Monday, August 25, 2014

The Best We Can

Does this sound familiar?

“The rules and regulations that govern work with the elderly are extensive. Basically this equates to an extraordinary amount of paperwork. Social workers typically enjoy working with clients and their families, but almost everything they do involves a form.”

The quote is from Bev Guerin, a social worker who deals with elder care in an article about social worker stress.

I am continually amazed when I visit my mom at her memory care facility with the daily work that goes on and the social network that is part of life there. Memory care residents, particularly the elder, are a challenge because the mental processes don't work quite right, and combined with the physical frailty of age, accomplishing simple tasks becomes extraordinarily difficult.

Some Alzheimer's patients can be combative, and I've witnessed some care givers hit, yelled at, and challenged. Heck, even I have become the target of some poor person who just doesn't have the mental capability to regulate their own behavior.

I have made friends with many of the families at the care center, and many have shared their stories with me.

Imagine your husband, who at one point was a vibrant, intelligent, community leader and provider, no longer able to care for himself and unable to comprehend the world around him.

I've seen the toll on his wife who visits every day, trying to make sense of his illness; remembering what he was like, and helping to feed him, guide him, and to do some basic things for himself.

She tells me that the doctors have said he's in his own world - it looks painful and frustrating but he doesn't comprehend that.
Mom long before memory issues.

In workers' compensation we deal with many of the same issues. We have people who get placed into unfortunate situations because of the luck of the draw, and it is our job to make things better for them.

The front line workers in the equation have a tricky balancing act in making sure that benefits are delivered timely, accurately and in compliance with legal and regulatory mandates, and at the same time holding out compassion and understanding for the recipients.

It doesn't always work.

There are some workers' compensation "caregivers" that either lack adequate training, or are following rules that aren't applicable to a specific situation, or for some reason have developed a distaste for the injured worker and allow passive-aggressive behavior to drive the claim.

There are those that don't understand that workers' compensation is not a "full service" system, that there are restrictions, complications, deviations, and yes, many, many forms.

I'm reminded of this fact every once in a while when I get an inquiry from an injured worker who stumbles upon my blog or WorkCompCentral seeking answers. These are typically desperate people who have gotten wrapped up in their own cases.

Sometimes expectations of what the workers' compensation system is all about are unrealistic, and on the other hand sometimes the system doesn't meet sensible assumptions.

“There is nothing more stressful to a social worker than handling the family’s unrealistic expectations,” says Guerin. “Sometimes family members are so full of hope that they refuse to believe in the reality that their loved one is getting older.”

I think that sometimes workers' compensation parties (whether injured worker, employer, claim adjuster, etc.) refuse to believe in the reality that this is not a justice system. Some injured workers seek rectitude and want the workers' compensation system to punish the employer or the insurance carrier. Some adjusters seek to vilify a claimant, or an employer seeks to make an example.

I'm not trying to be smug, indifferent to these folks' situations, or insensitive - this is just a reality check: the workers' compensation dispute resolution system is ONLY about whether or not there was a work injury, and whether or not medical treatment is being delivered and indemnity paid within the boundaries of the law.

There are some elements of "fault" inherent in some justiciable issues, such as serious and willful misconduct or unlawful discrimination, but for the most part these are ancillary to the main topics of inquiry.

I understand that some want justice and due process. Some seek redress for the harm caused them. Some want to punish those perceived as responsible for the bad times.

I get that.

There are plenty of cases too where benefits have not been delivered to the injured worker appropriately, if at all. There are plenty of cases where the pennywise decision is actually a pound-foolish one.

And there are plenty of cases where the carrier or employer seems to taunt the injured worker with investigations and delays, or trying to put blame where none exists in order to escape liability.

What does all this have to do with Mom's memory care facility and care givers?

There are some at the residence that appear rather normal, and they behave nearly normal. It is only upon inquisition that you can see that something isn't quite right.

And there are others that are obviously quite afflicted with their Alzheimer's or other memory disease. Even out of that population there are very few that exhibit any challenging behavior. Most of the time these folks just need some assistance.

We can't right all the wrongs in the system. It's too big. It's too broad. There are too many cases.

We can do our jobs as best we can and we should have reality checks every once in a while.

Take a day and wear some other shoes. For example, claims folks should take a day to go to a workers' compensation court or hearing room and just observe what goes on; attorneys should take a day to visit a claims administration office and see how things get done.

It may seem trite, but education by observation is very powerful. You'll see that most everyone appears and acts normally. There are going to be some that seem to deviate but are no harm.

And there will be some that need much more attention and help than the system can deliver. We just have to help them the best we can.


  1. IF we are to truly be a "Social Program" and not and insurance co. as it is now. Then why not just go with the ACA, and who cares where the accident happen? And then we would still have OHSHA to police the employers for safety hazards. And we could have a scaled back comp to cover Time loss if needed. Then my friend. NO ONE WOULD be left behind. For this we can't help all and it's ok that we harm a few, because we help so many is getting old... no patient harm is acceptable, and we ARE patients first and foremost.

    Then after abolishing comp, we could abolish state med tort laws that hinder our rights to sue fair and square those who would harm us intently for profit, or to push a personal bias moral agenda unto us through our care, could go directly to courts of law to seek fast relief for the harm done. Then we would not have this Oh we help so many it's ok that we harm a few attitude that is creating undue social angst in our world that has had the violence rates at our hospitals and clinics across this nation sky rocket in just over the last 2 years. We are pitting Dr.s against patients so a few folks can prospers. Sorry David. But this is not a working system. If it were your family that had been harmed by it generationally? You wold be strung a different tune believe. Of course your bis. is kind of reliant on there being a comp system, as is, correct? Peace and thanks as all ways.

    1. I guess Im saying WE CAN DO BETTER

    2. Darren - a full, no fault, no questions asked, medical care system (24 hour care, universal health or whatever you want to call it) would be FANTASTIC, but as John Garamendi found out when he was CA Insurance Commissioner, pulling it off is exceedingly difficult. Not only are there deeply entrenched special interests, but the evolution of the law almost makes it an impossibility.

  2. David,

    You and I both know that not only can we do better, but that we should do better, right here, right now.

    It makes no sense to grnd injured workers into the dust because "the law" allows lawyers, employers, medical professionals, and politicians to do so to those who never stole, never fought, never once asked for anything that was not theirs to ask for, except a little respect, kindness, understanding, compassion, and treatment so that they can get back to work.

    But we treat injured workers like Mr. Bumble treated Oliver Twist, with contempt when he asked for more. And we do this because business people push their bought and paid for legislators to enact draconian laws and rules that punish the good, and defend the bad.

    And that NOT ONE G-DMN lawyer in SoCal will take someone's case is a stain on all decent and honest lawyers, everywhere. That they leave a good, decent woman to twist in the wind is an outrage and a scandal worse than the bad things work comp is accused of.

    That has to change. Not in ten years, or in twenty, but now so that no middle class or working class person injured on the job through no fault of their own is not ground down into the dirt. Societies that allow that to fester suffer social upheaval eventually.

  3. do not do insuring of life, but we can insure students against poor grades for written work and essays.