Nursing documentation for medicare

Plan A questions:

1. To those choosing Plan A worth having "Part B coinsurance or copayment" coverage over not having "Skilled nursing facility care coinsurance" coverage?
2. Can one switch from Plan A to Plan N when it is worth having "Skilled nursing facility care coinsurance" coverage?

Medigap online discussions and YouTubes focus on Plan G and Plan N costs. Plan G covers both the following, Plan N does not

• Excess Charges
• Part B coinsurance or copayment**

** Plan N pays 100% of the Part B co-insurance, except for a co-pay of up to $20 for some office visits and up to a $50 co-pay for emergency room visits that don’t result in an inpatient admission.
This evening, reviewing BCBS Medigap Plans, it was the first time I came across a Medigap provider offering Plan A to my location.
Reviewing Compare Medigap Plan Benefits, Plan A is the same as Plan N except...

• Plan N covers "Skilled nursing facility care coinsurance"
• Plan A covers: "Part B coinsurance or copayment"

BCBS Medigap premium costs for Plan A and Plan N are equal. Hence, the initial question: Why choose Plan A?

My daughter is 14 months and has been being seen by early intervention just after 12 months. We have a developmental pediatric clinician come over every week. We are waiting on our first appointment for speach therapy, and we were referred to OT. Oh, and hearing test is next month.
She was assessed 2 weeks ago but we are still waiting for the written report and diagnosis if one is found. She doesn’t gesture, no clapping, pointing or waving, she never has. She has tried to high five but it seems at the contact of our hands she is disgusted or disturbed by it. She also doesn’t babble,no vowel sounds and doesn’t understand, we’re confident she has a comprehensive language disorder. Despite lots of encouragement she hasn’t yet shook her head yes or no.
About 3 weeks ago she started randomly shaking her head “no”. I’m still breastfeeding until she’s ready to wean so the first time was when she was tired and she was nursing.
It’s almost every day now, in the car, during screen time, when I’m talking to her. But Im noticing it when she’s tired. Sometimes it’s just a little like shake shake shake, but other times it’s more aggressive and longer or little pause in between.
She has lots of stims, lots, and they’re great. Mostly. She has a few that are self harming but this head shaking I’m not sure if this is seen often and could be a stim, sensory seeking? I also have documented and submitted videos of her zoning out/blank stares to our psychometrist and psychologist hoping that too is addressed in our evaluation report.
Anyone else LOs do this to or does anyone have any insight? Should I be requested a neuro referral?

Super, super quick runthrough of Montgomery; a patient wasn't warned that a natural birth in her situation came with a risk of numbness/paralysis. Her child suffered a significant complication which could have been avoided by a C-section. To cut a long story short, regarding risk, patients are entitled to be told anything they reasonably might want to know, and anything they want to know, rather than anything a doctor thinks it is sensible to tell them.
Regardless of the details of the case, the important takeaways relate to how we get consent and what information we give when we are seeking it. Find out how risk averse a patient is, what matters to them (piano prodigy might consider a 1% chance of finger numbness totally unacceptable, someone whose main hobby is sex parties might consider a chance of impotence intolerable), and tell them the risks insofar as they want to listen.
Now. Let's think about nurses and noctors doing surgeries.
I think an average member of the public, your man/woman off the street, would want to know there is a risk they'll be under the knife of someone who didn't go to medical school, and whose practice as a surgeon is legally and clinically experimental. At least compared to a surgical registraconsultant, who has a bare minimum of a decade of relevant and highly stringent training. So just imagine.
You're consenting a patient for a procedure in a department where there are noctors operating. You tell the patient that there is a risk they'll wind up on a list where a non-doctor operates on them.
Patient isn't happy to hear this; you explain that the department considers it safe, but there are people who consider it unsafe. "Well what would you want doctor?" "I'd want a surgeon myself, but the NHS is eager to provide people with choice." If the patient has any reservations about a noctor operating on them whatsoever, allow them to document this on the consent form. There's a whole section for things they DON'T consent to.
Now, the most obvious rebuttal is that you'd get in trouble. This is unfortunately true. But you do have a pretty strong defense against anyone who openly comes after you.
"Not only CAN I do this, as per the law I MUST. I have a legal responsibility, as per Montgomery, to tell patients all the risks they would consider relevant. Given that the vast majority of surgical departments apparently consider non-doctors operating to be an unacceptable risk, I think it's reasonable to assume a typical patient would want to hear about it. If you would like me to begin breaking the law, I'd welcome it in writing."
And yes, if the noctors and their enablers hold power and sway in your department, you'll end up with fewer procedures and less time in theatre. But the option exists, and not only CAN you do this, as far as I can tell you are OBLIGED to do so.
If anyone has any corrections regarding my reading of Montgomery I'd really welcome them by the way, I'm not a lawyer, nor am I an ethicist. All I know is that if I'm ever being consented for surgery, I will be having it put down in writing that I don't consent to AAs/PAs/Noctors handling my anaesthesia or operation.

Getting organized to sit down and write a major term paper is such a daunting task for us folks with ADHD. As a student I would have vague ideas of what I want to write, but lacked the executive function to get to the job done. I would stare at a blank Word doc, type a sentence, delete a sentence, repeat. Unexpected for a writing major, I know. Are you looking for a way to break out of this cycle?
May I present: the Index Card Method.
As a high school student in the 1990s, I was forced to use this method to write a ten page senior thesis. Nearly all senior level English classes in my school used this method. Prior to that year, I had seen students carrying around fat stacks of index cards, protecting them like their ability to graduate depended on them. It did. I begrudgingly followed this methodical approach even though it wasn't "the way I write." Ironically, I found it so helpful I continued using this method throughout college, and admittedly even in grad school 25 years later.
What is it?
It's a low-tech system of organizing your sources, topics, details, citations, and anything else that goes into your paper.
Why low-tech?
It is a hands-on process loaded with sensory actions. Physically handling and arranging the index cards helps me focus on a task. Filling out an index card and setting it aside and then picking up another FEELS productive. Seeing a growing pile of index cards as you move through the project LOOKS like productivity. These sensory activities boost my momentum.
The best part of this method is how it breaks down a mountain of a project into smaller tasks without requiring me to create a big plan before I can start working on it. The size of each task is literally the size of an index card. Plus, it is an opportunity to use those cool pens you bought the last time you said you would start journaling.
The Index Card Method cannot be done the night before a paper is due, at least I wouldn't try it anyway. If you don't like writing outlines or drafts, give this method a try - but if you're cramming, do give yourself a week to get it done.
How does it work?

Step 1: Cards

Get some 3x5 index cards. For a 10-page, double spaced paper, you will need around 300 cards.
Do not get 150 4x6 cards. They must be 3x5.
For this post, I will assume anyone following this method is using lined index cards. It does not matter if the cards are lined, but know that when I say "On the top line write..." I mean where the actual top line of the card would be. This also means you will be writing across width of the cards in landscape orientation, meaning a full line of text on a 3x5 card runs 5 inches, not 3 inches.
There are two simple, but vital rules to remember when creating cards.

1. Only write on one side of the card. Leave the other side blank. You will need to see all of a card's contents at a quick glance.
   
2. If you make a mistake on a card, immediately tear it in half so it doesn't get mixed up with the ones you want to keep.
   

Step 2: Thesis card

You will only have a thesis card if you are writing a thesis (argument) paper.
In the center of the top line of your thesis card, write "Thesis Statement."
Now write your thesis statement below that.

Step 3: Topic cards

In the center of the top line write "Topic." Below that, write the name of a topic related to your thesis statement.
Topics should be broad, written as one or two words. Create as many topic cards as you think you will need. You can always create more later, so don't get stuck on this part.
Example: topics related to a thesis on the healthcare industry may include: Insurance, Costs, Medicare, Medicaid, Prevention, Prescription Drugs, Hospitals, etc.

Step 4: First Layout

Spread out your topic cards on a table. Select the broadest topics and line them up in a row in the order in which you would like them in your paper. Now arrange the narrower topics in columns below the broad topics in the order that makes sense to you. Using the example of the healthcare industry in the previous step, "Costs" may be a broad topic with "Insurance" and "Prescription Drugs" listed beneath it.
Split a topic if you need to. "Costs" could also be split into "Consumer Costs" and "National Costs", then "Insurance" and "Prescription Drugs".
Don't expect to have a lot of topic cards at this point. You may only have one or two subtopics for each broad topic. This is fine. You can always add more as you go along.
Take a picture of your topic cards in this arrangement.
Congratulations, you just made an outline!
Now type it out. Title it "Preliminary Outline."

Step 5: Sources

Go find sources you would like to use for your paper. When you find a source you would like to use, create a bibliography card.

Step 6: Bibliography cards

In the center of the top line write "Bibliography".
In the upper left hand corner of the card on the top line, write the number "1", as it is your first Bibliography card. This is your source ID.
Now write the complete and proper reference of your source, formatted according to your citation style. Include doi links, if applicable. Where italic font is used in a citation, underline it on your card.
Open a new document file. Title it "References", "Works Cited", etc., depending on your citation style. Type out your bibliography cards in the order appropriate to your citation style. Most likely they will be alphabetical by author. As you find more sources and write out bibliography cards, add them to this document.
About citation styles:
A citation style is a way to reference your sources, specifically how you list them out and how you identify where you found a fact or quote.
If you are in highschool, your teacher will tell you how to write write and format sources and citations. If they don't, ask.
If you are an undergrad, most professors don't care which style you choose, but they want it consistent. If this is the case, I recommend using APA or MLA because they use simple, in-line citations.
If you are a graduate student, use the appropriate style for your field. If your reference style uses foot notes or end notes, please be aware you may need to create citation IDs later to help you stay organized.

Step 7: Read and Highlight

As you read through your sources, highlight anything that stands out to you that you may want to use in your paper.
This is where I would normally say it does not matter if your sources are printed or digital, but for many of us it does matter. Stepping away from technology is one the reasons I find this method so effective. I encourage you to print articles or photocopy sources when possible.
Your school likely has access to full-text articles online that can be downloaded as PDFs and printed later.
If your source is text from a website, right click on in the body of the text and select Print. When the print window pops up, select PDF (or Adobe PDF) as your printer. In the next pop up, select where you would like to store your file. Your source is now saved as a PDF. By the way, printing to a PDF is the easiest way to save a file while maintaining its formatting. Try it from any program. Now when you print it to paper, it will look like the PDF.

STEP 8: Detail cards

In the center of the top line write the topic related to the highlighted text. If you do not have a related topic card, make one.
In the upper left corner on the top line, write the source ID that matches the one on its respective bibliography card.
In the upper right corner on the top line of each card write the page number(s) from your source as "p 87" or "pp 87-88". If your source does not have page numbers, write your source's equivalent as it applies (act/scene numbers, time stamp, etc.). Look up a style reference guide for requirements.
Now in your own words, write about an area you highlighted. If you want to directly quote the article, make sure you use quotation marks. Otherwise, simply paraphrase it. Use complete sentences.
If you are copying a long quote and run out of room on a card, write the topic, source ID, and page number on another new card and continue writing your quote. In the bottom right corners write "1 of 2" and "2 of 2" respectively.
Create bibliography and detail cards for all your sources. Find more sources as needed. For a 10-page double spaced paper, expect to have around 150-200 detail cards.

Step 9: Second Layout

Lay out all of your topic cards in the same order as your preliminary outline, only this time line them all up in one row.
By this time you may also want to combine or eliminate topics because your project took a different direction from when you first wrote them. This is fine.
When you think you have enough detail cards, sort them into piles by topic. Now arrange your detail cards in columns under their topics in a way that makes sense to you.
Take a picture of all your cards in this arrangement.
Congratulations, you just layed out your final outline!

Step 10: Type Your Outline

Save a copy of your preliminary outline and title it "Final Outline." Fill in the text from the detail cards. Each detail card should be a separate bullet point on your outline. After typing out a detail card, add the citation at the end. You already know the source because you wrote the source number in the upper left hand corner of each card.
You should not have anything in your final outline that is not written down on an index card.

Step 11: First Draft

Save a copy of your final outline and name it "First Draft." Now arrange your bullet points into paragraphs. This is your draft.
Now print it . Proofread it. Ask a friend to proofread it. Mark it up and make any necessary changes on paper. Don't change any quoted text because quotes are ...well ...quotes.

