowhead

My wife was diagnosed almost 5 years ago. Earlier this year, I said to my son, in a joking manner, "I want my Mommy. I want her to tell me, 'Don't worry Ronnie, she (my wife) will be alright.'" I got to thinking about it later and it touched something inside of me. This may sound strange coming from a man, but I broke down and had a good, long cry. I'm an emotionally strong person and I hide my pain well, even from myself. But there are times when the best emotional and stress reliever is a good, long cry.

LadyTexan

I also wondered if DH would benefit from some of the therapy given his disease progression and his diminished abilities. When DH was discharged he was very medicated and his balance was way way off. 

I will say that the nursing and therapy visits have been helpful to DH and me. There is no "babysit" component to the therapy at all. Its a full 50 minutes or so of hands on therapy. I am actively involved in each visit.

Nursing -  identified that DH's blood pressure was very low. The low blood pressure was remedied by a medication adjustment. Nursing also emphasizes the importance of hydration, monitors DH's pain, instructs us to watch for blood clots, instructs us to keep active, instructs us keep DH's feet elevated, tracks falls and the possible cause, and emphasizes to me the importance of managing my stress level.

Physical Therapy (PT) - has been big on balance, walking, getting into the car, and trying to use both arms and both feet. PT uses great care to train us both on the few steps that are in our house. PT has also provided education to me on cognitive impairment. When DH performs his exercises, I actively participate by learning what DH is doing and how to help him do it and why it is important.

Occupational Therapy (OT) - is more task oriented. For example, how to safely sit on the toilet, how to safely sit in a chair and get up safely, how to safely get into and out of the bed. I am learning the most from OT, primarily about cuing DH. DH has apraxia which is kind of a disconnect between his brain and his body location and movements.

All providers have paid close attention to our home environment and made suggestions on how to make it as safe as possible. All providers have been extremely helpful. I am grateful to the doctor and that he ordered what he ordered.

McCott

Hello Crushed -- Thank you for the update on PT degrees -- Who knew there was an actual doctoral degree in PT ?  Do they have to write a doctoral thesis based on original research, I wonder?  I've always thought that was one central aspect of a doctorate.

As for PT and ALZ, it became basically impossible in my husband's last year, as he had scoliosis with intermittent back pain all his life.  He simply could not follow instructions and would smile and walk away -- almost always smiling, such a sweet guy, but he did not 'suffer fools gladly' as they used to say.  Not worth the PT person's time or the insurance company's money.

He was a really nice guy whom everyone liked, and he liked me.  That was the best thing that happened to me in my life.   Then he was gone -- just 'solid gone' -- as some song used to say.    I like the strange juxtaposition of 'gone' (nothing there) and 'solid' (something really there) -- kind of a paradox, 'solid gone.'  But the solidity of the emptiness is so real.

I think about your wife a lot.  She's gone, but not yet 'solid gone.'  Mary

Cynbar

Lady Texan, have you had any resolution on this social work issue yet? I was so impressed to read your account of the other services this agency is giving you ---- they really seem to be making a valiant effort to help both of you. I hope they have apologized and are working to solve this problem. Do they have any other MSWs on staff who perhaps cover other districts, but might be "borrowed" for your case? That might be something to request.

LadyTexan

Thank you for checking in Cynbar.

The HHA contacted me Monday morning. The call got off to a rough start when the administrator informed me the Medical SW was on vacation. Although I was annoyed by the inconsistent information, I wanted to focus on a solution: getting my husband seen by the Medical SW. The administrator quizzed me on our needs. She showed great compassion and apologized. She emphasized that the HHA is in the business of caring for people, and that they missed the mark. Since that call, the administrator found another MSW to see my DH via phone or telehealth. The MSW will be contacting me to set it up.

I am relieved by the call and pending resolution. 

Off topic: It was been an emotional week for me. Today is the anniversary of my youngest older brother's death. I did not put two and two together, until I felt an overwhelming sadness sneak up on me yesterday. Grief is so unpredictable. I am exhausted.

[Deleted User]

The user and all related content has been deleted.

Stuck in the middle

A physical therapist can be licensed in Missouri with a BS, MS, or DPT.  I think there's a MPT also.

[Deleted User]

The user and all related content has been deleted.

jfkoc

McCott..is this the same? I am always looking or ways not to use either...lol

fewer is used to refer to number among things that are counted, as in "fewer choices" and "fewer problems"; less is used to refer to quantity or amount among things that are measured, as in "less time" and "less effort."

Doityourselfer

Lady Texan, it's good to hear that the MSW will be contacting you to set something up for your husband.  Hope the days ahead will be a little easier for you.

David J

As a general comment about anger and venting, that’s one reason we are here. I have had days, as have you, where I was on the edge of an emotional explosion all day. Sometimes it is only intellectual strength and fear of consequences that kept us from blowing up. The issue at hand is usually small, but it is huge in the context of everything else that is happening.  LO had urinary incontinence?  No big deal. Well, if you had just changed her, it is 3:00 am, and she denies the entire incident, you’re exhausted, and there isn’t a clean nightgown available, maybe emotions get the best of you. 

Any emotional response you have is legitimate. Period. Others can defend the service providers, but if it causes angst and frustration for you and your LO, then they owe you better service. 

Hang in there everybody. Vent here, no judgement, please. 

Iris L.

When a person suffers vision loss and becomes blind, he is given much support and taught how to navigate sightless.  In the same way I have always believed that a newly diagnosed PWD and family could benefit from a multitude of support services and therapies to learn to navigate with dementia.  Nursing, physical therapy and occupational therapy are supports that could be beneficial to some degree.  Not for a cure but for a better quality of life for PWD and care provider. 

How people confuse less and fewer has always been a pet peeve of mine, especially when the confusion comes from television anchors who are reading from a script written by college graduates in English and other academic fields.  But I would never think to correct and embarrass someone in public.  I attended a presentation by a police officer after 9/11 in which he referred to the "tenets" of Islam.  But he spelled it "tenants."  I thought about going up to him discreetly afterwards, but I didn't, because I thought it wasn't my place.  I hoped that there would be a professional at the Police Department to handle that because I thought his presentation was otherwise excellent and needed.

Iris