Archive for the ‘advocacy’ Category
Simplicity
Today I sat next to a sick man. He told me about the tomatoes he grew this summer. Tomatoes so big and sweet, juice dripping down… he had devised a cage to keep the squirrels away, and it worked. His partner chatted with a nurse about working, as a girl, on a farm, the meticulous methods that the older girls used because they were paid by the quantity of work they produced.. the fun, the hard, hard work. They both spoke of their home, the expense of having someone help him there, still cheaper by far than the nursing home, but not so insurable.
Most people do not ask me to help them find the best or the fanciest things. They want the simple things, really, the things that easily fold into their life as they have come to enjoy it. Staying up late, morning crossword puzzle, and coffee. The TV turned on just for the noise, or not. The birds outside the window, feeder filled. An open window. Grass. Beloved pets at our feet, on the bed, spoiled rotten.
A long time ago, I had been talking to a woman at her home, and called to check in. Her husband told me that she had been in the hospital, and was now at a nursing home nearby for short-term rehabilitation.
I went to see her. On the bed of the room she was staying in, I saw only a suitcase and a cane, but not the woman. I looked, but the room was dark, too. Walking back to the nurse’s station, I saw her small figure walking slowly down the hall. She grabbed my arm, and walked with me to the room, and shut the door.
“Julie,” she said, “I just went upstairs! I just told the nurses that I am going home!”
She had just been exploring, as she was keen to do, and had found the long-term portion of the facility–and talked to people who said they had been there for more than a year. She said she did not want to become one of them.
A few weeks later, I called her again. She told me that she had had a wonderful Sunday recently, cooking and laughing with her husband. She said that in all, she spent many days in bed, sometimes had a hard time. She had help, just about enough of it.
And for those Sundays, the scent of her native dishes, the sun streaming into the windows, plates on a table, being home mattered more than anything. Simple pleasures.
Wishin’ and Hopin’
and thinking and praying…
Though it’s early in the year, we seem off to a tough start. The obituaries (yes, I read them) are a mile long, daily, and the hospitals have been swamped. The calls are more urgent, despite the increased awareness I have noticed about programs that used to be “the great secret” or otherwise underutilized.
The damning thing about knowing all the options is that it makes the situations with no options all the more visible. It gets harder and harder to be the bearer of bad news, but it is so often the situation we face now. I mentioned a few of these groups in my last post, but they keep returning, constantly, similar situations, different stories. It seems obvious that change is needed, but it cannot come fast enough.
It seems so obvious that we need houses we can access, neighborhoods, transportation, and help. And yet, as we see solutions so easily adaptable at times, it seems far from everyday thinking. Stairs? No problem. More highways instead of public transportation? No problem. It seems as obvious as global warming–we are burning, like Rome. Yeah, I know. It sounds like fool talk.
Perhaps it is the thought of winter, here with us for a few more month, but I do not want to wait, to watch more people in despair. I want to skip to the part where we feel productive, where the change seems to be around us, people talking. The number of people who are truly in trouble, suffering, seems to be growing. The danger is that we are not prepared. The advantage is that it will be impossible as the numbers grow for this problem to remain invisible, ignored.
Resolutions
I resolve. I solve. I wish I could solve the difficulties I see in the lives everywhere.
In particular, I am thinking this eve of 2013 of the many, many people who by some stroke of bad luck are seen as “less worthy” of entitlements, like life.
I am thinking of the non-elder community. Not to discount the very real needs of people over 60, but after four years and 275 visits to consumers, I have to say: age really is just a number. I am saddened enormously that on a policy level, we still remain separate, we aging and disability folks. In many respects, I think our communities are farther apart than ever right now.
I have thought about this over and over as I have worked in my own mind without these sorts of biases. In spite of my efforts to look at people as people first, and categories second, I remain frustrated by the “eligibility” requirements of programs that help people.
A few words of advice:
Do not acquire any other chronic, progressive disease that hits in your 40s or 50s. It will derail your entire life and leave you bankrupt just when your teenage kids and middle-aged spouse need you to be in prime earning power. If you have to get sick like this, wait until you are 60 and can get help more easily.
If you have to have a developmental disability, do your family a favor and score low on your IQ test. Please. Otherwise, you will not qualify for the help you need, and will either exhaust your family or be left to figure out a sometimes cruel and confusing world on your own.