Step 12: Final Copy

Save a copy of your First draft and name the file "Final Copy." Type the edits you handwrote on paper. I realize with today's technology a lot of proofreading and peer editing is done electronically. This is fine. If you're using Google Docs, be sure to use Suggestion Mode. If using Word, turn on Track Changes.
Your paper is done.
High school students, if your teacher doesn't think you've made enough changes between your draft and your final copy, hand over your stack of index cards, both outlines, and your highlighted sources. They will know you didn't use ChatGPT or copy someone else's work because you can't fake what you've just handed to them.
Edit: See my other post for a technique that harnesses your ADHD to help you organize a project or to present new ideas to a group.
https://www.reddit.com/TwoXADHD/s/Y4pUfQR0R3

Prosecutors said someone unlawfully disclosed the name of at least one witness in a murder case that's scheduled to begin Tuesday in Albany.
ALBANY — Jasper Mills, a longtime criminal defense attorney in Albany, was warned by a judge Friday that he could be subject to a criminal contempt charge if he disclosed — even inadvertently — the identity of at least one witness in a pending murder case who received death threats after the confidential document identifying him was shared with the defendants and others.
The case, which is set for trial next week, involves four men who are charged with murder in the January 2021 shooting of Shanita Thomas, who was pregnant with her third child when she was gunned down at a Central Avenue party. Four others were wounded in the shooting.
Mills, a candidate for Albany County Family Court judge, represents 35-year-old Vramir Branch, who with three other defendants is facing charges of murder, attempted murder, weapons possession and evidence tampering in connection with Thomas' death.
At a hearing Friday in Albany County Court, Judge Andra Ackerman heard arguments from prosecutors on their motion for an order to have the court review boxes of documents that were seized from at least three of the defendants' jail cells at Albany County Jail this week. Prosecutors filed the motion after a witness in the case, who is in federal prison, learned that he had become the target of a death threat and was placed in protective custody.
Prosecutors are asking the court to review the materials to see if there are documents among those found in the cells that were subject to a protective order, and should not have been provided to the men.
As the hearing began, Mills stepped forward and appeared to take responsibility for what he described to the judge as an inadvertent disclosure of the witness information. He said that he had been discussing the witness with another client on Tuesday, a day after he received the information from prosecutors, and then placed the document on a conference table in his office as he juggled a meeting with three other clients who were in his office that day.
“Just so I can be clear here: Did you have documents that were subject to the protective order out on display when you had other individuals that have charges that you’re dealing with and speaking with others on that case … ?,” Ackerman asked Mills. “Who else was in that conference room? Who else had access to that document?”
Mills confirmed that he showed another client — who is not involved in the case — a copy of the document and asked that person what they knew about the witness in the murder case.
“There was a lot going on,” Mills told the judge. “I showed the individual the document. There was nothing in the protective order that said you can’t show it, it just said that you can’t distribute or disseminate it.”
Mills said the next day — Wednesday — an ex-girlfriend of his client in the murder case texted him an image of the document and asked him about the witness listed in the record, and whether that person had given a statement.
But that image, according to prosecutors, is different than another image of the document that was being distributed on social media websites this week.
Assistant District Attorney Jessica Blain-Lewis, one of the prosecutors in the case, told the judge that meant that someone had apparently distributed a second image of the document — and that it was not the image in the photograph that Mills claimed had been taken in his office.
As Mills confirmed to the judge that the image of the document the woman had texted to him had markings on it that he had made, she interrupted him and asked, “(Do) you think it is advisable for you to receive counsel before you continue talking? Because it appears to me that it’s going in a direction, and whether it’s negligence or whatever, but this could be … a severe violation of the protective order which could subject you to a criminal contempt (charge).”
Mills responded that he “didn’t disseminate or give anyone anything.”
“Don’t you think you have an obligation, pursuant to the protective order, to protect those documents?" the judge said. "And you’re telling me that you’re leaving them lying on a conference table in the open and going to another office for about an hour, meeting with other clients, that there won’t be an issue here?”
As Mills began to respond, he was interrupted by Daniel Smalls, another defense attorney in the case, who whispered in Mills' ear for about 20 seconds.
Mills then asked to approach the bench, and moments later he said in open court that he would not say anything more until consulting with an attorney.
As the hearing unfolded, the four defendants — Branch as well as Raa’jiem Coleman, Terrence Anthony and Marcelle Perry — looked on and said nothing. They were clad in jail clothing, and at least one of them had a few supporters in the courtroom.
Blain-Lewis, one of the prosecutors, then asked the judge if she could clarify some of the admissions that had just been made by Mills.
She noted that a thumb was visible in the image of the document that Mills said was photographed, apparently without his knowledge, while it was on a table in his office. But Blain-Lewis said the photo of the document that has been disseminated on social media sites “is not the same photo,” although the markings on the document that were made by Mills are the same.
The document, known as a “witness disclosure,” is often turned over by prosecutors to defense attorneys shortly before a trial begins. They generally list the names of witnesses and summarize their testimony. In this case, that document was subject to a protective order, which meant Mills could discuss it with his client beginning one week prior to the trial that is scheduled to begin Tuesday.
Prosecutors in Albany routinely seek protective orders in cases involving murders, gangs and gun violence. Through the years, the district attorney's office has said that incidents of witness intimidation and death threats have caused many individuals to decline to testify in cases like this one.
The protective order prohibited Mills or any of the other defense attorneys from sharing a copy of the witness disclosure document with anyone, including their clients. Blain-Lewis said it also prohibited them from discussing the contents of that document with anyone but their client, although Mills admitted during Friday’s hearing that he had talked to someone else about one of the witnesses.
“What that means, your honor, is that someone has an actual copy of this document,” Blain-Lewis told the judge as she explained that there are two images of it. “I do believe that this court understands the length at which defendants will go to stop people from testifying, and in this case we had a legitimate, real death threat, and the effect that this is going to have not only on that witness but (the) trial itself concerns … my entire office.”
The case is assigned to acting state Supreme Court Justice Roger D. McDonough; Ackerman presided over Friday’s hearing because he was not available. Ackerman granted the order allowing the court to review the materials that were seized from the defendants' jail cells.
If there are documents in those materials that were subject to the protective order, it could lead to further investigation of how they were disclosed and by whom.
A violation of a protective order could lead to a criminal contempt charge, which is a misdemeanor crime. It may also be subject to review by the Attorney Grievance Committee for the Appellate Division, Third Department in Albany, which investigates allegations of misconduct by attorneys.
Thomas, 35, was an aspiring nurse and a promoter of her friends’ businesses who grew up in Albany. The father of her oldest son, Elijah Jr., was Elijah Cancer. Cancer was a former gang member turned anti-violence advocate for 518 SNUG. He was shot and killed breaking up a dispute at a party in July 2018. No one has ever been charged in connection with his death.
Court records indicate all four defendants charged with killing Thomas have lengthy criminal records, including convictions for violent crimes and weapons charges.
Anthony and Perry previously served time in federal prison after being convicted in a racketeering case against a South End gang known as the Original Gangsta Killas. They pleaded guilty in 2010.
Branch previously served time in state prison for attempted murder, weapon charges and promoting prison contraband.
June 7, 2024 Photo of Brendan J. Lyons Brendan J. Lyons MANAGING EDITOR
https://www.timesunion.com/news/article/attorney-scrutinized-murder-witness-receives-19501061.php

So I’m an LPN in a nursing home. Recently the facility sent a few CNAs to MA-C classes, so they can help us pass meds.
I work 7p-7a with one other nurse to about 110 residents. It’s a nightmare most nights, and I’ve almost walked out about a dozen times. Dayshift has 3 nurses, and 4 MA-Cs and still leaves 6pm med pass to us, all wound care that’s supposed to be done 7a-3p, assessments, changing O2 tubing, and catheters. I mean some nights we have time, but our psych unit is usually left with no nurse assigned to it, and the other nurses I work with don’t want to deal with it. So I end up spending 90% of my night on the psych unit keeping the residents from fighting or escaping, and unable to get to my other patients. Meds are always late because I can only move soo fast, falls happen every night, it’s just a shit show. I’m always stuck with the paperwork, I&As, endless neuro checks on that side, 15 minute checks, and whatever else.
Well, I complained and threatened to walk out and my boss decided to give us a MA-C on the psych unit from 7p-11p. Except she takes it upon herself to do insulins, injections, and mess with stuff she shouldn’t touch. Our facility has made MA-Cs a “supervisory position,” but the MA-C thinks that means it’s okay for her to give the CNAs the okay for things that should clearly be up to the nurse. A resident fell around 8pm one night, and I was on the LTC side of the facility passing meds. The MA-C never came and got me, and told the CNAs to get the resident up and put her back to bed. I walked passed this woman’s room later and heard her screaming. I checked her out and her foot was blue, leg was turned all the way out, and about 2 inches longer than the other leg. Classic broken hip. I asked the CNAs what happened and they said she fell hours ago. I was soo pissed, I wrote them all up. My boss told me I couldn’t write up the MA-C because she was doing what she thought was best. The resident ended up dying in the hospital from a massive PE. The MA-C tells the CNAs that she’s their boss, and they have to listen to her, not the nurse.
Several other negligent things have happened, and made me look shitty because the CNAs tell the MA-C and not me. Like new skin tears or bruises that dayshift finds, and get pissed at me for not documenting. Even worse that she’s on the psych unit, because these people require closer observation and more care. Plus, they can’t speak up for themselves.
I have brought this up to the CNAs and the MA-C, I’ve asked them to please tell me when something happens, and if the MA-C tells you to do something you know you shouldn’t, come tell me! A few of them like to argue and say the MA-C is their boss, but I just tell them “The MA-C doesn’t have the authority to make medical decisions, that’s what us nurses are here for.”
I’ve even confronted my boss about this, and she tells me to be on top of the CNAs more and don’t worry about the MA-C. It’s kind of hard to do with 83 residents, especially after you’ve told us all that the MA-C is the CNAs supervisor.
I’m just tired of finding out about things happening after the fact, and this MA-C making me look like a shit nurse. It’s frustrating as all hell and I don’t wanna leave because I love my old folks. They deserve the best care!

TIA FOR READING & RESPONDING!!!
Single parent here, with 1 child. While I was out of the state for a job interview, my elementary-aged son "Jeff" was left in the care of his God Mother "Sarah" at our Michigan home. His God Mother Sarah started to fall ill, and jumped at the chance to drop Jeff off for a playdate at his best friend's house "The Smiths" around the corner (something we do often). Mr. Smith, a single Dad, decided to take all of the kids, including my son Jeff, to another friend's ("Mr. Clark") house, without notifying us / asking for permission for my son to go.
Mr. Clark (the friend-of-a-friend whom we do not know) then took the kids on an ATV ride, also without my knowledge or permission. No one was wearing a seatbelt or helmet. The ATV is only a 2-seater, but Mr. Clark had 4 people total (himself and the 3 kids, including my son Jeff) riding in it. Mr. Clark was driving the ATV in a field adjacent to his property, that he doesn't own. We learned that the field is owned by a HUGE company (one of the largest in MI) and has No Tresspassing signs posted along the road it borders. It is unclear if Mr. Clark was invited to use the field to ride his ATV in or not. I think it is most likely that he was tresspassing.
Mr. Clark was showing off his driving, with the kids onboard the ATV, and he lost control and rolled the vehicle. The ATV rolled over and trapped my son underneath it, breaking his femur completely in half, right in the middle of his thigh. My son also hit his forehead hard on the ground and got a concussion. Thankfully, the other kids and Mr. Clark were not injured.
Mr. Clark lifted the ATV off of my son. And Mr. Smith ran out to the scene to assist. Mr. Clark then ran back to his house and got a flat board and zip ties. Together, Mr. Clark and Mr. Smith -- the only 2 adults onsite -- zip tied my son's leg to the flat board to stabilize it. And then they loaded my son into the back of Mr. Clark's truck. No police or paramedics were called. The location is NOT remote. Mr. Clark and Mr. Smith drove my son to the ER. And then I got a call from the ER doctor explaining that my Son had been in an accident, and he needed emergency surgery, and would be medically transported alone to another hospital where a pediatric surgeon could perform the proceedure asap. I had to answer questions about resucitation, the risks of anesthesia, the risks of surgery, and blood transfusions etc. over the phone from thousands of miles away.
My son ended up needing to have a long titanium rod permanently installed in his femur, running the full length of the bone, and secured in-place with 4 screws. All of this happened so fast, I couldnt get home in-time. And my son's God Mother ended up having Covid. So there was no one from our family at the hospital with him, through all of this. I rushed home, but couldnt get there in time for the surgery.
When I talked to Mr. Smith (our son's best-friend's Dad) afterward, he indicated that the accident happened in Northville, MI. But when God Mother Sarah talked to Mr. Smith separetely, he indicated that the accident happened in Westland, MI. However, the ER and hospital my son was taken to were both in the Ann Arbor area. The 2 different locations given were a red flag, so I started looking into their story more. Thankfully my son had his phone on him at the time of the accident and we were able to get the location -- it actually occured in Washtenaw County! We drove out to the site of the accident and my son confirmed it was the correct location. So we are wonderning WHY the adults onsite lied about the accident location, and also why didn't they call 911 / police to make an accident report etc. We don't know if there was alcohol or any substances involved in the accident.
Now, we are 2 months past the accident and surgery. It has been hard on all of us, most especially my son Jeff, who has had to deal with the pain from surgery, missing out on 2 months of school, being isolated from his friends, and the physical struggle of learning how to walk again. He missed all the end of year school events he loves. He will be missing out on summer camp and traveling too. He won't be able to play sports in the fall. And it is unknown if he will experience issues with his knee and hip later on in life. There is also a possibility that his body will one day reject the rod implant and he will have to have it removed. My usual happy and upbeat kid is depressed and doesn't want to be seen or to socialize. He goes to Physical Therapy 3xs a week. And we have a slew of doctor's appointments to attend. The caregiving is very involved -- he's only just now even able to make it to the bathroom. He has had to live on our couch because his bedroom isn't accessible to him with his injury. I was laid off last year, so I was job-searching when the accident happened. I haven't been able to start a new job because I have to be at home caring for Jeff. Now, money has run out, bills are piling up, and my once great credit has taken a drastic nose-dive. And my son will very likely lose his 2 best friends if we sue. This accident has had a much bigger negative impact and cost on us than anyone anticipated. Additionally, we have not heard anything from Mr. Clark or even Mr. Smith since the accident.
It now appears that Mr. Clark and Mr. Smith are possibly dating. We are guessing that they did not want that information to be known, so that's why they lied to us about where it happened. We also learned that Mr. Clark is a paramedic and firefighter. And we already knew that Mr. Smith is a nurse. The fact that they made sure there was no documentation of the accident, and that we didn't even know WHERE it occured or the details of the occurence ... it just felt like an intentional cover-up. Also, while my son was in the hospital right before surgery, Mr. Clark promised my son he would buy him a horse later. I believe this was an attempt to manipulate my son / bribe him into not disclosing the accident details. Finally, we have learned that my son's best friends (The Smiths) have since returned to Mr. Clark's (post-accident) and have ridden again on the same ATV.
I spoke to a lawyer who said we have a pretty strightforward personal injury case. He said that we could sue Mr. Clark and ultimately get a settlement from his homeowner's insurance policy. I am worried that, because the accident didn't happen on Mr. Clark's property (but instead occured in an adjacent field owned by a large public company) that Mr. Clark's homeowner's insurance will deny the claim. My lawyer said that they will not do that, because then the large company that owns the land it DID happen on will come after Mr. Clark's homeowner's insurance, and that "they won't want to deal with that, so they will settle the claim." My main question is -- Does this sound correct?
Some other questions I have are:
1. Who should we sue in this situation, to cover my son's medical expenses and possible future issues that he will have with his leg?
2. Is it accurate that, even though it didn't happen on Mr. Clark's property, AND they were likely tresspassing, that his Homeowners Insurance will still likely payout?
3. Is it worth it to sue the landowner (huge company) upon which the accident happened? From what I've read, sometimes children aren't considered tresspassers. And sometimes landowners have a resposibility to keep children safe on their property.
4. Is there a way to find out if someone has homeowners insurance, and auto insurance on an ATV, without them knowing?
5. Does this estimate from the lawyer seem accurate? Likely payout of $250k because that's the limit on homeowners insurance policies by-law. And then the Lawyer takes 35% of settlement, plus expenses. So approx $100k to Lawyer and $150k to us? Timing: 1 year total.
6. Would it jepoardize the lawsuit if I reached out to Mrs. Smith -- who recently divorced Mr. Smith? I am very concerned about my son losing his 2 best friends, who are like family to us. Especially if there's not a strong liklihood that we would win.
7. Any general recommendations?
THANK YOU SO MUCH FOR READING & RESPONDING!!!

