Today was the big day: we signed the contract with an assisted living facility and got the keys to her room. We can start moving things in immediately, she takes up residence July 12, two weeks from today.

Update re beds: D has decided she wants her full bed in there, at least to start, so it looks like we're not getting a temporary or new bed at this time. Thanks everyone for your suggestions! They were very helpful! Also, she has a week to change her mind about this plan.

After the signing, which was a 2+ hour process, we went out for lunch, then adjourned to her place and measured furniture.

Due to dealing with her move, I'm going to be somewhat hosed over the next two weeks. (If you have a favorite moving company that does small moves on the North Shore, feel free to mention in the comments. I have two recs already, but I could stand to get quotes from one or two more. Also, I feel nervous about trying to book movers in 14 days or less, so want a pool of leads at hand.)

I was hoping to get at least one post out this month, but right now I'm so exhausted I can't see straight, and I have lots of patients tomorrow and part of Friday, which is the last day of the month. We'll see.

The good news is that in the middle of July, whatever my availability had been, it (knock on wood) should be substantially improved. Not only will we be getting D settled, I have a bunch of patients all going on protracted vacations, so my clinical caseload will be temporarily lightened.

Once D is moved, we'll need to start worrying about what to do with her house, but there's no urgency on that. I think that while there's some minimal stuff that we'll get out of the way, G and I are planning on taking a nice break from Dealing With Things And Evacuating Houses for a little while.

Of course, all that goes out the window if D's health takes a turn for the worse – or for that matter if any other emergencies emerge. But right now I'm hopeful that later this coming month I'll be able to be around more and be shoving more posts out the door. Here's hoping.
Constant readers will recall that I wrote a three-part post titled, "Why You Can't Find A Therapist, No, Really". I posted Part 1 on Sept 1st and Part 2 and Part 3 on Sept 30th of last year.

The clinic I work for as a contractor recently paid me, for my last pay period, an amount of money that was four times my typical earnings. Admittedly, how much I actually get paid fluctuates pretty wildly, but I figured I would have noticed having either 4x in arrears or having seen 4x as many patients as usual. But I'm paid via direct deposit, and the corresponding statement saying what I was getting paid for is put in my mail box at the clinic, so I had to wait till I was back in the clinic – today – to pick it up and find up why I was getting all this money.

The statement mystified me when I got it. It was two whole pages of pairs of canceled previous payments and replacement payments and at first I couldn't make heads or tails of it, and then I realized that I was looking at a statement where almost all the patient sessions listed had happened in 2016.

As I mentioned, last month, for the first time in decades, we got a raise. A big raise. Not big enough to be adequate, but big enough to be astounding. It was, we thought, effective starting May 1.

No. Turns out the raise was retroactive. To – apparently – Oct 1, 2016...

...The day after I posted the final sections of "Why You Can't Find A Therapist, No, Really".

Rumor has it that the raise – more properly, the increase in rate paid by at least two of the Medicaid providers – happened because MassHealth (Massachusetts Medicaid) leaned on them to do so, to fix the emergent strike.

Um.

MassHealth? Are... are you there? Are you reading my journal?

If so, thank you! (If not, still thank you!)

I have a few other suggestions for things you could fix!

For instance: I'm currently doing an amazing job (or so my chart reviewer wrote) doing care coordination with a big medical team involving four clinics, three hospitals, and family all involved in the care for a patient with an emergent psychotic illness. I can do that because the patient has MBHP, and MBHP pays for case coordination if it's extramural. I'd like to point out that it's insane that if I have a 15 minute conversation about the diagnostic formulation for a challenging and high-risk case with an in-house psychiatrist, I don't get paid for it (and neither do they), but if I do the same thing with a psychiatrist at a different clinic, I do. How wack is it that I literally wouldn't be able to afford to spend the sort of time on this case that I did (and continue to!) if the patient hadn't coincidentally decided he didn't like my clinic's available psychiatrist and went and found himself another one through his PCP. Surely this can't be the incentive system you want me or the patient (or the psychiatrist) to be functioning under – one where patients are incented to get their psychiatric care from an entirely different facility from their therapist.