Do not have a mental illness. Just don’t. There is a reason that people who recover from mental illness call themselves survivors, and it has more to do with the “treatment” system than it does with the illness itself.
I know this all sounds quite cynical, and sadly enough, I could go on and on. It is difficult not to be pessimistic as we approach the many changes happening in the disability world right now. Over and over, we see younger people with disabilities all the more marginalized–and perhaps more tragically, fooled into thinking that they are truly included in the unified effort to streamline services and health care. I believed in these efforts, once, and want to think that understanding will still come.
But I see much more often that money changes hands behind closed doors, that those who do not understand the very human right of self-determination are left with the funds to reward those who are compliant, those who do not question, those who play nice…
I resolve to cause more trouble, to question more, to speak up, again. And again.
I resolve to tell these stories, to love more, to convince you to love more, too.
Tragedy
We are all shaken by the tragedy in Newtown, Connecticut. It is unfathomable to most people that anyone in a peaceful society could walk into a school–an elementary school, no less–and start killing.
But are we such a peaceful society? I am troubled enormously as I read the comments on any online news site, for nearly any story, anonymous opinions that I always suspect reveal the true opinions of their writers. Blame: a mental illness is to blame, a divorce is to blame, a gun is to blame. Truth: tragedy from many aspects, resulting in the loss of so many innocent lives. Tragedy to be the family of any of the victims, including the shooter himself.
Liza Long wrote her own response to the shootings in the Blue Review. It is a brave account of what it is to be the mother of a child with mental illness. It is a brave piece, or perhaps a foolish one, as Long will no doubt know years from now, as her son grows, as her name (and his) continue to be attached to the article she wrote.
To allow oneself to be identified as a parent of a child with a mental illness requires a certain faith in the world: faith that others will be understanding and accepting, that they believe in recovery and in the safety that will remain in the community even when people with mental illnesses live within it. Even when we know that they live within it. Events like the shooting in Newtown, Connecticut, only reinforce the notion that we indeed are not safe. The question is why.
The truth is that even within medical communities, mental illness is treated differently, stigmatized, separated. It is not unusual in the hospitals I visit that the staff from the main hospital do not even know the staff from the locked psychiatric units that are beneath the same roof.
Mental illness attracts our attention, and our fear.
Our fear stands in the way of reaching out, too often. We resent the effort it takes to understand, much less to accept.
Our fear leads to cruelty, I fear–the sort of cruelty that then creates even more barriers to treatment. If treatment is hell, after all, a person is best off staying clear of it…
I do not know why Adam Lanza chose to kill 26 innocent people, 20 children. I shudder to imagine the mind that envisions such horror and enacts it. Maybe I never want to understand. I can imagine that understanding was needed perhaps years ago.
I do know about the many families that live in constant fear that a loved one will finally break down completely, that the Psychiatric Emergency Services were wrong when they determined that the loved one is not a threat to him/herself or others, that the 72-hour stay is over, that the family will soon become victims, that the said loved one will wrap a car around a tree or jump off a bridge or become a heroin addict or steal or harm or God forbid kill someone. I do know about the families that I see too often, families who watch as the chaos takes over while the violins play in the background, families who believe they are a guardianship away from effective treatment.. sometimes. Assuming there actually is effective treatment.
I wish I could point to the advances that come to mind: the Rosie D. case in Massachusetts, which resulted in the creation of the Children’s Behavioral Health Initiative. To mental health parity. To increased awareness in general.
But sadly, from my weary place here in Massachusetts, I see still more restrictions, everywhere: CBHI only for MassHealth consumers. Mental health providers woefully low in numbers, and for those direct staff, so often underpaid, so often inexperienced if initially enthusiastic, so often burned out. Inefficient procedures for hospitalization. Near-impossible eligibility for DMH services. Some great champions in mental health, yessir. But too few. And too much harm already done to erase the fear of those with mental illnesses who have sought treatment, and found instead a prison, real or under the guise of healthcare.
I have not even mentioned the weapons. Oh dear God, those weapons. Why? Who needs assault machinery in a suburban neighborhood? Who needs to arm an army from the basement of a home? Why do we make it so easy to buy something that has no other use at all but to kill?
Like most people, I imagine, I felt sick at the thought of the parents, their nightmare. I wish I had answers, quick solutions, a magic wand. But where would I even point it? I know that we cannot build the supports necessary to prevent these sorts of tragedies without a great deal of work–early work, before things happen (call it prevention)–belief, training, money. And will.