Last year my cousin helped my grandmother apply for SSN benefits and accidently applied her for Medicare. We did not know that she even qualified for it but they gave it to her. She did not know she had Medicare until she received a bill for $1000 in May. We called the SSN office to see if she could get the Medicare benefits removed and they told her that she should come in to present her documents to prove legal residency in the U.S. and go from there. My cousin and grandma went. The office explained that my grandmother should keep the Medicare to see if it can cover a surgery she needs and could get assistance to pay off the $1000. They filled out the medical assistance form and they are asking for proof of citizenship. She is not a citizen but we sent proof of her TPS status. Should she continue trying to get medical assistance and keep Medicare? Any advice is appreciated for this situation.

Don't want to spam the sub, but this one is a good fit for the tons of posts about wanting to break into the field. If you have some sort of qualifications, here's an $18/hour proofreader job. Message the recruiter at the bottom of interested. I get nothing from this, just trying to help y'all get what you've been asking for.
Client is Centene, a major Medicaid provider. Short contract so you could get in, and have experience needed to apply to your next gig...
I got your profile via Job Portal and wanted to check if you are seeking new job opportunities. I have a Proofreade Copy Write Technical Writer role that aligns with your skills, Position is initially 2.5 Months contract.
I have mentioned the job description below for your review, do let me know the best time to connect with you
Thank you for your time. Have a good day!
Details:
Job Title: Proofreade Copy Write Technical Writer
Location: Fully Remote
Duration: 2.5 Months
Shift: 8:30A.M to 5P.M local time
Yes - OT IS Required. Weekends including Saturdays and Sundays
Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD):

1.  These contractors would be responsible for review of the 2023 Annual Notice of Changes, as well as assisting with review of other documents owned by the Product Communications team. 

2.  Proofreading documents using PDF, excel and vendor software 

Describe the performance expectations/metrics for this individual and their team:

1.  Quality proofreading – ACCURATE AND QUALITY proofreading in a TIMELY manner. NOTE: There will be NO COPYWRITING in this role. It is limited to PROOREADING ONLY 

2.  Tell me about what their first day looks like: 

3.  Computer set up/CNC required trainings/getting familiar with system and documents 

What previous job titles or background work will in this role?

1. Editor, proofreader, technical writer, Medicare related role

Thanks & Regards !
Owais Ahmad Associate Recruiter
Direct : +(412)564-0360
Email : Owais.ahmad@pacerstaffing.com

Does Medicare only pay for a shared room at a skilled nursing facility? Or can someone get a private room covered? My brother-in-law will be transitioning to skilled nursing soon, and he will need a private room.

~Rayray~
It felt frustrating in Chongqing. I was rather stuck in Hechuan. I got accustomed to lajiao (spice) there. I was a Midwesterner at the age of 22. I was raised in Illinois. I became a manic—a Ferris wheel on fire—I was hiding under a bed in a hotel. Bold like napalm. Sometimes I can never stop. Even when I was 18 in a ward arguing with staff. Always want to fight things. That’s why I refused the meds and went on a plane from America to China. I was going to be an English teacher. And like a light switch, the change and SSRIs turned me into a mess. It would be my first time experiencing psychosis. My biggest issue. I never imagined I would be stuck illegally in a country suffering a psychotic episode in my early twenties.
Transplanted as pollen. I was left with a backpack and a cellphone. With a downloaded app called WeChat. I had arrogantly quit a university job in a fit. Spent the past months full of energy and not sleeping and neglecting myself, including not eating, to work on a novel. Not considering myself normally religious, I had obsessed over occult ideas during that time. Spending nights reading Aleister Crowley—haven taken a rusty pocket knife to carve a pentagram on my chest for spiritual protection.
I did not have funds to fly home. My visa was connected to my previous job, which meant I had now made it void. I was an illegal resident now in China.
I used a nifty app called WeChat as a messaging app, it allows users to find people near them that are also looking for others. It was like a virtual pond. All kinds of people, including sex workers trying to make things happen.
It could with luck be used to find people looking for people in terms of other kinds of work. It was helpful on many occasions for finding gigs working at English training schools and also finding work as a private tutor for people.
WeChat also works as a digital wallet.
Mania makes me irritable. Enough to tell a boss to fuck off. Thoughts ricochet within me. Bumper cars collide.
Being stuck and angry sucks. I scrolled and scrolled on a Huawei phone.
Absolutely pissed off at this world.
Pissed at the times police wanted to take me away for being a mess.
Sometimes women get pissed. Scrolling through their phones. Angry at their cheating husbands. It really is not that hard to have flair—be a damn white oddity. Like moths to a porchlight. Particles of sand through hands. This is when I first started the habit of it…
I rather go by a rather empty name of Rayray… with further explanation needed but now is not convenient. But I assure it is interesting enough and has some importance.
Habits are various in nature in how they attach to and eat at marrow—like atom bombs flashing as rays evaporating DNA—sets in a way less than human as putting myself in the cage of bad things taken up—my time as a former heroin addict is left as stretch marks on me in various ways. The same goes for the first time I found myself making arrangements with middle aged married women while desperation of waves whiplashed me like sandpaper hands coming at me to leave me in a tiring state of abrasion.
I had spent a night snuck away into a hotel. Found someone on a business trip. Instead of registering I waited to sneak along into the hotel elevator amongst a group of others attending the hotel, as I had no card. I headed to a designated room number. Originally I was sitting in a park. Playing on WeChat and found someone in their mid-thirties. Pictures were exchanged and I said no. She brought up paying for the hotel if I arrived. I agreed and went along.
When I met I washed up after her and we used our phones to awkwardly translate what we would do.
Room service knocked. I found myself hidden under a bed as I was not registered to be there.
It seems unusual that it was around this time I had started working on a story of my life as a heroin addict when I got caught up in my worse manic episode ever experienced during my age of 22. Finished half that story before never going back to it after my manic episode had ended. Now I am here writing about it and wondering if the same can happen again in the process of this work.
It feels extremely cliché I would write a novel about struggles with heroin addiction. It has been done many times. It’s just lame of me.
I feel like my thoughts are bit off. I left the hotel the next morning with the little money I did have on a debit card. Turns out the woman was from Taiyuan. It is a city in the northern part of China in the province of Shanxi—coal country with the worst air pollution in China. She has a colleague in Taiyuan that takes courses at an English training center. I was able to contact this place in the morning via a shared contact on WeChat given to me by the stranger I met that night.
Before I knew it I was sending my information and documents in my backpack at an internet café in a fax—with the intent that the woman agreed to share my information to the training center as she shared my contact to its hiring manager. It would land me a job that day that would help me out of my situation. Things turned not quite out as I expected though. I was shifted like a ball to somebody else to contact for a training center geared to teaching children.
I took what I had and ran off to a train station after taking the public transit. Unfortunately I was shit for money and could not afford a high speed rail pass. The slow train would take thirty-two hours to get to my destination. I would have taken a room with a bed but all I could afford was a hard seat for the travel.
Things were getting better for me in the circumstance considering I had found someone willing to take me for work despite my visa situation.
The thirty-two hour train ride was horrendous in some ways, but mostly I was in excitement despite the circumstances. I’m always giddy when disappointed. I moved up and down the aisle of the train. I could not speak mandarin, but it did not stop me from trying to interact with everyone. I talked many ears off during the train ride. I went up and down the aisle trying to interact as a moth to porchlights—I could not stop even if I had wanted to. I found great enjoyment the times I did get to sit across a table from somebody my age heading to Taiyuan from Chongqing. They were a university student returning to their hometown. Another passenger who sat beside me was an elderly man with hard boiled eggs, he was eating one after another one. I highly enjoyed each and every conversation that I had. It was like my head was a lightbulb wanting June bugs to bang against it with the intensity of Roman candles shot at my mouth of nicotine tinged teeth.

“If you find someone in Shanxi it is practice to pay the family money before you can get married. You would also have to already own a home and a car,” told my new friend across in their seat from me—a university passenger friend named David.

“Not necessarily what I was looking for. When is the next stop for snacks?” When the train stops I am able to get out and to have a walk onto the platform to buy various goods from the vendors to take back with me to eat along the ride to Taiyuan.

I had all my important documents tucked in my bag. This included my health clearance and obviously I made no mention of my mental health diagnosis or history to the doctor who had to evaluate me. My diploma and TEFL certificate were tucked away securely. A TEFL is a certificate that stands for Teaching English as a Foreign Language, it qualifies me to teach English as a second language abroad—it had only took a few months of taking a course online that I had paid for to obtain.
It is easy to be happy when you can trick yourself as your own con artist. Mania can make you deceive yourself. One can be doused in napalm and still not fully recognize what is actually going on. Same goes the flicking of psychosis. Even when I have nothing I find myself in my radiating irritation the most qualified of things—the velocity of my rhythm sets me out of an orbit.
The pressure cooker keeps me moving like a propeller at times. I finally arrived at Taiyuan. I arrived at the station to be greeted by Ryan my manager and his assistant Jennifer. We had our hello and introduction and they helped me get to a taxi that would bring me to my new apartment. I finally had a residence again. Apparently they were desperate for a teacher. The last teacher was from New Mexico and apparently they pulled a midnight run—that is when a teacher in the middle of the night disappears onto a plane back home without any notification of it.
The apartment was okay. On the fourth floor with no elevator, so it was a bit of a climb up a dark stairwell not lit correctly.
My job was a training center that had a location near Yingze Park in the center of the city. I was to be paid in cash via envelopes. I would assist in teaching kindergarten all the way up to high school aged students there in private lessons paid by their parents. I would also be assigned by my company to various primary schools in the city. I would take public buses to various schools paid by the company I worked for to give English lessons as I bounced around to various classrooms and schools in the city. Often I would receive a phone call to avoid going to work that day if my boss got inside input that officials would be doing raids to check foreigners’ visas that day.