And thank goodness that he had MBHP, as pretty much an amazing fluke. No other MassHealth payers pay for care coordination at all. If this guy had been on NHP or Tufts/BMC when he came down with schizophrenia... I shudder to think. Do you realize how much I've been on the phone with MGH's ER and APS and social workers and psychiatrists at local mental hospitals in the last six months?

Don't you think there should be some sort of provision for what happens when someone presents with a psychotic disorder? Like, when a provider slams the big red "R/o Schizophrenia" button, the payer has to start paying for some case coordination? (I'd also recommend that for substance abuse cases, where patients can manipulate providers around meds; and in mandated reporter cases, where you should probably have payers pay therapists for their time filling in DCF/DPPC/DES or whatever.)

I have to think that the time demands of handling such a high-risk case are part of why some – maybe many – therapist are leary of working with psychotic or other high-risk patients. I've been there. I've twice spent four hours – half a work day – keeping a patient in crisis calm and coordinating with the BEST team and then the hospital, and never saw a dime for any of it. Who wants to bring a patient onto their caseload, for whom the total compensation divided across the total hours of work for that one patient come to less than minimum wage?

And I'm just talking about care coordination – I'm not even talking about CPT 90839 and 90840 which last I checked were still universally unfunded. Funding that would be way cool.

I have many other fine suggestions – I swear many of them even aren't just suggestions you pay me more money! I'm happy to talk more about reforms in mental health care.
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([personal profile] siderea Jun. 27th, 2017 09:29 pm)
Oh god I didn't know it was possible to be this wet without actually wading into a body of water.
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([personal profile] purplecat Jun. 27th, 2017 09:06 pm)
People compare Mark Gatiss who stories to the Pertwee era surprisingly often to my mind. I think he's on record as saying it's his favourite era of the show and it's true his stories tend to have a straight up monster or villain but the Pertwee era is typified, I would say, by the presence of overtly political themes (absent from Gatiss') work and a fairly sparse and functional approach to setting where Gatiss' (possibly because of his interest in Victoriana) tends towards the Gothic. In fact, apart from the fact Gatiss doesn't borrow from Horror tropes, I would have said that the Hinchcliffe era was a better point of comparison.

All of which is a long-winded way of saying that, no matter what the rest of the Internet might think, I can't really imagine Empress of Mars in the Pertwee era.

More under the cut )

This is, I get the impression, the episode that Gatiss has always wanted to write and I think it shows. It is having a lot of fun, telling a ripping yarn, and manages to feel both like a Doctor Who story and like a Scientific Romance.
purplecat: (dinosaur)
([personal profile] purplecat Jun. 26th, 2017 09:23 pm)
We were supposed to be going to Bristol Comic Con but they cancelled the con. So instead we were let loose on the unsuspecting Bristol countryside.





More pictures under the cut )
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([personal profile] kareila Jun. 24th, 2017 07:02 am)
Continuing to have trouble setting aside time to focus on work with the kids home for the summer.

After taking my mom to her doctor appointment and subsequent errands on Tuesday, I spent most of Wednesday through Friday sick in bed with a fever and sore throat, but no other obvious symptoms. Now I'm finally feeling better, and Robby has decided that since Tropical Storm Cindy's gift of some ridiculous number of inches of soaking rain will prevent him from doing his usual maintenance out at our church this weekend, this is the best time to disrupt the downstairs living area and try to finish constructing Connor's loft bed.

If I didn't have to take the kids to swim lessons today, I'd probably flee to the library and try to get some serious work done. Maybe that strategy will work next weekend, if I can find someplace to go that isn't closed for the holiday.

In other news, Steam is having their annual sale and I've discovered that most of their older LEGO games (pre-Marvel) are PC-only. I really wanted to put the Harry Potter games on my laptop so that I could play them without broadcasting them to the rest of the household. There's also a PC game that Connor wants that is too resource intensive for his poor old gaming PC. But I read on Twitter last night that Starship Titanic is on Steam for $1.49, so I'll get that if nothing else. I've been wanting to play it again ever since I saw Passengers.