I hope we will. I hope we can.
A la recherche…
“Longtemps, je me suis couchée de bonne heure.” But not so much now, except at the end of a week like last week, which, like Proust, seemed to go on without respite, but with some satisfaction I hope in the end.
(The sentence is not mine, but Proust’s, not translated, because the translation gets too complicated. But here goes: “For a long time I went to bed early,” sort of, but it is also the first and only short sentence in the volumes that consumed so much of my younger years. Now, transplanted here into my blog, it is just the beginning of my next rant.)
Satisfaction, I admit, is a stretch, light of the season seeming to go out at just the wrong time as a few fear-mongering Senators came up with excuses around home schooling and parents’ rights and what-not to knock down ratification of the UN Convention on the Rights of Persons With Disabilities. Reading Santorum’s explanation in the Daily Beast, I find myself frustrated that he and the likes of Sarah Palin assume that they get disability and “special needs” children because they are parents. They have been there. And they have. Well. Kind of.
Truth is, I might agree that a parent is best equipped to make decisions about his/her own child, disabled or not. But I am quite sure that Santorum has never had to feel intimidated at an IEP meeting, or has ever had to fight too hard for accommodations, much less for ways to pay for the long list of services that his child might need. His claims that “international bureaucrats” would determine what is in the “best interests” for a child only reminds me of the countless IEP meetings that I personally have attended, for my own children and with other parents. So often have we gone in first wishing for what is “best” and learned that we can ask for what is “appropriate”.
Just to note, reading on in Santorum’s statement, I wonder if he really has any idea what he is talking about when I see things like this:
“How would this new standard play out in a battle between a single mom fighting a stubborn school district for special-education services for her disabled child under the Individuals with Disabilities Education Act? That landmark legislation signed by President George H.W. Bush made it clear that parents—not government officials using a “best interests of the child” standard—are ultimately in charge of their child’s education.”
All right, the single mom, poor single mom fighting the school. Been there. Done that. But what landmark legislation does Santorum mean? IDEA was reauthorized in 2004, signed not by George H.W. Bush, but by his son, George W. Bush. As landmark legislation, it was the 1975 special education act signed by Gerald Ford (yes, renamed I admit from Education of the Handicapped Act (EHA) to Individuals with Disabilities Education Act (IDEA) in 1990 under George H.W.) that was the beginning, truly. Maybe Santorum is confusing this with the ADA, which indeed was the landmark disability legislation under George H. W. Bush..
But I digress noting these sorts of mindless details. In the end, I am ashamed that we could not pull this off. I am glad that so many strong supporters came together to support ratification of CRPD, to promote disability rights worldwide, to support this human rights issue–but sad that they were defeated by a few fools. So sad that these fools use their power to walk backward in the world.
In the meanwhile, my hard-earned sleep came at the end of the week, a week of watching the Duals Demonstration Project as it rolls merrily along to readiness. No comment. Yet. I did have a dream where someone in a room next to a big important meeting was playing “Dueling Banjos” which of course begins rather quietly before all hell breaks loose, and in the dream, people in the meeting were becoming agitated in the process. I am sure this has nothing to do with the tense energy that seems to be building. We move forward.
But suffice it to say that I am planning on my full eight hours of rest as this rolls out.
More anecdotes next week. The stories continue, all compelling, trends continuing of burned-out (or injured/sick caregivers), aging parents of adult children with developmental disabilities (many of these adults now have health care issues of their own that are affected also by their disabilities). More to say, to think about, to wish for. Until next time…
Inspiration
The hospital was busy when I walked in, the familiar professionals all gathered in their huddles as I walked past and found the room number. The son of my first call peeked his head around the curtain when I knocked, and I waited as he discussed his parents’ care with the doctors who were already there. Another family called my office, and a message arrived on my cell phone, running late, child sick, will be at the hospital soon.
Hospitals are hectic places nearly all the time, except in those moments of seemingly infinite waiting: waiting for a change, a death, a birth, a room somewhere else. Working with crisis is difficult, but in a hospital the notion of normal is flipped–because it is the designated separate space we have created within our society to cope with emergencies, with the events that so often are the catalyst for enormous changes within our lives. But within the institutional setting, the “abnormal” is normalized, categorized, redefined to fit within rules and structures imposed perhaps at first to lessen the chaos, but sometimes it seems only to tighten the control. Contained, life’s catastrophes seem nearly manageable.