A taxi ride would always be a thrill. Caused me nerves at first, but I came to love the flying in dangerous ways along a busy road. I remember a driver beeping their horn away as they drove onto the sidewalk to pass people. They treated the pedestrians as if they were in the wrong. I came flying in front of a primary school at its front gates. I was going to start teaching a first grade classroom and a kindergarten classroom. The way schools are set up is with a wall around the entirety of the exterior of the school. There is a gate at the front where one or two security will be waiting to let people in and out of the complex of the school.

I walked in front of the gate to greet the security. It was my first time with an assignment at this school. The guard said they had never seen me before and wouldn’t let me in. Not a big nuisance while I called my boss who then called the school to sort out the situation.

I miss the classroom so much. I ended up teaching in China for five years at various training schools. After returning to Illinois, I still taught as a primary school teacher in a public school.

I often feel extremely ugly from inside to my outside, but something is attractive there. This does not come just in terms of flirting and relationships—mania makes me a genuine lightbulb that flickers in a way that encourages the insects to me—everyone looks like a June bug—this is what I have come to understand about life. But that ugly does kind of stay like rot in a cavity that leaves a bad taste in the mouth that smells foul—hoping nobody catches the smell near me—it must tie into my struggles with bulimia over the years.

The same goes for my years as a teacher—in relation to the whole lightbulb phenomenon—I’m positive it is tied to mania and hypomania. The younger students always were fixated on the information I was teaching to them. I kept over the years methods taught to me and self-taught that I found extremely effective with younger students when it comes to teaching.
Everything was physical in learning in terms of intensity and ambition. When teaching my first grade classroom I would create flashcards for the vocab we would work on and implement in creating new sentences with. We would chant these words together in a way that made me a clown while teaching. Students would yell out the word that I presented with intense enthusiasm. As I walked by students it was expected that while they yelled out the word they would also physically hit the card. Later I would also work on physical gestures and acting out of vocab words and they would follow the actions and phrases with me.
I would often eventually turn the class into two teams. When students got an answer right I would behave comically and full of energy—I would give them a high five and pretend they were so strong with it that it hurt my hand in the process with much exaggeration—the students always seemed to never get tired of this act.
One game I would play involved drawing two stick figures with happy faces on them. Each figure would represent one of the teams for the classroom. I would draw a hungry alligator under the figures. Their faces would also be comical in appearance and full of exaggerations. Each figure had a parachute placed over them and four strings attached. During the game the students would race to say the word correctly represented on the flashcard or the correct word for the gesture I was making. The team that was not the slowest would lose a string on the parachute. If a team lost all four strings they would fall to the alligator who would eat them. The students found it hilarious with my actions involved in it. I would also draw tears and a person praying to represent anticipation and worry of falling down each time they lost a string.
I had a tooth game too. I would draw too large faces for each team. The team that could answer the flashcards and gestures the quickest would have a tooth drawn in their mouth. The team with the most teeth would win and it would look rather funny as the mouth grew and grew with an abnormal and extreme amount of teeth.
I often did other physical and interactive games like having students run to the word I showed a card to or gestured—each word would be attached to a point in the classroom on a wall.
I know it sounds grandiose, but the parents always seemed to think I was great at my job.
The word vulnerable means so many things to me. That word is like the coal to form the generator that makes the guiding energy for the ethics I follow in my life—I hold very strongly to these values that have developed on how to live—I can express it more later but I greatly attach a kind of Christian value system to it, which makes sense considering I was raised in a Lutheran household and always went to church, Sunday school, and went to my courses and went through my confirmation—everyone is a bit of a mop—some pick up clean water and others dirty or a mix of it—waiting to find the people to drain them voluntarily or involuntarily. I was born vulnerable. I walk pigeon-toed and grew up tripping on my feet—I speak with a soft feminine voice. Bipolar disorder makes somebody vulnerable. There was much vulnerability in being eighteen and hospitalized involuntarily for my first manic episode—tied to a stretcher. I have almost a sense of us vs them—the vulnerable and those that harm the vulnerable—take advantage of the vulnerable—I feel this is a very much Christian in the idea of the unfortunate are more holy than the rest of the bunch—children are like that in terms of being born into a cruel existence—a cruel existence I felt at times in my life and so many do—making sure harm does not come to those in need gives the light of purpose to go bright inside like a Christmas tree in my brain—this light of happiness and warmth. I never expected I would fall in love for teaching due to the antidepressant effect provided. It would become my career for a decade. Some grow up wanting to be a teacher, I became one by accident, desperation, and being saved.
Sometimes I inflate on self-hate like a helium balloon that needs to be tied to a wrist to not float away.
In my early teens I started struggling with bulimia and image. I remember when my mother caught me in the act. I was not offered help but criticized. I was called a girl for my problems and threatened to be taken somewhere to be fixed of my confusion. I don’t identify as transgender. I identify as a man that struggles with bulimia and happens to have feminine qualities.
I attribute it to circumstances that happened to me—a justification for the pain at times—an attack on aspects of bisexuality.
After a long day of work I did what my young self often did. I went clubbing with friends. I feel like even if I hide aspects of myself such as being bisexual, people can spot it regardless. I’m extremely secretive about it and not comfortable displaying that vulnerable aspect of myself.
My friend from England went with me. He was about six years my senior. Big guy. Tall. The clubs name was Maoye.
I always enjoyed the free drinks available to foreigners—it was done to attract Chinese clients, as the idea was foreigners being there would attract people.
Amongst the hot and sweltering crowd a man grabbed ahold of me. I felt stuck. I was taken off guard. Pushed and cornered. While on me I managed to push him off. But it all serves as a reminder of the vulnerability of my life.
A nail was placed into my hand—a constant burn and reminder of that vulnerability.

Part 2
From self-hate I can also be so grandiose. I am like a Christmas tree that is lit up. Sparklers so pretty that you cannot let go of them, even if it burns your fingertips and hurts.

From heroin to sex, you can smother the pain. You drain the ocean to fill a void in these times. It ties to mania as well. That restlessness and irritability is extinguished by the paradox of throwing kerosene to everything burning. I’m so grandiose to hide my insecurities, I mistake my misfortune as a mark of something ugly virtuous—the neon of vulnerability pulsating like a star within me. Swelling on a pain.

Bad habits. I want you to judge me and tell me what’s wrong with me. Give me a verdict.
Stress a trigger for mania, and I was stressed from the incident I had experienced at the club. I bloated like a tick to distract from locusts of thoughts that could not shut up with their commotion.
I had been sleeping around more than before. My brain was Christmas tree lights. I accelerated on a generator—I made a mixed episode worse.
Tease a disaster when you are heightened like a blimp. Full of hydrogen. Hoping to burn up ad rain down like napalm.
When the pretty candles on the Christmas tree are left untouched—not looked at like a kettle on burner that has been forgotten—the dry neglected tree will into a house fire.
I’ve had four attempts in my life so far.
When I attempt I don’t cry for help. I feel too vulnerable. I’m afraid.
Hate police and wards.
Downing pills.
My past failed attempts made me aware of everything done wrong before. The sleeping pills alone might not do what I was looking for at that time. I bought an electrical cable. This way if it failed I would still be unconscious and choked out by the cord—fail safe plan to end my life.
The words coming out of my mouth slowed down. I started getting second thoughts. Stuck my face towards the toilet bowl while on my knees. Sticking my fingers down my throat. Leaving blood vessels bursting in my eyes.
Went stumbling outside and waved a taxi down and asked to be taken to the local hospital.
Never expected finding myself checked into a psych ward in a foreign country.
Nietzsche has a quote in reference to chaos in life and how it is needed to create a star—this reference holds so much value to me. Sometimes stars hit together just right to create fate out of the worst of things. The ward lead me to meet the woman made of paper. She would one day become my wife. I would have two daughters with her. Forge together as soldiers to face the obstacles in life. Someone who would save my life during a future attempt when I was found unconscious from an overdose. The smartest and toughest woman I have ever known. Someone to build trenches with.
I liked it when she stuck that needle in me for an IV. It must correlate to being a heroin addict. The pushing of something in my vein correlates to happiness and purity.
The woman made out of paper was my nurse in the ward I was stuck in. What attracted her to the mess that is me I will never understand fully.
The woman made out of paper is named Lilu. She was one year older than me and one of my nurses at that ward in Taiyuan. She was from Zhengzhou—a city in the province of Henan that is based in the center of China. I am sure as the reader it would be nice to know why I call her the woman made of paper.
She struggled with her own demons. She also deserves much praise for her resilience and brains. When she was born she was raised by a family that adopted her and often neglected and abused her growing up. Her biological family is distant from her, even though she has an identical twin—they felt too poor to take care of her and made the choice that they needed to be less of one child as she also has an older sister—her twin got to stay with that family but she was given up and adopted. I am sure this must bother her even if she never will talk about it to anyone in her life—as she is one to refuse ever discussing emotions and feelings, as this is not her personality type—she is very much a fighter. I think most would struggle with wondering why they were the one let go of—it also must hurt her knowing that the family would have a son and keep him.
Despite all these circumstances, she graduated top of her class of four thousand students—Chinese high schools can be quite large serving a large region—they often serve as boarding schools. She was a smart and hardworking student. Circumstances never made her stop trying to be the best and moving forward and she never made excuses for herself. In university she also did well and got accepted at the most studious and hard to obtain nursing position at the number one hospital in Shanxi.
I have already ranted and gone on about my affection and feelings tied to heroin. Drinking of entire oceans to fill voids.
Paper is a void. It asks for calligraphy to be written on it to make braille. This way when fingers run over skin to tell its worth—the reason for its troubles on display—it forms connection through those words of declaration—the whining for why things are the way they are—the filling of a void like a heroin addict needing a cure to cure kicking legs—two papers come together to write upon one another—as a paper I am her typo—I stand as a falling mess with nerves like tripwire, I keep failing and losing my composer, while she stands stronger as a declaration that has been written on me, my very own typewriter—when I was chased I listened to her and joined as one. I wish and intend to always serve the woman made out of paper who has saved my life and has always been there for me, being so strong despite circumstances—amongst the wind of turmoil in life I follow along her path like a sail.
It was love at first sight for her but not for me. I had no interest in dating her at the time. I worked across the street of that hospital in an office building for a training center as a part time job. I would teach adults English who paid for private lessons near to Yingze park in the center of Taiyuan. She signed up for classes for me to teach her and brought me food on almost every other day that she had prepared. Eventually we found ourselves coupled fully.
As paper we write on each other—eat each other.

Hey guys, I'm working at a clinic and at my company the secretaries, nurses, and call center people are sending us random direct messages on the EMR direct chat constantly throughout the day.
The issue is that these messages pop up on our screen and we have to click on it or else it keeps on popping up. We see a lot of patients so I don't have time to address random questions that aren't related to my job title. Some of my colleagues just ignore them. I can't since I have a conscience and in case there is actually something relevant that pops up
Here are some samples of the messages I get throughout the day
"Patient is curious if you'll go over test results with him" (I sent patient a detailed message on the EMR patient portal a day or two before. Regardless, pts should be given an appt to go over test results if they so desire)
"Patient is curious if they can get an appt with you" (Inappropriate as I'm not a secretary. I tell call center person to send these messages to the secretary)
"patient is curious if you will call them for their telehealth appt" (I already documented my attempts to reach pt in the EMR which the call center person has access to)
I've told them repeatedly over the last 6 months to direct messages via the non urgent messaging portion of the EMR and not to the direct chat; this way we don't have pop ups interrupting patient care. The non urgent messages go to our inbox and don't pop up on the screen. We are supposed to monitor our inbox daily which I do. Also, the vast majority of these messages are not things that I should be addressing like scheduling appts and such.
I complained and complained and some manager decided to notify a higher up of the company. The clinic manager already knows about this issue but doesn't have control over call center people.

1. I'm trying to not get fired since I want to work her for at least 6-7 more months before moving to a new job and don't want a bad reference. Thankfully even as a youngish attending I am almost financially independent (2 yrs away at current living expenses) due to frugality and a high savings rate.

Is this a fire able offense? I'm only concerned about my resume getting affected or being branded a problem child physician.
The call center's direct boss said that the company wants staff to be able to message doctors directly in the chat for important patient issues and to improve patient satisfaction. I told them that emergent issues should be addressed to clinicians but non emergent messages ("patient wants a refill of chronic X med") should not be sent to the direct chat and are unacceptable/inappropriate. I told them that bureaucratic messages like referral questions should be sent to the referrals coordinators. (it's their job)
2. Do other clinicians get consistent random non clinical questions on the EMR direct chat? I'm not talking about inbox messages but actual direct messages in the chat that pop up on your screen.
At my last job we didn't have these frequent direct messages. In the past at this current company we didn't get these random messages all the time either in the direct chat.
Any advice you can offer? I don't like the job but it's better than my last one, albeit lower paid.
Edit: Other clinicians have told me that they're getting spammed by the call center and random ancillary staff. I was going to let the higher up know that other people are getting inappropriate messages distracting us from our work. Sound good?