I'm also realizing how much cheaper and easier to find the PlayStation 4 is compared to the Nintendo Switch, and that's probably also the better platform to choose if I want to play Kingdom Hearts 3, assuming it ever gets released.
kareila: Sora outlined in silhouette against a heart shaped moon (kh2)
([personal profile] kareila Jun. 21st, 2017 02:36 pm)
I've written several times over the years about how much my kids and I enjoy playing LEGO video games, especially the franchise tie-ins, and I appreciate being able to go back and read those older entries and see how that relationship has evolved as the years have gone by. In particular, it struck me that once upon a time I wrote about how Connor would join me in two-player mode on the Wii, but Will never joined in, although he liked to watch and advise us, and would play the mobile versions of the game on the DS or the iPad.

Well, that has officially changed. After assisting me in various areas of the first Harry Potter game over the past couple of weeks, today Will started a solo playthrough of the second Harry Potter game.

The original LEGO Star Wars, the game that started it all, came out the same year he was born, in 2005. So I feel like my love of these games and the lives of my kids are entwined, in a sense. All these years later, I consider the Harry Potter games to be my favorites, so it's a bit surprising to me to realize that I only completed the second Harry Potter game once, although I've played through the first one four times now. I wish they would release a remastered combined game for the Wii U like they did for the PS4.

As near as I can figure, I own all of the LEGO franchise tie-in games except for Indiana Jones 2 and LEGO Star Wars III: The Clone Wars. I even repurchased for the Wii the ones I originally played on the Playstation 2. I haven't completed the more recent ones, though, since I got distracted by the introduction of LEGO Dimensions.

This is the first summer in a while that I can remember not having a new LEGO game to play. LEGO Marvel Superheroes 2, which appears to feature the Guardians of the Galaxy, has been announced for later this year, but it will require me to purchase a newer console, so we're probably getting a Nintendo Switch for Christmas. Connor's already asked for one anyway.

Just for fun, I made a chronological table for the various franchise games - not including the LEGO Movie Videogame, LEGO City Undercover, or LEGO Dimensions and its various expansions.

Read more... )
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([personal profile] purplecat Jun. 21st, 2017 08:34 pm)
Reading: Still Crime and Punishment which should be no surprise. However I had anticipated being further in than Chapter 5 by this point.

Listening: Stuff you Missed in History Class on William Moulton Marston, the creator of Wonder Woman. So far he's invented a lie detector and is investigating women's emotional responses to bondage - suddenly Wonder Woman's lasso takes on a whole new dimension. He appears to have been both a feminist of sorts* and a polygamist. The former of which is, I gather, very evident in the early Wonder Woman comics (particularly his belief that the world would be a better place if run by women) the latter somewhat less so.

Watching: We have discovered Stanger Things. Very reminiscent of E.T. (it opens with a D&D game, is set in the 1980s and much of it is short from a child height viewpoint (a characteristic of E.T. according to B.))

*neither of his partners got suitable credit for their, in some cases considerable, input into his work.
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([personal profile] purplecat Jun. 20th, 2017 08:09 pm)
While I was in Texas an old friend and his wife took me out for the day including a trip around Texas' Capitol





Piccies Under the Cut )

I don't know anything about being religious — it's utterly foreign to me. But I do know a thing or two about being articulate, and about being brave. This sincerely religious young woman is articulate (remarkably so, given her age and the circumstances), and brave (by any measure), as she stands before her congregation and speaks truth.

Unfortunately one of her church's pastors cut off her microphone before she finished. but if you watch the video through, you'll here the last few paragraphs as well.


(Commentary elsewhere on the net asserts that the pastor shut her down because he disapproved of the content of her remarks. I do not find the evidence in the video entirely conclusive on that point: For all I know each speaker gets an allotted time, and the pastor's usual way of informing people they've gone over time is to cut off the microphone. So I'm not making that claim. But it's out there, and I didn't think I should ignore it either. But I also think it's a distraction: Mormon pastor cuts off 12-year-old's mike when she comes out to her congregation is doubtless better clickbait than the original title. But it shifts the focus from a noble act to a cowardly one — and shifts our our response from ennobling to ignoble.)

Large Image under the Cut )

Answer: No.