And indeed, last Friday, the families were facing health crises that will change their lives. In these particular cases, the accidents and illnesses may have been one more thing, the defining moment of acceptance that, yes, this is important, our lives are not what they were. We must do things differently when we leave.
I was thinking about this over the weekend, the notion of life-altering events and our definitions of “disability”.
My agency held its first gala fundraiser on Friday, an event that reminded me of the many people who have fought so hard to redefine “normal”–and more than that, to open the world to people who by some stroke of bad luck find themselves separated from the rest of the world because of a body that in some way does not work the way that most people’s does.
When I was younger, I read Foucault, looking at notions of power and sexuality in literature. In so many ways, analyzing things I was reading seemed so detached from ordinary life, but Foucault’s lessons were vivid reminders of how our organizing of the world has created so many barriers to people who do not fit within the confines of what we deem acceptable. His discussion of the dehumanizing aspects of the medical regard (translated to “gaze”), come to my mind each time I think of the harm that has come of seeing the human body as a separate entity from the human being it contains. The very origins of the independent living movement reject this “medical model” of disability, too, as it sees disability as a problem to be fixed, rather than seeing the whole person and his/her individual needs around life itself.
I am inspired when we have moments to reflect on the courageous moments in history, moments that someone like my own boss Paul Spooner spent chaining himself to inaccessible public buses, or arriving to rescue someone from an institutional setting. I am so glad that my job was created, not to rescue people from nursing homes so much as to keep them from ending up there to begin with.
At the same time, I find myself still frustrated at the barriers that still remain, mostly the financial ones, but the lack of accessible housing and transportation and employment, as well. As I walk into crisis day after day, in the temporary institutions that are hospitals, I keep thinking that there must be a better way to fold these events better into the context of our lives, to expect it, and to adapt to the changes that come, so often. This will never be accomplished without listening to the people who need the services and accommodations, and I will continue to fight for this as long as I need to. It is good to know that so many amazing people have paved the path already.
And in a sad moment this morning, I remembered yet another person who inspired me and helped me numerous times in my work to bridge the gaps in the very face of crisis situations. I have written before about the Neighbor Brigade, a volunteer effort organized town-by-town to help people with the very stuff of daily existence that is so hard in an emergency health situation. Neighbors helped many of the people I saw with things like rides to visit a recovering spouse in a out-of-town short-term rehabilitation hospital, with hot home-cooked meals, with a visit to a pet or a plant. I was always stunned by both the generosity toward people who needed help, but even more by what the opportunity to help out gave to the volunteers themselves. This is the stuff of community, and it was created by a woman named Pam Washek, who herself was diagnosed with cancer at the age of 36. After she recovered, she made it her mission to help others in the situation she had been–many without strong support networks. The last time I talked to Pam, she was on her cell phone on a Saturday afternoon, calling to let me know that she had found a ride for a woman… It was July. Little did I know that she would become sick once more about a month later.
Pam died yesterday.
Pam, I hope you and your family know what a difference your life made to so many others.
About Never Giving Up…
Never give up.
They are words I have lived by for such a long time, but once in a while I have to stop myself and think about what exactly they mean.
I thought of this just yesterday as a woman described to me the long journey she has endured through a medical procedure that was supposed to be life-altering–and was. The problem is that it was supposed to make her feel better, but instead has left her with a series of side-effects and subsequent infections, illnesses, and depression. A doctor recently told her that he was troubled by the advice she had received. Yes, he would have recommended the surgery, but he would have also told her about the risks. At her advanced age, she may well have decided to maintain her active lifestyle instead, even if it had meant that her life might end quickly and soon. Now, she spends days on the telephone trying to figure out how to cope with her new-found dependence on other people–not something she laments in itself, but an enormous disappointment when she felt that her doctors were promising a longer, healthier life. She told me she felt bullied into treatment.
I returned to work after a week’s vacation–the first long break I had had in several years. Moments of laughter and bliss reminded me of the things that are so vital to life, the things that make our fight for independence and equality all the more poignant.
My work as it is right now is meant to be a series of short-term relationships with people who need a hand in an urgent moment. An accident, an illness, a sudden realization that what had worked before no longer works. If I can save people time and aggravation by connecting them with resources that will not give them another list of places to call, it can be great. No wrong door, we say. And some of us fully believe in the power of that community.