2/2022! That is the year that my husband and I applied for his change of status. It wasn’t until 12/2023 they finally gave him his travel documents. His job doesn’t allow for time to travel until the summer. We planned this trip where he leaves to go see his kid for the first time since he was an infant and then to meet in his home country where I would meet his family for the first time. I extended an extra day and changed shifts with another nurse bc I was going to meet his grandmother in person! I balled like a baby bc of the excitement and he was going to see his grandma for the first time in a very long time. Well she died this week and all of my excitement has turned to utter sadness. My sadness is also fused with anger bc of MY government, a government I willingly served for 15 years and continue to serve has let me down. All of my feelings of abandonment are right at the surface. All of these people around me obnoxiously filled with excitement for this foreign country they are traveling to and I am holding back tears. I can also see why other countries don’t like Americans as well bc I don’t like these entitled people myself.

Currently a band 3 healthcare worker; and our ward manager has become very nasty towards staff members including myself the last while. I try not to take it to heart and get upset, but incidents have occurred and it has gotten to me.
Our new system launched during the week which was everything is now on the computers. Me and the other HCA took a rover for ourselves and we were going around helping on the computers seeing if any Nurses needed help. Mind you, our ward has received very little support from anyone so we are basically just fending as we go along. I do obs and I was updating this on the computer. She had then informed us we were on the computer too much and we weren’t allowed to use the rovers so to return them, and that she doesn’t want us to see us on the computers again for the rest of the day. So how am I meant to update obs ? Do other stuff etc, me and the other HCA cleaned everything, treatment room, sluice and patients bedsides, done everything we were meant to do, stocked up and lifted sharps boxes and cardboards. It came to around 8pm she begun saying HCAs were spending too much time on the computers, and sitting about when they should’ve been other duties that needed done (the place was spotless), this obviously really annoyed us, I have a duty to check obs and I can only file the documentation either through the computer or the rover.
The ward manager has not done anything to support us with the new system, instead has sat about completely ignoring the nurses and not taking an interest.
Another time I had changed a patients bed sheet and left linen on the floor, she then came behind the blinds and begun screaming at me and threw the linen at me and told me it weren’t good enough. I was so embarrassed I could’ve cried. I know the linen shouldn’t have been on the floor but there is no way to get on like that.
I simply do not feel supported about situations and just feel like our ward manager does not g care about the staff. There are other incidents but I don’t want to go on about them. Is there anything I can do about this?
EDIT she also had the other hca crying during the week because of the way she was getting on.

~Rayray~
It felt frustrating in Chongqing. I was rather stuck in Hechuan. I got accustomed to lajiao (spice) there. I was a Midwesterner at the age of 22. I was raised in Illinois. I became a manic—a Ferris wheel on fire—I was hiding under a bed in a hotel. Bold like napalm. Sometimes I can never stop. Even when I was 18 in a ward arguing with staff. Always want to fight things. That’s why I refused the meds and went on a plane from America to China. I was going to be an English teacher. And like a light switch, the change and SSRIs turned me into a mess. It would be my first time experiencing psychosis. My biggest issue. I never imagined I would be stuck illegally in a country suffering a psychotic episode in my early twenties.
Transplanted as pollen. I was left with a backpack and a cellphone. With a downloaded app called WeChat. I had arrogantly quit a university job in a fit. Spent the past months full of energy and not sleeping and neglecting myself, including not eating, to work on a novel. Not considering myself normally religious, I had obsessed over occult ideas during that time. Spending nights reading Aleister Crowley—haven taken a rusty pocket knife to carve a pentagram on my chest for spiritual protection.
I did not have funds to fly home. My visa was connected to my previous job, which meant I had now made it void. I was an illegal resident now in China.
I used a nifty app called WeChat as a messaging app, it allows users to find people near them that are also looking for others. It was like a virtual pond. All kinds of people, including sex workers trying to make things happen.
It could with luck be used to find people looking for people in terms of other kinds of work. It was helpful on many occasions for finding gigs working at English training schools and also finding work as a private tutor for people.
WeChat also works as a digital wallet.
Mania makes me irritable. Enough to tell a boss to fuck off. Thoughts ricochet within me. Bumper cars collide.
Being stuck and angry sucks. I scrolled and scrolled on a Huawei phone.
Absolutely pissed off at this world.
Pissed at the times police wanted to take me away for being a mess.
Sometimes women get pissed. Scrolling through their phones. Angry at their cheating husbands. It really is not that hard to have flair—be a damn white oddity. Like moths to a porchlight. Particles of sand through hands. This is when I first started the habit of it…
I rather go by a rather empty name of Rayray… with further explanation needed but now is not convenient. But I assure it is interesting enough and has some importance.
Habits are various in nature in how they attach to and eat at marrow—like atom bombs flashing as rays evaporating DNA—sets in a way less than human as putting myself in the cage of bad things taken up—my time as a former heroin addict is left as stretch marks on me in various ways. The same goes for the first time I found myself making arrangements with middle aged married women while desperation of waves whiplashed me like sandpaper hands coming at me to leave me in a tiring state of abrasion.
I had spent a night snuck away into a hotel. Found someone on a business trip. Instead of registering I waited to sneak along into the hotel elevator amongst a group of others attending the hotel, as I had no card. I headed to a designated room number. Originally I was sitting in a park. Playing on WeChat and found someone in their mid-thirties. Pictures were exchanged and I said no. She brought up paying for the hotel if I arrived. I agreed and went along.
When I met I washed up after her and we used our phones to awkwardly translate what we would do.
Room service knocked. I found myself hidden under a bed as I was not registered to be there.
It seems unusual that it was around this time I had started working on a story of my life as a heroin addict when I got caught up in my worse manic episode ever experienced during my age of 22. Finished half that story before never going back to it after my manic episode had ended. Now I am here writing about it and wondering if the same can happen again in the process of this work.
It feels extremely cliché I would write a novel about struggles with heroin addiction. It has been done many times. It’s just lame of me.
I feel like my thoughts are bit off. I left the hotel the next morning with the little money I did have on a debit card. Turns out the woman was from Taiyuan. It is a city in the northern part of China in the province of Shanxi—coal country with the worst air pollution in China. She has a colleague in Taiyuan that takes courses at an English training center. I was able to contact this place in the morning via a shared contact on WeChat given to me by the stranger I met that night.
Before I knew it I was sending my information and documents in my backpack at an internet café in a fax—with the intent that the woman agreed to share my information to the training center as she shared my contact to its hiring manager. It would land me a job that day that would help me out of my situation. Things turned not quite out as I expected though. I was shifted like a ball to somebody else to contact for a training center geared to teaching children.
I took what I had and ran off to a train station after taking the public transit. Unfortunately I was shit for money and could not afford a high speed rail pass. The slow train would take thirty-two hours to get to my destination. I would have taken a room with a bed but all I could afford was a hard seat for the travel.
Things were getting better for me in the circumstance considering I had found someone willing to take me for work despite my visa situation.
The thirty-two hour train ride was horrendous in some ways, but mostly I was in excitement despite the circumstances. I’m always giddy when disappointed. I moved up and down the aisle of the train. I could not speak mandarin, but it did not stop me from trying to interact with everyone. I talked many ears off during the train ride. I went up and down the aisle trying to interact as a moth to porchlights—I could not stop even if I had wanted to. I found great enjoyment the times I did get to sit across a table from somebody my age heading to Taiyuan from Chongqing. They were a university student returning to their hometown. Another passenger who sat beside me was an elderly man with hard boiled eggs, he was eating one after another one. I highly enjoyed each and every conversation that I had. It was like my head was a lightbulb wanting June bugs to bang against it with the intensity of Roman candles shot at my mouth of nicotine tinged teeth.

“If you find someone in Shanxi it is practice to pay the family money before you can get married. You would also have to already own a home and a car,” told my new friend across in their seat from me—a university passenger friend named David.

“Not necessarily what I was looking for. When is the next stop for snacks?” When the train stops I am able to get out and to have a walk onto the platform to buy various goods from the vendors to take back with me to eat along the ride to Taiyuan.

I had all my important documents tucked in my bag. This included my health clearance and obviously I made no mention of my mental health diagnosis or history to the doctor who had to evaluate me. My diploma and TEFL certificate were tucked away securely. A TEFL is a certificate that stands for Teaching English as a Foreign Language, it qualifies me to teach English as a second language abroad—it had only took a few months of taking a course online that I had paid for to obtain.
It is easy to be happy when you can trick yourself as your own con artist. Mania can make you deceive yourself. One can be doused in napalm and still not fully recognize what is actually going on. Same goes the flicking of psychosis. Even when I have nothing I find myself in my radiating irritation the most qualified of things—the velocity of my rhythm sets me out of an orbit.
The pressure cooker keeps me moving like a propeller at times. I finally arrived at Taiyuan. I arrived at the station to be greeted by Ryan my manager and his assistant Jennifer. We had our hello and introduction and they helped me get to a taxi that would bring me to my new apartment. I finally had a residence again. Apparently they were desperate for a teacher. The last teacher was from New Mexico and apparently they pulled a midnight run—that is when a teacher in the middle of the night disappears onto a plane back home without any notification of it.
The apartment was okay. On the fourth floor with no elevator, so it was a bit of a climb up a dark stairwell not lit correctly.
My job was a training center that had a location near Yingze Park in the center of the city. I was to be paid in cash via envelopes. I would assist in teaching kindergarten all the way up to high school aged students there in private lessons paid by their parents. I would also be assigned by my company to various primary schools in the city. I would take public buses to various schools paid by the company I worked for to give English lessons as I bounced around to various classrooms and schools in the city. Often I would receive a phone call to avoid going to work that day if my boss got inside input that officials would be doing raids to check foreigners’ visas that day.

A taxi ride would always be a thrill. Caused me nerves at first, but I came to love the flying in dangerous ways along a busy road. I remember a driver beeping their horn away as they drove onto the sidewalk to pass people. They treated the pedestrians as if they were in the wrong. I came flying in front of a primary school at its front gates. I was going to start teaching a first grade classroom and a kindergarten classroom. The way schools are set up is with a wall around the entirety of the exterior of the school. There is a gate at the front where one or two security will be waiting to let people in and out of the complex of the school.

I walked in front of the gate to greet the security. It was my first time with an assignment at this school. The guard said they had never seen me before and wouldn’t let me in. Not a big nuisance while I called my boss who then called the school to sort out the situation.

I miss the classroom so much. I ended up teaching in China for five years at various training schools. After returning to Illinois, I still taught as a primary school teacher in a public school.

I often feel extremely ugly from inside to my outside, but something is attractive there. This does not come just in terms of flirting and relationships—mania makes me a genuine lightbulb that flickers in a way that encourages the insects to me—everyone looks like a June bug—this is what I have come to understand about life. But that ugly does kind of stay like rot in a cavity that leaves a bad taste in the mouth that smells foul—hoping nobody catches the smell near me—it must tie into my struggles with bulimia over the years.