From the early days of the hiatus/wilderness years/whatever you want to call them...
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([personal profile] xela Jun. 16th, 2017 04:55 pm)
I just discovered that I haven't been receiving email notification of replies to my posts on Dreamwidth anything like consistently. Like, only about 30%. I'll be replying to the just-found soon.
jadelennox: Demonic Tutor, Jadelennox: my Magic card (demonic tutor)
([personal profile] jadelennox Jun. 16th, 2017 02:50 pm)
Don't give stuff.

When official voices for a charity or a cause ask for stuff, you can give stuff. Give what they request, only what they request, and in good condition. Don't give unwashed or unfolded clothes. Don't give expired or open food. Don't dump and run.

Give money. Give time. Give votes. And if you know they want your stuff, give stuff.

After Hurricane Katrina, waterlogged schools full of developing mold were inundated with donations -- of textbooks from the 1960s, torn paperbacks nobody wanted, and old national geographics. Then it became their problem to throw away someone else's unwanted stuff.

Don't make suffering people the solution to your problems about not wanting to throw unusable clothes in the trash. Don't make them the repository of your helpless survivor's guilt.

From The Guardian's liveblog of Grenfell Tower aftermath:
He added: “I haven’t seen this much aid out of a war zone, but the council just hasn’t stepped in. There is too much in the way of donations. But the problem is how to get it to the right people, and what you do with the surplus. One man, I’m sure with the best of intention, left a massive box full of milk - and now volunteers have to figure out what to do with a box of gone-off milk.”


From twitter user [twitter.com profile] pastelchalk:


We feel bad throwing things away. Find a charity that actively wants your things, or suck it up. We feel bad being okay when disasters happen. Go volunteer to help, or become an activist for those trying to prevent similar tragedies, or write a check, or suck it up. The best of intentions and a fiver will buy you a cup of coffee.
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([personal profile] siderea Jun. 16th, 2017 01:06 am)
I keep having bright ideas that seem very plausible, but which then seem to not work in reality. I'm wondering if any of you can advise me about the following.

D, who will be moving into an assisted living facility shortly, is undecided about what size of bed she wants. The room she will have is quite small, so on one hand, she wants to maximize floor space. On the other hand, she's used to sleeping in a full size bed, and not sure she can handle downsizing to a twin.

So I had the brainwave that maybe we could use one of the rent-to-buy furniture places to rent a twin bed for her to try out. While we'd pay a premium for doing this, it would allow her to change her mind and have her full bed moved in if she didn't like the twin, without having to pay the full price for the twin if she didn't like it.

Now, I thought my question would be whether rent-to-own furniture places would even rent mattresses in MA given our laws about reusing mattresses – it turns out they do – or whether rent-to-own furniture places, having the reputation they do of being skeezy, are too disreputable to contract with or would have terms unfavorable to doing what I want – it turns out their model and rules seems ideal to our purpose.

But no. The problem seems to be whether rent-to-own furniture places on the North Shore will rent an entire twin bed.

There only seem to be two furniture rental places that serve the North Shore, Rent-a-Center and Aaron's. Both seem to be convinced that only children use twin beds. Aarons, at least, will allegedly (per website) rent a twin mattress and boxspring set, but none of their bedsets or electric adjustable bed bases are compatable. Rent-a-Center has no twin mattress sets at all; all their twin beds are for children, and either bunk beds, or platform beds (no place for boxspring), all of which are strangely inaccessible with things like elaborate superstructures (e.g. to make the bed look like a car, or a Cindarella coach) or higher than usual bed surfaces for under-bed storage (Captain's beds).

Does anybody have any suggestions about this? I can call the stores and ask if they have things available not on the website, but I figured I should stop and ask if there's things I should know that I don't. Like does anybody know of a local alternative? Has anybody done this?
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([personal profile] siderea Jun. 15th, 2017 05:01 pm)
Via Metafilter: Developers Who Use Spaces Make More Money Than Developers Who Use Tabs

Apparently, a suprisingly robust finding, even after controlling for absolutely everything obvious, and a lot of clever non-obvious things, too.

While correlation does not imply causation, in case you were wondering: 8.6% higher, on average.
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([personal profile] purplecat Jun. 15th, 2017 09:11 pm)
It was the end of my first year at university. I went on holiday in a ramshackle minibus with an assorted bunch of Arthurians. The sun shone. We went south.



Lizard Point, Cornwall
.