But more often than not, the need comes not from the disability itself, but rather from the maneuvering necessary to gain permission from an insurance company, a human service agency, the government, or a doctor. What matters most, not within the context of a medical system, or a payment structure, or a menu of best practices–but within the context of our own lives?
It troubles me when I meet people who have undergone procedures that may well fall into the standard treatment regime for a given illness, or who have gone through the appropriate channels for.. say, mental health services… all with absolutely no long-term benefit to the person who was trying to remain or become more healthy. In too many situations, I wonder at the very motives behind a surgery or even a prescription, when the consumers themselves are kept ignorant of the whole picture, or ignored if they ask questions.
I do not think it is a situation of giving up when a person decides not to treat a condition, not to undergo the biopsy, not to have the surgery when the treatment itself may well be more traumatic than the condition it is intended to relieve. But too often, I see too many people who realize this only after the fact. “If I had only known…” they tell me, as they then try to maneuver a set of stairs, to obtain life-sustaining durable medical equipment, to see a therapist at a frequency that actually is therapeutic… Permission for the stuff of life, the adaptations that make it possible to live real lives with our various states of humanity–it is not a matter of compliance with a treatment plan, or cooperation with a human service system, or affordability within a payment model.
Never give up, I say, on the vision that the world can be bigger, more flexible, more inclusive.
Thanksgiving
I have taken off the entire week for Thanksgiving, partly to prepare for the turkey, and partly to get some sort of a break before the commotion around Dual-Eligibility starts in earnest.
I am stunned in many ways at the number of referrals that sail into my office now. When we first started the project four years ago, we expected to be inundated with calls from social workers and others who were trying to help people remain or reintegrate back into the community. Imagine… a free service that gives that connection…
But we all know the story: new project, something else to remember, a hassle. Or, if it works, another trusted part of the community, a stepping stone, a colleague. I guess I have gotten there. Many of the people I see know someone else who regularly makes referrals to me. We have a wonderful community now, most of the time.
Still standing in the way are the agencies and entities with their own interests preceding those of the consumers they serve. Growth can destroy an agency if it happens so quickly that the agency loses sight of its core values, or if those core values are skewed to begin with.
Last week was filled with the sort of heartbreak that comes from a completely messed-up system. I am already frustrated enough with the incredibly restrictive nature of Medicaid waivers. As I have stated in the past, why a waiver? Why is the system still filled with such institutional bias?
And why, when a person has a brain injury or a life-ending illness, or a significant physical disability, why oh why do we attach those waivers only to getting out of a nursing home?
To explain, we have some waivers in Massachusetts that pertain only to people who have “served time” in an institution for ninety days. If you have an acquired brain injury, for example, there is hope if you have been incarcerated in a nursing home. Money Follows the Person, a demonstration project for Medicaid recipients, also is based on that same nursing home stay.
So, Olmsteadians and others, where are the Home and Community Based Services to prevent these nursing home stays in the first place?
I need these resources, RIGHT NOW, for the people I see. They keep asking, you know.
I don’t like to tell people that the options are to become impoverished, to divorce the people you love, to play the system and make it work… It just seems immoral. It is.
I am so thankful, thankful for the mere thought that our country has ventured into territory that even questions the barbaric healthcare system that we have. We seem to ignore that people actually do age, get sick, need help, remain human.
I am thankful for my own health as I write this, as transient and wonderful as these moments are.
I am thankful for the freedom to fight for what I believe in, and I believe that healthcare is a human right.
I am also thankful for movies like the one I saw this weekend: The Sessions. Thankful for humanity, love, emotional, for the physical body and its existence on earth. Thankful for creativity, and humor, and once more, thankful for love.
He Wants the Real American
The election is, at last, over.
I am relatively happy with the way things turned, out. Relieved may be a better word. But not everyone feels this way, a fact that came crashing down on my idealistic soul in a bar on election night.
Now, you would think that event planners would have better sense than to schedule a singles mixer as we awaited the turnout from such hotly contested races. But schedule they did, and I signed up. I thought it would be interesting–and it was.
For one thing, it was an icebreaker for the nervous mingler to look up at the screens and comment as states turned either red or blue. That was a somewhat entertaining, but as a person with strong feelings about the issues brought up in the campaigns, I could not help but voice my overwhelming concern during the last year (several years, actually) about access to healthcare.