The same goes for my years as a teacher—in relation to the whole lightbulb phenomenon—I’m positive it is tied to mania and hypomania. The younger students always were fixated on the information I was teaching to them. I kept over the years methods taught to me and self-taught that I found extremely effective with younger students when it comes to teaching.
Everything was physical in learning in terms of intensity and ambition. When teaching my first grade classroom I would create flashcards for the vocab we would work on and implement in creating new sentences with. We would chant these words together in a way that made me a clown while teaching. Students would yell out the word that I presented with intense enthusiasm. As I walked by students it was expected that while they yelled out the word they would also physically hit the card. Later I would also work on physical gestures and acting out of vocab words and they would follow the actions and phrases with me.
I would often eventually turn the class into two teams. When students got an answer right I would behave comically and full of energy—I would give them a high five and pretend they were so strong with it that it hurt my hand in the process with much exaggeration—the students always seemed to never get tired of this act.
One game I would play involved drawing two stick figures with happy faces on them. Each figure would represent one of the teams for the classroom. I would draw a hungry alligator under the figures. Their faces would also be comical in appearance and full of exaggerations. Each figure had a parachute placed over them and four strings attached. During the game the students would race to say the word correctly represented on the flashcard or the correct word for the gesture I was making. The team that was not the slowest would lose a string on the parachute. If a team lost all four strings they would fall to the alligator who would eat them. The students found it hilarious with my actions involved in it. I would also draw tears and a person praying to represent anticipation and worry of falling down each time they lost a string.
I had a tooth game too. I would draw too large faces for each team. The team that could answer the flashcards and gestures the quickest would have a tooth drawn in their mouth. The team with the most teeth would win and it would look rather funny as the mouth grew and grew with an abnormal and extreme amount of teeth.
I often did other physical and interactive games like having students run to the word I showed a card to or gestured—each word would be attached to a point in the classroom on a wall.
I know it sounds grandiose, but the parents always seemed to think I was great at my job.
The word vulnerable means so many things to me. That word is like the coal to form the generator that makes the guiding energy for the ethics I follow in my life—I hold very strongly to these values that have developed on how to live—I can express it more later but I greatly attach a kind of Christian value system to it, which makes sense considering I was raised in a Lutheran household and always went to church, Sunday school, and went to my courses and went through my confirmation—everyone is a bit of a mop—some pick up clean water and others dirty or a mix of it—waiting to find the people to drain them voluntarily or involuntarily. I was born vulnerable. I walk pigeon-toed and grew up tripping on my feet—I speak with a soft feminine voice. Bipolar disorder makes somebody vulnerable. There was much vulnerability in being eighteen and hospitalized involuntarily for my first manic episode—tied to a stretcher. I have almost a sense of us vs them—the vulnerable and those that harm the vulnerable—take advantage of the vulnerable—I feel this is a very much Christian in the idea of the unfortunate are more holy than the rest of the bunch—children are like that in terms of being born into a cruel existence—a cruel existence I felt at times in my life and so many do—making sure harm does not come to those in need gives the light of purpose to go bright inside like a Christmas tree in my brain—this light of happiness and warmth. I never expected I would fall in love for teaching due to the antidepressant effect provided. It would become my career for a decade. Some grow up wanting to be a teacher, I became one by accident, desperation, and being saved.
Sometimes I inflate on self-hate like a helium balloon that needs to be tied to a wrist to not float away.
In my early teens I started struggling with bulimia and image. I remember when my mother caught me in the act. I was not offered help but criticized. I was called a girl for my problems and threatened to be taken somewhere to be fixed of my confusion. I don’t identify as transgender. I identify as a man that struggles with bulimia and happens to have feminine qualities.
I attribute it to circumstances that happened to me—a justification for the pain at times—an attack on aspects of bisexuality.
After a long day of work I did what my young self often did. I went clubbing with friends. I feel like even if I hide aspects of myself such as being bisexual, people can spot it regardless. I’m extremely secretive about it and not comfortable displaying that vulnerable aspect of myself.
My friend from England went with me. He was about six years my senior. Big guy. Tall. The clubs name was Maoye.
I always enjoyed the free drinks available to foreigners—it was done to attract Chinese clients, as the idea was foreigners being there would attract people.
Amongst the hot and sweltering crowd a man grabbed ahold of me. I felt stuck. I was taken off guard. Pushed and cornered. While on me I managed to push him off. But it all serves as a reminder of the vulnerability of my life.
A nail was placed into my hand—a constant burn and reminder of that vulnerability.

Part 2
From self-hate I can also be so grandiose. I am like a Christmas tree that is lit up. Sparklers so pretty that you cannot let go of them, even if it burns your fingertips and hurts.

From heroin to sex, you can smother the pain. You drain the ocean to fill a void in these times. It ties to mania as well. That restlessness and irritability is extinguished by the paradox of throwing kerosene to everything burning. I’m so grandiose to hide my insecurities, I mistake my misfortune as a mark of something ugly virtuous—the neon of vulnerability pulsating like a star within me. Swelling on a pain.

Bad habits. I want you to judge me and tell me what’s wrong with me. Give me a verdict.
Stress a trigger for mania, and I was stressed from the incident I had experienced at the club. I bloated like a tick to distract from locusts of thoughts that could not shut up with their commotion.
I had been sleeping around more than before. My brain was Christmas tree lights. I accelerated on a generator—I made a mixed episode worse.
Tease a disaster when you are heightened like a blimp. Full of hydrogen. Hoping to burn up ad rain down like napalm.
When the pretty candles on the Christmas tree are left untouched—not looked at like a kettle on burner that has been forgotten—the dry neglected tree will into a house fire.
I’ve had four attempts in my life so far.
When I attempt I don’t cry for help. I feel too vulnerable. I’m afraid.
Hate police and wards.
Downing pills.
My past failed attempts made me aware of everything done wrong before. The sleeping pills alone might not do what I was looking for at that time. I bought an electrical cable. This way if it failed I would still be unconscious and choked out by the cord—fail safe plan to end my life.
The words coming out of my mouth slowed down. I started getting second thoughts. Stuck my face towards the toilet bowl while on my knees. Sticking my fingers down my throat. Leaving blood vessels bursting in my eyes.
Went stumbling outside and waved a taxi down and asked to be taken to the local hospital.
Never expected finding myself checked into a psych ward in a foreign country.
Nietzsche has a quote in reference to chaos in life and how it is needed to create a star—this reference holds so much value to me. Sometimes stars hit together just right to create fate out of the worst of things. The ward lead me to meet the woman made of paper. She would one day become my wife. I would have two daughters with her. Forge together as soldiers to face the obstacles in life. Someone who would save my life during a future attempt when I was found unconscious from an overdose. The smartest and toughest woman I have ever known. Someone to build trenches with.
I liked it when she stuck that needle in me for an IV. It must correlate to being a heroin addict. The pushing of something in my vein correlates to happiness and purity.
The woman made out of paper was my nurse in the ward I was stuck in. What attracted her to the mess that is me I will never understand fully.
The woman made out of paper is named Lilu. She was one year older than me and one of my nurses at that ward in Taiyuan. She was from Zhengzhou—a city in the province of Henan that is based in the center of China. I am sure as the reader it would be nice to know why I call her the woman made of paper.
She struggled with her own demons. She also deserves much praise for her resilience and brains. When she was born she was raised by a family that adopted her and often neglected and abused her growing up. Her biological family is distant from her, even though she has an identical twin—they felt too poor to take care of her and made the choice that they needed to be less of one child as she also has an older sister—her twin got to stay with that family but she was given up and adopted. I am sure this must bother her even if she never will talk about it to anyone in her life—as she is one to refuse ever discussing emotions and feelings, as this is not her personality type—she is very much a fighter. I think most would struggle with wondering why they were the one let go of—it also must hurt her knowing that the family would have a son and keep him.
Despite all these circumstances, she graduated top of her class of four thousand students—Chinese high schools can be quite large serving a large region—they often serve as boarding schools. She was a smart and hardworking student. Circumstances never made her stop trying to be the best and moving forward and she never made excuses for herself. In university she also did well and got accepted at the most studious and hard to obtain nursing position at the number one hospital in Shanxi.
I have already ranted and gone on about my affection and feelings tied to heroin. Drinking of entire oceans to fill voids.
Paper is a void. It asks for calligraphy to be written on it to make braille. This way when fingers run over skin to tell its worth—the reason for its troubles on display—it forms connection through those words of declaration—the whining for why things are the way they are—the filling of a void like a heroin addict needing a cure to cure kicking legs—two papers come together to write upon one another—as a paper I am her typo—I stand as a falling mess with nerves like tripwire, I keep failing and losing my composer, while she stands stronger as a declaration that has been written on me, my very own typewriter—when I was chased I listened to her and joined as one. I wish and intend to always serve the woman made out of paper who has saved my life and has always been there for me, being so strong despite circumstances—amongst the wind of turmoil in life I follow along her path like a sail.
It was love at first sight for her but not for me. I had no interest in dating her at the time. I worked across the street of that hospital in an office building for a training center as a part time job. I would teach adults English who paid for private lessons near to Yingze park in the center of Taiyuan. She signed up for classes for me to teach her and brought me food on almost every other day that she had prepared. Eventually we found ourselves coupled fully.
As paper we write on each other—eat each other.

Small community hospitals are great for pay but suck in a lot of ways but this is dangerous and I'm not sure what to do
The ICU nosocomial infection numbers went up because the nurses don't care. Instead of retraining the directors (nursing and intensivists) decided that they would stop allowing anyone to order blood cultures in the icu including Infectious disease and the primary physicians (open ICU). We had no idea until our cultures were being canceled without documentation. They said it was a system policy (it's a large system even though we're a small community branch).
It turns out that it's not a system policy but rather just the department trying to hide numbers which puts our licenses and the patients health at risk. An ID doc and a nocturnist made a huge deal about it and we found out that even though we were told "safecares" go to the main system admin they actually don't at all and just go to the people who want to cover this all up.
Just venting but also curious wtf you can even do in a scenario like this

