Case Managers Are…Never the Same Day Twice

When the older woman with schizoaffective disorder is lost in a panic to her delusions of a terrorist coming to kill her, I am there to de-escalate, calm, redirect, and if needed call mobile crisis response to help facilitate transfer to a hospital.

A resident’s bank account got hacked and it took two months for social security to redirect his SSDI check to the new account, leaving the resident unable to pay his rent for those two months. I find an agency to provide rental assistance and help the resident through the application process, including uploading supporting documentation when the resident’s own technology skills or access fail.

When two residents, each with their own physical and mental health challenges, get into a name-calling feud with each other, I mediate and persuade them to find ways to coexist in the same building without resorting to physical aggression.

When a third-party case manager notifies me in the early morning that her call with one of our mutual clients/residents the evening before resulted in a threat of specific harm toward one of the other staff in my building – and she did not know who else to report the threat to besides me – I notify my supervisor then follow state reporting laws (like she should have immediately). Then I wait half the day for mobile crisis response only to be told they are too busy to respond and to call back if the threat becomes emergent. But oh, they could have responded the evening before because they were less busy then. I then spend the next week working with upper management on the appropriate level of response to the threat and how to further interact with my resident with the threat looming. I also wonder what happens if the resident follows through on the threat and whether I’m next on the list because of reasons…

A resident with a history of trauma asks for help finding a female dermatologist who accepts both Medicare and Medicaid so she will not have any out-of-pocket expenses – but not with this particular county medical group or any of their satellite clinics because they give horrible service. I run my Google-fu and find a couple of possibilities, but only if the resident’s primary care doctor can get prior authorization from Medicaid for the referral. I pass the information on to the resident and wish her the best of luck. 

When an aging veteran’s rep payee/caregiver takes the battery from his motorized wheelchair for three days as “punishment”, leaving the veteran unable to get to the grocery store or any food place to feed himself after previously only being able to carry 2-3 days’ worth of food home on his wheelchair at a time, I make the call to adult protective services. I also advocate with this resident’s external case manager numerous times over several months for a higher level of care due to the resident’s inability to meet his own needs in fully independent living and decreasing quality of life. The day before Thanksgiving, a substitute case manager filling in for the holiday week sees what I see and transfers him to the hospital, then finds him a place in hospice. My resident is literally dying while his primary case manager ignores or placates me for months; it took a substitute to hear and believe. The resident passes before the turn of the year but at least his last bit of time is comfortable.

A new recently homeless resident moves in and I welcome him to the building. Less than a week later he seeks me out and I help him establish his utility account, request utility assistance, research food assistance in the form of prepared meal delivery, and find local grocery stores in walking distance with maps and step-by-step directions from first exiting the building, and locate where common areas are in the building. An appointment to figure out how the machines work in the laundry room will happen a couple of weeks later.

I file at-risk reports, death reports, contact notes, intake assessments, first and third quarter assessments, as-needed health screenings, weekly quality assurance reports, and APS/CPS reports. I attend half a dozen or more meetings a month and run group weekly and monthly social and educational programming for the residents I work with…after cajoling them to attend. Attendance at resident programs is always a herculean task, despite creating newsletters, calendars, and flyers that are delivered directly to their doors and posted in elevators and other common areas. 

I am an information broker, benefits application guru, technology tutor, marketing pro, life skills coach, mediator, property management liaison, community partnership builder, crisis responder, activities coordinator, housing educator, harm reduction specialist, budgeting advisor, and peer trainer.

I am a supportive housing case manager, and this is only a fraction of what I am and do.

Lynn PinkertonLynn is currently a supportive housing case manager in the San Francisco Bay Area. Lynn has been a social services case manager for eight years and has worked in child welfare, community mental health wraparound, and affordable housing support services. In her spare time, Lynn is an avid reader and crafter.