A man tried to convince me that he was justified in his stance against universal coverage, because his company is looking at penalties of over $5 million because the company does not offer health insurance to all of its employees. I was shocked: shocked that rather than offer insurance, the company had decided to swallow the penalties. Shocked also at his reasoning. He told me that the people have jobs, and fewer people would be employed if the penalties ate that deeply into the profit margin.
Problem is, I see people die from lack of access to timely and affordable healthcare. I see the stress and the ultimate, unwilling non-compliance to medical plans because people cannot afford medications or outpatient visits. The man claimed, as Romney did, that people go to emergency departments for care; they do not go without. I told him that if he could walk one day in my shoes, see the people I see, he would change his mind.
He was pale when I told him good evening, and I was not sure in the end if he was just angry, or if he really considered what I had said.
I walked to the far end of the bar, where a man, and another man who turned out to be the cousin, introduced themselves. The first man had not voted. The second had, but up to that moment had refused to share with his family which way he had voted.
What he said upset me more than any other thing I have heard this entire election cycle. It upset me, perhaps, because it was real. It was tangible. And they were his deepest feelings, he said.
“I voted for the real American,” he said.
I am terrible at disguising my feelings. And true to this, the first man looked at me, and said only, “Uh oh.”
Truth is, I was sure I had misheard the cousin. I was sure that I had misunderstood. I was sure that in downtown Boston, in 2012, I could not be hearing the racism I had heard from a few people when I was a kid in Missouri. I was sure that despite the hate and fear that comes into our homes via Fox News and much of talk radio, no one could utter such a sentiment to a stranger, in a social setting.
But deep down, as we have been seeing with sentiments against women’s rights, I know that hatred has a voice, and therefore, a space. Power.
It shook me, glad as I was the next morning to find a new senator in Elizabeth Warren, and the same president with Barack Obama. The people spoke, and most of them do want a real American–one of the real Americans… the one who best represents the nation that we are right now.
No luck for me in the singles mixer. I had planned to stay for only an hour, and I did. I went home to spend the remaining hours with my kids, albeit it with a new realization of the sincere need we have in our land to unite, to reach across, to love.
And in this, I also want to thank the veterans who have served our country. I meet many of them, many who are getting older now, many who have stories they never told, others who have stories they never stopped telling.
In an ideal world, I wish we could all serve, if not in the military, in a volunteer capacity, serving the needs of our people throughout the country, uniting us all in earnest, as we see, up close, who we all really are.
Pouring Down Like Silver
The weeks lately seem to come in like the hurricane last week. Round here, wind and relatively minor destruction, some fear. Other places, much worse. And so it seems as news comes in and will continue to rush in tomorrow and possibly beyond. As understood in that infamous Chinese curse, we are living in interesting times. This was the week to think about a new database, my present work, and a new project headed our way. We survived the storm, and carried on.
So, once we were back to work and on the road again, I found myself on the one hand trying to catch up with the enormous number of referrals I have had lately. I am glad that the community seems so cohesive. Often, depending on the situation, I find myself surrounded by many colleagues in similar care coordination/coalition building/resource finding roles. I am glad that we know to call one another and work together when people call upon us for support.
And on the other hand, I find myself drawn into a brave new world of healthcare at this point, as I contemplate–deeply–the about-to-launch demonstration project known familiarly as “The Duals”.
Individuals who are dually-eligible for Medicare and Medicaid represent a vulnerable disabled population. The sorts of ping-pong games between the two insurers have delayed medical care, therapies, services, and equipment for most people at some point, often with aggravating, if not tragic results. Change is needed.
At the same time, change is frightening, especially when it feels that there may be a buck to be made… or saved. And given the sorts of systemic abuse that many people, notably those with psychiatric disabilities, have faced throughout history and throughout individual lives, it is no surprise that invitation to “new and improved” packages is met with cynicism, as well.
I am newly diving into this world, swimming deeper into the history and ideas the Dual Demonstration Project contains. The insurers–Integrated Care Organizations–have just been named on Friday. And from my early glances, I can see that it is an opportunity to explain to come to the healthcare world and tell the stories of what it is to have a disability in this world. The Duals are the pioneers, not only for this project, but for the entire Affordable Care Act, as it looks to this challenging coordinating effort.
And tomorrow… Vote! The ballot in Massachusetts, particularly, has perhaps never mattered more.
Only Anecdotal 