I stopped at the threshold of the door, other kids hopelessly trotting beside me. I peered into the facility. It was a range of nauseating shades of both neon and pastel colors that melded together like fire and ice. While I could see the general outlines of shapes like yellow circles, green squares, and vague silhouettes of toys and chairs, I couldn’t make out any fine details, or even really where everything was. Every time I blinked things looked slightly shifted. I turned to glean a look at the outside world one last time, before crossing the threshold and entering the daycare.
Immediately I knew that something was off. The air was different. It was dry, and thick and itchy. I immediately began to scratch at my throat as more tears pricked my eyes at the stinging atmosphere. The place smelled of sickening saccharine, like the inside of several cheap perfume and candle stores. It was so thick I could taste it and began to cover my nose to hide it from the stench. The whole thing was an assault on the senses.
The walls were almost all made of murky windows, none of which I could see out of effectively. The back wall, which presumably led to the massive dome, had a variety of neon and pastel shapes on a grassy field and blue sky. A large, ever-watchful sun lay at the top of the wall, functioning as a clock. The floor was made out of thick, green carpet. Just from the way I stepped on it, I could tell it would be uncomfortable to sit on. A variety of beanbags and toys were strewn about the room. I headed over to the far wall, where two long rows of multi-colored cubbies were located. One was slightly too high for me to reach, while the other was on the ground. Since I didn’t want my stuff to get stolen on the first day, I went to place it on the top row, standing on my tippy toes to reach it, but I was just barely tall enough to place the bag in the cubby. I ended up crawling down to reach the lower level of cubbies, placing the bag in the cubby taking a few of the surrounding toys, and hiding my pack behind them.
I turned around quickly at a long, groaning sound from behind me. The massive crimson doors began to close like the lid on a crypt. The two silver-haired women were shutting it from the outside.
“Children, form yourselves in a semi-circle at the center of the room,” another silver-haired lady said, standing in the center of the room. Kids from all corners obeyed. Some, the fresher-faced among us, moved with vigor you’d expect of four-year-old children. Others though, ambled over, aching under the burden of movement. They were hunched over, lowering their necks to the floor and scratching at them, creating the illusion of a raw collar of flesh like a leash on a dog. I scanned the sea of 60+ kids, looking for the red hair and verdant eyes that saved my life a moment ago. I found her, sitting at the farthest end of the arc, eyes trained on the floor. I sat down next to her, she didn’t seem to notice.
“Thanks” I whispered my gratitude. She curtly nodded her head but did not respond verbally.
“Children,” the woman began, her stiff tone matching her stance. Four more women had gathered around the speaker, all with wiry silver hair and sharp blue eyes.
“I will now outline the procedures and regulations of this fine facility. We have rules, and any attempt to undermine them will be met with swift retribution. Is that understood?” The children around me snapped from their trance to affirm with enthusiastic head nods. Even the girl beside me fervently nodded. I followed suit.
“Rule one, no one is to talk to anyone about what goes on inside this facility. Any attempt to do so will result in immediate punishment. You will all sign a document later today affirming this, a legally binding contract. Failure or refusal to sign this will result in severe punishment.” Everyone nodded.
“Rule two, everything you have here is a privilege and can be taken from you. This is the consequence of bad behavior.” Everyone nodded, as if on cue.
“Rule three, when asked a question about yourself, you will answer. Failure to do so will result in punishment. Because of the few who are misbehaving, unfortunately, all of you will have to feel the consequences. Normally, the schedule would include a designated playtime, naptime, and sugary snacks would be provided. However, those privileges are removed at the moment on account of some who refuse to cooperate. It doesn’t bother us, and you can make it stop at any time. All you need to do is get those of you who remain tight-lipped to answer our questions, and the discomfort you feel will fade away.” This time, the newer kids, including myself, started to doubt and question. The deal that they offered us seemed too good to be true, comfort for a few honest answers to stupid questions was an easy choice to make. Despite this though, a voice deep within me, experience, nagged at me not to place my faith in them. I couldn’t rationalize it, but I knew I was right in my hesitation to believe them. So often does the serpent lie in flowery bouquets of divine promises, and I was sick of being bit.
Other kids, though, wandered headfirst into the mouth of the snake, turning on each other quickly and sending venomous looks and words toward the many mute kids. I couldn’t bring myself to say anything and sat quietly, twiddling my thumbs.
The silver-haired women didn’t intervene, letting the anger boil and the bickering build to a point where fights were close to breaking out, kids borderline screaming for the silent to speak their peace, but to no avail. Finally, a thunderous, cutting shout snuffed out the fighting. It was a noise with no discernable source because it certainly wasn’t human. It was mechanical, like a plane flying fast and low to the ground. All the same, everyone turned to face the silver-haired woman, and she continued to talk. No one, aside from a few of the fresher-faced, questioned the noise.
“Rule 4, we will have a daily lesson lasting 30 to 45 minutes. These lessons have real, practical applications, and you all would do well to observe. At no point will we teach you false information, and any attempts to undermine the lesson should not be taken seriously, and will be met with punishment.” More nods.
“Rule 5, your comfort and healthcare are things we wish to understand. If at any point there is some intricacy you would like us to be made aware of, such as your favorite color or something that is making you uncomfortable, notify any one of us and it will be taken care of. That is all for now. We will start by playing a game that will let us all get to know you. We will ask questions. Make your choice, and choose wisely,” she finished.
“Now, the game is simple. We will ask one of you a question, and you will answer. Then, you will ask one of your peers the same question, until everyone has answered. Then we will begin the process again. If someone does not answer the question, they will need to place a mark on the star chart under your name,” she said. She pointed over to the wall, where a large colorful smiley face rested on the wall. There were five tiers. Stars dotted the lower four tiers, but none were in the fifth tier.
“Let’s start with you there,” she pointed straight at me, of course.
“What is your name?” The question brought me that familiar numbing, and I knew now that I needed to act fast before I was compelled to say my name. I looked over to the girl, who now had turned to me, and was subtly shaking her head.
My mind scrambled to think of a lie I could tell, reaching for my favorite tv show I had watched two nights back.
“A-Alvin,” I said, color returning to my face in the form of a scarlet blush. I pictured the colorful world of singing chipmunks in my mind, trying to distract myself from the woman's gaze.
“Alvin,” the woman repeated, eyes narrowing. I nodded.
“Very well, Alvin. Please ask a friend the same question, and then go place a star on the chart,”
I pointed to the kid in front of me, passing on the question to him. Then I got up, stepped over and around my peers, and went over to the chart. Next to it stood a cabinet with a glass bowl of golden star stickers.
“Write your name on the star, so we know it’s yours”, the woman called over. I turned to face her, greeted by her devilish gaze.
“I can’t,” I said. I didn’t know how to spell.
“I’ll show you then,” she said, rising to her feet. She quickly strode over towards me. She stood uncomfortably close, towering over me. Once again, she grabbed the spot on my arm now with an uncomfortable welt, and gripped it tightly. She placed a pencil in my hand and began puppeteering my arm to write the word. She started with a sloppy-looking c, followed by an a, l, v, I, and n.
“Now, Alvin, what does that spell?” She asked, her tone deathly serious, her molten stare melting my brain. I could hear my bones begin to creak under the strain of her grip as it tightened, but I didn’t register any pain.
“A-A-Alvin,” I said, stuttering.
“If you don’t tell me your name, young man, the shadows will come to life and eat you. Now, what is your name?” She asked again with growing annoyance.
“Shadows?” I asked, my eyes widening with fear. I could feel that the serpent’s tongue had caught my ear.
“Yes. Shadows, the monsters under your bed. They will come up to you, in your sleep, and they will rip and tear at your flesh, eating you piece by piece, chunk by chunk. Then, they will take your face and wear it as your own, and use it to kill your parents. You’ll be a murderer, even in death, and the devil himself will swallow what little of you is left whole,” she said. “Unless, you give us your name. Without your name, the shadows won’t know who you are, and they won’t be able to find you, and that is a promise” she finished. By this point, the whole of the kids had turned to look at me and the silver-haired woman. Their faces were pale, anemic, the same wide-eyed sickly fear that I’m sure was on my face.
Without missing a beat, the woman took the star with my name on it and placed it on the first tier of the chart.
I won’t bore you with the details of what happened for the rest of the day, because it was honestly pretty mundane. They had everyone learn a basic lesson about shapes and colors, offered some mild but inoffensive food that I didn’t eat at the behest of my polka-dot friend, and just let us do what we wanted for the rest of the day. It was a pretty normal experience. But it didn’t feel that way. Even in our free time, all the children were silent as a grave. No one talked or complained or even cried.
I had asked them about the air, why it was so itchy.
“It’s always like that buddy,” they had said. The closer the clock got to 4, the pick-up time, the closer I moved to the door. I was the first one out when they opened the doors from the outside, the two women outside still standing watch. I had never seen them come in.
But none of that mattered because now, my dad was here. I saw him standing there, nervously tapping his foot, arms crossed. An anxious look was on his face, but only for a moment, and when he saw me a smile returned to it. He ran to meet me and scooped me up into a hug.
“Hi buddy! How was your day?” he asked, a highness in his voice tipping off excitement, worry, and relief. I wanted to tell him everything, all of it, but words that were not my own came out instead. “Great! It was great!” I shouted. The words ‘Rule One’ flashed behind my eyes.
It was exactly what he wanted to hear.
“Oh, I’m so glad!” He said, nearly brought to tears. “I’m so glad you came around bud!”
I turned back to look at the daycare. All of the women, both in and out of the daycare, had their eyes on me.
In the daycare itself, I saw that many kids hadn’t moved at all. Instead, they watched, their eyes reflecting the light of the outside world. They looked hungry, starved of sunshine and fresh air. None of them moved though. Polka-dot girl was one of them. I saw her withered face snatching feverish glances at the world outside the daycare’s neon walls.
My dad followed my eyes into the daycare, then to the women in white.
“Shouldn’t they be leaving? Are that many parents usually late?” he asked.
“Many parents are not as attentive as you are,” she said, a comforting smile accompanying her words.
My father smiled, satisfaction sweeping away any concern he felt for the children in the daycare.
“I could never forget this one, he is the light of my life,". He gave me a gruff kiss, his stubble scratching at my cheek.
“It shows. He is a wonderful child,” the woman’s eyes shifted onto me, her smile taking on a more malicious tint as her eyes narrowed. My father didn’t seem to notice.
The car ride home is uncomfortably stuffed with questions contrasted by one-word answers. It was all I was capable of without breaking the rule. My father would occasionally peek his face out from behind the seat to check in on me with dewy eyes and a reassuring smile, but I could tell he lacked an understanding of my predicament. His senses were clogged with saccharin optimism, and I don’t blame him in any way. What was happening sounded like something out of a movie, some online conspiracy thread, or political vendetta against the government raising your kid.
The sun started to set, fought off by the rising moon which blanketed the sky in streaking orange banners of conflict. The trees darkened, and the refreshing shade they once offered now turned to foreboding darkness. A thin shroud of mist blanketed the ground. I curled into myself, seeking a reprieve from the woman’s words. Shadows cast by everyday normalities metamorphosed into devils right before the frightened eye of my mind. Even the car’s interior felt vulnerable to the supernatural forces I had matched myself against. Certainly, my father couldn’t protect me. He had failed me before, and the built-in security one should feel around a parent had eroded away from the past year of deceitful assurances.
As crazy as it sounds, the only place I knew I could count on was the daycare. The ones who confirmed the insane, childish notions of monsters in the darkness, seemed prophets of deific wisdom, warning unknowing mortals of their serendipitous ignorance.
After what felt like hours, we arrived back at our home. Dad climbed out of the car, grabbing his and my things, and hoisted me out of the carseat, before setting me on the ground. I looked up at the large house we lived in, taking in it’s features for seemingly the first time. It had a triangular shape, with a pointed roof. Ivy coiled the sides like the side of a castle, and the deep gray paint that once shown proudly was now lost it’s luster, marked by faded streaks. Large black windows reflected the gold of dusk like pools of sunlight. The house cast a long misshapen shadow across the lawn, the tip reaching the end of our driveway.
“C’mon bud, let’s get inside,” he said, striding off towards the stairs. I did my best to follow behind him, but I was neither agile nor graceful in the dim light of dusk, and quickly fell behind. It didn’t help that every few steps I stopped to check behind me.
My father began to whistle, absent-mindedly picking up the tune the birds around us carried. He climbed the cement stairs two at a time, stopping at the large mahogany door to find his keys. I hurried across the driveway and made my way up the path, reaching the first of the stairs. Gripping onto the iron railing I hoisted myself up, fighting to keep the dizzying thought of heights at bay. I repeated the process, each time glancing over my shoulder. I was on the third stair when I heard the pop of the lock, the jingle of keys and the squeaky hinge of the door opening. I looked up the stairs to see my father stepping in the house, taking off his shoes, before he turned, and started to close the door.
“Wait!” I gasped, picking up the pace as I practically threw myself up the fourth stair, abandoning the railing and going on all fours like a ragged animal.
“Oh, Cal I’m sorry, I… I don’t know what happened there, Imust have thought you were inside already,” Dad said, swinging the door open. He stepped out onto the porch and down the stairs, grabbing me up and over his shoulder. I was panting, my breath lost to the stairs. I looked on over the dewy fields of grass constituting the lawns of our neighbors, hoping to find the source of the tune that was still playing. I almost screamed when I found it. Singing a monotone, harsh tune stood a woman in white on the sidewalk parallel to ours across the street. It was the same whistle my father had, like a bird. No, like someone trying to sound like a bird. High pitched and erratic, but with the cadence of a human. She had her eyes on me, on our house, her lips twisted into a toothy grin. She made no sound, but I could hear her. I began to aggressively scratch my throat. We made it into the house, where my father set me down, and began to close the door.
“Look!” I said, peeking my head out through the windows bordering the door.
“What bud?” Dad asked, opening the door and following my gaze.
The fog had intensified, a misty maelstrom swirling around the street, swallowing the woman.
“I’ve never seen fog move like that either bud,” he said, closing and locking the door. Even in the fog, I could still see her silhouette, her whistle running through my ears like a sharp wind.
I ran through the house, frantically searching for my Pointer. I had left it in the living room underneath the beige upholstered couch. It was a blue metal rod with a cartoonish gloved hand that pointed upwards. Because I was so short, it was the only way I could reach the light switches. Starting in the living room, and working my way through the house, I turned on all the lights in the house on the base floor. I didn’t have the nerve to head upstairs alone. The haunting tune of the woman still rang in my ears, only it had gotten louder and more intense. I realized that it wasn’t my imagination, my father was still singing that tune. He stood stiff in the kitchen, chopping something foul-smelling, probably some kind of disgusting vegetable. His eyes looked unfocused like TV static.
“Please stop,” I said from the other room.
“Stop what?” he asked. I attempted to whistle, but instead blew air and saliva with a funny face.
“Whistling?” he asked, amused. I nodded my head.
“Why?” he asked again.
“It hurts my ears,” I said.
“It does? Are you okay bud? You haven’t looked right since yesterday. Are you sick?” He set the knife down on the counter, and moved towards me quickly, bending down and taking my face in his hands. A sharp clarity returned to his eyes, combing my features for any indication of illness or distress. He moved down, placing his ear to my chest, listening for any indication of labored breathing.
“I’m fine,” I said. “I just don’t like the whistlering”.
“Whistling,” he corrected, lifting his head to once again look at me, searching for answers.
“You would tell me if something was wrong, right?” he asked, his gruff voice softening.
“Yeah,” I said, looking away. All I could do was lie. He closed his hand into a fist before extending his pinkie.
“Pinkie promise?” he asked. I nodded, holding out my pinkie.
“Alright,” he said, intertwining my pinkie with his.
“Let’s get you settled in okay? We are having macaroni and brussels sprouts.”
Ugh, brussels sprouts. I hated them, the smell and the taste. He hadn’t made them since I had thrown up all over the table after eating a few.
I followed him over to the high chair in the kitchen. It looked like something you would see in a rundown war base in Vietnam, splattered in food and heavily mangled. I was a picky eater, to say the least, and it was only made worse by ignorant, stubborn nannies playing the old “here comes the airplane” gambit. My dad hadn’t had time to replace it yet. He took me under the arms and lifted me into that beat-up old thing. I struggled to get comfortable, the feathered cushion worn down from many battles that had taken place in the chair. It didn’t help that it was far too small for me, I had outgrown it a few months ago and could sit at the regular chairs. He missed a lot of things while at work, and I think knowing that would only make him feel worse, so I went along with it.
My dad went to the rough granite counter and picked through the cabinets, gathering two plates, a plastic bowl, silver forks and spoons, and napkins. He set them down, unfolding and scrunching a napkin into a makeshift bib and tucking it into my shirt. He set down the porcelain plate and pink plastic bowl, before serving the macaroni onto the plate, and scooped the rancid sprouts into the bowl.
I grimaced at the sight of them, my mouth dry at the putrid smell, so strong I could taste it.
My father sat at the opposite end of the table.
“Now I know you aren’t the biggest fan, but we all have to try things we don’t like. And who knows, maybe you’ll come to love brussel sprouts,” he said. It was such a dad thing to say.
The meal carried on, mostly in silence, I avoided the sprouts like an awkward topic of conversation. My father took note of this of course.
“Bud, you haven’t touched your brussel sprouts,” he said, blowing air through his nose. Heavy breathing was always a sign that his frustration was rising. He must have had a long day at work.
I groaned, unable to stop myself from voicing my repugnance. I could tell he wasn’t having it, so with a heavy hand, I speared a sprout on my fork and tentatively took a bite. It took every bit of me not to gag immediately and spit out the rotten thing. It took even more to chew it, slippery and charred, before forcing it down my throat. I looked back at my father, whose face wore a look of charmed satisfaction, like a kid who burnt the feelers of an ant. He was looking at me, but it was like it wasn’t him who was seeing me. He started tapping his silverware on the white tablecloth, muffling the impact of metal on wood, but not enough to keep the melody he crudely played from reaching my ears. It was the whistle of the woman in white.
The lingering taste from the sprout intensified, going for my throat like a hand. It was pungent, itchy, so itchy. I began to claw at my neck once again, the familiar action bringing me back to that daycare with the air that seared my flesh with a molten prickling, like firecrackers stuffed beneath my skin now going off. I began to cough, choking on the taste and smell. I slammed my heels into the chair, my free arm banging furiously against the table, driving it down with such force that the porcelain shattered beneath my hand, leaving cuts in my flesh. My head flew back on its own, hacking and croaking and wheezing with so much force that the chair followed its lead and tipped with me. I hit the ground, hard, blurriness lidding my eyes. The back of my head throbbed with sharp pain. I reached back and felt my hand grazing flesh, the hot stickiness of blood now coating my fingers. My hair was coated in it too, I must have hit the ground much harder than I thought.
“Calvin??!? Calvin!!!” My father rushed to me, jaw agape at the gruesome scene. He fumbled with his pocket as he ran to the kitchen, snatching a roll of paper towels with one hand as he dialed 911 in the other.
“Hello?! My son fell… he hit his head, and his throat? He’s bleeding, and I think he might be having a seizure!” he continued on. “Calvin stop it!” He yelled, trying to wrestle my hand off of my throat. It moved with strength and will that wasn’t my own. He grabbed my forearm, wrenching at it. As soon as his skin touched mine, an explosive pain blazed through my entire body. I felt in that instance what I imagine a nail feels when struck by a hammer, like lightning ruptured through me. An ear-splitting scream erupted out of me, my arm now swelling with purple welts the size of grapefruits. They expanded and contracted, pulsing hypnotically. I heard my bones not just break, but splinter under a force no human could muster.
I can’t recall much of it after that. All I remember was the buzzing neon lights of the ambulance, the wispy voices of horrified nurses, and my father shakily telling the police that he had no idea what had happened.

