I am both a provider and a consumer in the world of healthcare. This story starts with being laid off and ends with me finding a new job. It’s a story with actors spanning all generations and illustrates how we are all in this together. Spoiler alert: it ends with me trying not to tear up as a member of the newest generation to enter the workforce prepared my lunch.
Late one Thursday afternoon in June I received an email: “please clear your schedule and come meet me tomorrow morning.” Some combination of new ownership restructuring and pre-positioning for next year’s insurance changes had led to a Baby Boomer and a Gen Xer sitting across from me and asking for my equipment and signature. Another person that I reported to (Xennial), remarked that I took it much better than someone else. I was thinking of it like a paid vacation. I have no way of knowing for sure, but I believe that one of the reasons I was chosen was because this Gen Xer met the company guidelines for severance and my younger cohorts did not.
Home health is an incredibly rewarding field that has benefits, like flexibility, not found in other care settings. However, it does seep into every corner of your life because there is more paperwork, and clinicians need to call each patient to set schedules and to check on status. Patients that require home health tend to have more acute issues. Increased contact frequency of patient, care team, and physician is needed to properly support these individuals. Just to compare EMS contacts in settings that I have worked: sports coverage over 4 years – twice because EMS was staged on scene and two additional athletes being driven to ERs by friends/family; outpatient clinics over 14 years – none with 3 being sent straight to their PCP and one did end up hospitalized; home health 5 years – at least 10 (3x for caregivers) with 8 resulting hospitalizations and a few more ambulances would have been called just by protocol alone if I had been unable to reach a nurse or doctor.
Side Note: Take care of your blood pressure, immediately report adverse medication reactions, do not miss PT/INR checks if you take Warfarin, if you are a caregiver remember to take care of yourself, report immediately if you have increased edema, weight, and difficulty breathing
I quite enjoyed my severance. I had time to develop my art and to complete inventions that I had been thinking about. I did feel this need or responsibility to make it productive. How many people wish, dream, and pray for a chance to take time off with pay? I felt pressure not to waste it. Back to the health system bit….
COBRA insurance was too expensive so I searched the ACA Marketplace. Ouch. I ended up with a short term plan that saved hundreds of dollars a month. These plans pack a year’s worth of deductible into six months and make you promise that you don’t have a long list of ailments, including an oven bun. Good thing insurance companies do not recognize Lyme Disease as something that can have lasting effects. [I think it just paid for my flu shot and PPD test, fingers crossed.]
Getting ahead of myself here. Back to the time line.
As the beautiful severance vacation started to wind down, I began to be less casual about skimming Indeed job listings. There were not as many postings as I had thought there would be, but enough. I applied to one position that looked really interesting. The phone and in-person interviews went well but was not quite what they were looking for at that time. They asked if they could call me in a few months because they anticipated that I would be a good fit down the road. I applied several other places with a couple of interviews that went well, but for several reasons, on both sides, things did not work out. About this time is when some skilled nursing facilities (SNFs) laid off clinicians. Job postings started to look a lot leaner and have more competition. Applying to SNFs became useless as there were enough people in the market with exact match experience to fill what few jobs were available. Home health companies were not really hiring, and good outpatient settings have always been competitive.
I’m sure every industry has shady companies and healthcare is no exception. I am not referring to the idea that everyone has to be ready to defend any decision that results in less billing than what e-suite thinks each patient should average. These companies may have found insurance loop holes or know how to do just enough legit stuff to make them look like good companies. I have run into these type companies over the years and avoid applying to them. I learned my lesson when a company was mishandling information (HIPPA violations). I expressed my concern and they told me I was wrong. I quit soon after and received my W-2 in an inappropriate way. I may have reported them if they had not gone out of business. That company was also really good at shifting risk to it’s workers. Some companies set up their business model so that their employees or contractors have to absorb risk. Examples: the clinician needs to provide most/all equipment including tablet with phone service, the patient cancels after the clinician spends time prepping their chart, talking to them on the phone, and driving to their home and gets paid nothing.
After a few months of looking around for a job, the company that said they would call me in a couple of months actually called. I now have a job and need to do all the things that are required to work in most healthcare settings. My fingerprints were still in the system and I was able to answer all of the security questions without needing to research or request documents. With the background check in full swing, I needed to get my PPD (tuberculosis) check and decided to get my first flu shot. I knew that I would be able to isolate myself relatively well for the next couple of weeks. To be clear, the flu shot will not make you sick. My immune system is a little weird. I worried that the couple weeks it takes for my immune system to respond to the shot might be risky when working with patients. Well, its other clinicians and office staff showing up to work with viruses that has always made me the most nervous. During cold and flu season, I used to show up in a mask because there always seemed to be at least one person in the room that should have stayed in bed.
I chose to go to a local pharmacy’s care clinic. It amazed me that that it was completely booked the first day I went and by the time of my appointment the next day, it was booked as well. I was a little sad that people were not seeing their PCP but then remembered that mine is no longer seeing patients and the doctor office I had transferred from was no longer seeing anyone under 65. I could not get price or coverage information from my insurance. Local urgent care locations did not have prices listed online but the pharmacies did. I have not been charged anything yet as it will be sent to insurance first.
I arrived to have the PPD test read (>48hrs after application) and had a nice discussion about how great their electronic health records were because each visit could be completed while the patient was there. No after hours paperwork! The clinician gave me the flu shot after explaining everything and even showed me the box.
The services I needed were recognized as new job stuff and we started talking about layoffs. The Millennial had a friend that had been laid off from a SNF. After seeing how busy this clinic was over the past few days, it shocked me when they said that they were also laid off and the clinic was closing. (This information only came up as a part of care planning as they knew I was still looking at jobs and PPD test is only good for six months). But its always busy and such a service to the community! Well, if it’s not making money….but what about all the people that buy things because they are there for a visit? It just all seemed so sad.
Subway felt like the least unhealthy convenient choice for eating my feelings after the visit. There were people there, but it was not busy. The Gen Zer behind the counter had such an easy smile and pleasant way. Nothing unusual or extraordinary happened. Maybe that is why I started to get a little emotional. The big picture of another generation heading into the pile of bullsht. Maybe it will start to get a little better. I just know I’m tired of it getting worse.
-Additional note: Just signed up for insurance through the marketplace. It is an easy system to use but the base price of plans has gone up quite a bit. There are plenty of reasons for this. It is worthy of a book, not just a paragraph at the end of a long post.