My sister, who was a nurse, died of Covid at the age of 44 two years ago. The NHS are now claiming her pension is their pension and there is no payment owed to her family. 15 years worth of pension contributions gone and there is no death in service payment.
Given her age, my sister wasn’t expected to die of Covid when she was admitted. When it was looking grim a knowledgeable colleague rushed to her bedside for her to sign a Aw33e form so a death in service payment could be made to her surviving family.
Sadly my sister had just died when she arrived at her bedside. It is the absence of this form that the NHS is using to effectively take her pension for themselves. They say even if she had been alive to sign the form it wouldn’t have mattered because they needed to have received it and approved it before it was valid.
Does anyone know of a circumstance where the NHS has waived the need for aW33e form for a death in service payment to be made to surviving family members? Or an existing exemption in the regulations which an existing exemption in the regulations which removes the requirement for this forms?
This really isn’t about money. It is about the principal. My sister was working very few hours the last two years of her career due to her disabilities and as everyone knows the death and service payment is calculated on an average of the last two years so even if my sister had filled out the form before she died, the payment to her family would be minimal. I just find it outrageous and callous that when the NHS makes a decision towards its own staff it always seems to chose a miserly and callous option.
My sister was a respiratory nurse who was retiring on ill health grounds. She had served for 17 years. She had to fill out a 28 page form to progress her ill health retirement despite the reason for retirement being arthritic hands which made handwriting very difficult.
The NHS are pushing us to agreed with their proposal, but whenever we go to sign the form we physically can’t do it because it seems so unfair to my sister. She was paid so little only then for her pension to be confiscated and no payment to her family due to the absence of a form not filled in partly due to us being in a pandemic.
If the process takes longer than two years, which it has , the government also charge 40% tax on any payment they give to us. Not sure why that rule exists.
I would encourage every nurse, every member of the NHS who is retiring due to ill health to sign the AW33A form. just in case and avoid your pension being confiscated.
My post is to ask if anyone has been told by their health authority that the AW33A form is not needed or has been waived. This would mean we could go back to our health board and challenge them on this point
Ps. My sister thought she religiously paid for her RCN membership. She always took it seriously and Wood say how important it was however it seems there was a problem with the direct debit and she had stopped paying two years before her death so we haven’t had access to their services.
OPTIONS PROVE WHY WE NEED AN EXAMPLE
This is what we are advised.
The AW33E form is crucial in the NHS pension scheme, specifically for ensuring that benefits are correctly allocated upon the death of a member. This form designates the beneficiaries who will receive death in service payments. Typically, the NHS requires this form to be filled in to process such payments efficiently and correctly.

Regulatory Framework and Exemptions

Under normal circumstances, the completion of the AW33E form is a requirement as per NHS Pensions regulations. The NHS Business Services Authority (NHSBSA) outlines that this form ensures the accurate distribution of benefits. However, there are certain conditions under which exemptions or alternative processes might apply:

1. Default Beneficiary Rules: If an AW33E form is not filled, the NHS pension scheme has a default beneficiary hierarchy. This generally follows the legal next of kin structure, which can be used to distribute benefits in the absence of the AW33E form. These rules are based on statutory provisions and ensure that benefits can still be distributed, albeit not necessarily according to the deceased's specific wishes.
   
2. Discretionary Powers: The NHS pension scheme administrators have some discretionary powers. In cases where the form was not filled due to exceptional circumstances, administrators can use their discretion to allocate benefits. This, however, is often considered on a case-by-case basis and typically requires supporting documentation to justify the absence of the AW33E form.
   

Justifying the Lack of a Form

There can be various justifications for not having a completed AW33E form, which might include:

1. Administrative Errors: If the form was not filled out due to an administrative oversight by the NHS, it might be possible to appeal to the pension administrators for discretionary consideration.
   
2. Unforeseen Circumstances: Sudden death or severe illness that prevented the member from completing the form might be considered a valid reason. Documentation from medical professionals can support such cases.
   
3. Pandemic-related Disruptions: The COVID-19 pandemic created unprecedented disruptions. If the form was not filled out due to pandemic-related reasons, such as the inability to access necessary documents or administrative offices being closed, these might be used to justify the absence. Evidence showing attempts to complete the form or pandemic-related restrictions could support this argument.
   

Pandemic Clauses

While there is no specific clause within the NHS pension regulations that directly addresses the pandemic, the extraordinary nature of the pandemic has led to increased flexibility in various administrative processes across the public sector. The NHS and other public bodies have recognised the need for adaptability during these times. It may be beneficial to highlight any pandemic-related issues, such as lockdowns or health complications, that prevented the completion of the AW33E form when seeking discretionary consideration.

Conclusion

While the AW33E form is generally required for death in service payments, there are mechanisms within the NHS pension scheme regulations that can allow for benefits to be distributed without it. These include default beneficiary rules and the discretionary powers of pension administrators. Justifying the absence of the form can involve demonstrating administrative errors, unforeseen circumstances, or disruptions caused by the COVID-19 pandemic. For specific advice and to pursue any of these avenues, contacting the NHS Pensions is essential to discuss the individual case and provide the necessary supporting documentation. …..
We are going to try these approaches again, but that is what we’ve been doing for the last two years and it got us nowhere. An actual example of an exemption being made would be so powerful for

https://m.youtube.com/watch?si=br41hnj6yAi_v-tv&v=4Y93-Ze3mvA&feature=youtu.be
time line added to my comments to show were I am at in the recording.
start /
00:11NDIS has pace datat they could if they wanted to release it - they implied it was because it needed to be pulled quarterly.
1:05-the timelines and PSG is unrelated to personal circumstances - it's related to legislation
1:43-Currently NDIS are not working within PSG timelines they are consistently missing them.
1:55 This recording was two months ago, and I haven't seen a quarterly data report for March from the NDIS - brb will look for that.
2:14 NDIS could release data about how long it takes between the access request, decision, and plan stage - but they appear fo have declined to provide this.
3:00 PSG legislation timelines could have been pulled one week in to pace rolling out. They could have shown did we meet them for all participants we supported that week. Yes / no. If they can't and I seriously question that because fit for purpose here is at risk.
3:45 Senator Called out NDIS for not operating under the PSG and NDIS did not respond. It was summarised beautifully critical wait times and the NDIS can't say what their response is because they don't want to show data.
4.14 - A bit of a flaw in your whole job of rolling out PACE - you had one job call out would have made me laugh if it was not so tragically terrible.
5.03 - There are access requests that get made to NCC that do not go to LACs and go to planners and the profile of the plan is the same regardless of if it's a access met or access not met plan.
5:48 It has always been possible to send a access request and not so the profile till the planning stage when allocated a planning delegate - however there has been times when there is push back from NDIS when the profile is not done which cause further delay in making a decision.
6:10 a example of a connction plan. I'm not going to comment as I have done so a bit further down. If they are a participant then thhave met access. If they haven't met access they are a person with a disability with a community connections plan.
To date I have not seen any discussion on NDIS website to say training has occured. I have seen pace sessions badly offered, hidden withinthe pages of NDIS for providers.
what's not clear is when the NCC get contacted and eventually action this by sending it to a LAC period is not counted and there is no data possible to pull because I don't think they thought of that when they decided to ask LACs to do access. which is misleading at best. the date that a person enquire should be the date the clock starts ticking.
To date NDIS has not made it clear on their own improved website that if the option to decline a connects plan (it used to say if you want one) what the alternative is when you meet with a planner and need to add the person profile. I'm not sure NDIS is being transparnt in this meeting.
9:38 of that panel the first speaker was thrown under a bus the third speaker Penelope McKay whoes role it is to managing the community connections decision and could only read of what was said in front of them in such flat tone that they had to be asked to repeat themselves - the information is not wrong but I would have thought they would be the subject matter expert and be more fluid in their knowledge which when a sentence starts with "as I understand it" mans this person has never used the system.
It's really concerning that Penelope thinks a button has to be pressed to get to another page when answering the question about the CCP and both answers to yes or no gets to the next page . What kind of design is that !!!! Penelope did confirmed it will progress either way and doesn't prevent an access template progressing ahead. The access request template is not connected to the community connections template and both are filled in separately and can be finished interchangeablely of each other.
If this is Penelope's job then I am quite disappointed with her efforts because the senator was correct it's a very disappointing document to be given in regards to CCP and I have seen some truely terrible ones completeed by PITC and NDIS delegates.
13:00 -13:13 I could see the frustration towards the end about yoga and meditation for being tried when having a diagnosis. The head shake was telling but the NDIS CEO was smiling like this was amusing to them.
it's not the LAC's role to prescribe treatments. There are people with a disability who will ask for floatation tank sessions and yoga and other things to be funded and it's also not the role of mainstream.
There are community services such as community health, neighbourhood house and hubs that run yoga sessions for people. This information is then provided - not because of a disability diagnosis but because the person has a goal that is a daily living cost that can be provided in the community.
LAC or any delegate is recommening this randomly out of context to what the person is asking for in relation to their needs and goals - then this is operating out of their scope of practice and should be called out. Oversight regarding this poor practice is not a built in factor in pace.
I agree it's really poor service but it's not like Centrelink or Medicare are any better at delivering public services and given what's been happening within the government recently it doesn't sound like best practices are held higher and people made accountable there either.
13.45 peope think because they have already sent their access request to NCC that the application is being considered. It's not. That practice has changed. It can take a NCC 4-8 weeks to transfer that request to a PITC and there is no ticking clock taken into account with PSG.
16:45 a person has given information which was added to the profile in a "crap" way. This can be changed and amended at any time. The profile has always been on plans end of period. THE same profile is used on community connections plans WHICH turn into plans with funding IF access is met.
17:00 So it's disappointing that the panel hoped that the person wasn't doing yoga rather than hoping the PITC and NDIS wasn't prescribing it.
It's disappointing that the senator interrupted the primary panel speaker as time had run out and he was so close to getting to the clux of the matter but the momentum was lost and not all panel members got to speak.
Also by the senator and at the 19:00 mark he speaks about NDIS delegates
https://www.summerfoundation.org.au/planned-changes-to-the-ndis-unpacked-with-senator-steele-john/
The quarterly NDIS data for March 2024.
https://www.ndis.gov.au/about-us/publications/quarterly-reports
Sadly the data did not answer the Senators question ! If anyone sees the senator bring NDIS to question again please share the recording here.
It will be end of June/July I guess before the next data is provided.
Another really important point I want to make is PITC are unable to creat ACESS DECISON cases this isa function only NDIS delegates can do. So why is NDIS not showing the data for the length of time it takes for a request to become known, an access request made? At best the data isa fudge but I actually think it breaks the legislation rules because back when the NCC did access requests the milestone was on the day the phone call or email was done to NDIS.