Saturday, August 29, 2009

Homeless at Home: March 26, 2001

In addition to copies of my medical and financial records, I bring Michael Elliot's book, Why the Homeless Don't Have Homes and What to Do About It

I skim the list of references and I see names I recognize: Jonathan Kozol; Faulkner; Foucault, and I know I am in good company.

I begin my second journey to the Multipurpose Center #54 on Sutphin Boulevard in Jamaica, Queens; I try to prepare myself for the four-to-six hour wait that inevitably lies ahead of me.

It is my hope that buried deep within these pages and Elliot’s years of experience and wisdom, I will find some solution to my problem.

After my first few days in New York City, I quickly learn that the homeless cannot vote nor can we obtain a library card. Knowledge is power. Information challenges the status quo. Books are my friends.

When I browse through Barnes & Noble, I often see titles that catch my eye; and though I know nothing of the content, I am inherently drawn to Night is Dark and I am Far From Home by Kozol, and Tell Them Who I Am by Elliot Liebow.

Today is March 26, 2001; My first journey to Multipurpose Center #54 was January 26, 2001: exactly 2 months ago; After many calls to NYC No-Heat Hotline to complain about the situation, I still have no heat. I have no electricity and no water. My caseworker did not tell me she would be leaving her position with Protective Services for Adults (PSA) and I have not been contacted by any with Health and Human Resources (HRA) since March 5, 2001.

On March 7, 2001, I drove my beat-up 1994 Honda Civic over to the emergency room at NYU. By the time I arrived at East 23rd pulled over and asked two officers in the 3rd precinct to please take my car and help me find my way to the ER since my panic was overwhelming and I had lost touch with my senses and felt I was a danger on the roads; I had now lost my sense of direction both in concrete terms and in the abstract vision I had painted of my life.

Officer Collins and her partner, Officer Gavin did not laugh at me; they did not tell me I was crazy or delusional. They let me catch my breath and miraculously managed to calm my fears and prepare me for the short trip in the ambulance to the ER. Officer Gavin's wife has four cats. Officer Collins was off duty, yet she stayed with me.

In the ER for what seemed like several hours. True to their word, they miraculously got my car out to Long Island where it was placed in a garage safe from the NYC Department of Finance.
I hate cops. Always have. Ever since I found out my Daddy was a Fed. But they were an exception to the rule. There is always an exception to the rule. "Those who say it cannot be done should not interrupt the person doing it" (Chinese proverb)
Yesterday I was grateful for the sunny weather and a place to stay. Today it is snowing. Tomorrow I must return to Multipurpose Center #54 to file another application for Public Assistance. The weather may be nice or it may be cold, but night is coming and I am far from home. And I beg of you, tell them my name. Tell them I have a name. And last but not least, tell them who I am.

Social Services Fails to Prevent Homelessness

Start here. See if you can follow. I am now homeless, because the crazy roommate locked me out and MDHA fucked up big time.

After reporting a shooting and working WITH the cops to help curb the violence and drug activity in my community, they discovered that the maintenance man was a house arrest due to a drug conviction. The same maintenance man who had a key to my apt and would frequently enter without prior notification and on multiple occasions when I was not at home.

After calling the non-emergency police hot line 32 times to report excessive traffic and drug activity in my building without response, the next call I made was to 911 to report gun fire in the apartment directly downstairs. I'm a New Yorker. My dad was a fed.  I Lived through 9/11. I worked as a crisis intervention specialist under contract for Level II and Level III adolescents in state custody (Tennessee Dept of Children's Services)

I am no stranger to violence.

Notified the other day by DHS that I have no tenncare 8/14/09 but state records have me enrolled as active. SSA says I don't, now DHS says I don't but they won't take an appeal because the state says I do! WTF???

Then, they cut my food stamps off because the homeless do not have to pay rent or utilities.

MDHA still hasn't recerted, but they continued to pay rent 4 months after I moved out and sent the renewal papers to my old apt because they were unaware that I was evicted and sued for $4.50.  

Fair housing keeps asking for proof that I made due diligent effort, so tied me with bullshit looking for any and every excuse to blame it on me.

Couldn't find a new apt because it shows up as an eviction.  There's more, and everything is documented.
Oh yeah, my TennCare was terminated on 8/14/2009.  I never an RFI (Request for Information) or reason for this redetermination.  No one calls me back,

Sent via BlackBerry from T-Mobile

Health Economics: Free Market for a Public Good?

Click to call your member of Congress and demand quality, affordable health care!

I have a serious problem with the most recent health reform effort. Asking or expecting the health industry to reduce costs through self-regulation without accountability is simply ridiculous.

Health care is already completely self-regulated and controlled. A person does not have free choice when choosing a provider. Due to an unholy alliance of provider networks, insurance underwriters, pharmaceutical conglomerates and private for profit hospital corporations such as HCA.

By negotiating with providers and developing one-size-fits-all prescription formularies and treatment protocols, we remove the ability for the consumer to make independent informed decisions about the value of various treatment options.

We rely upon one the ratings of physicians who have self-interest in controlling access and information to accurate information through their reliance upon Certification and Licensing Boards. By limiting access into the profession, health care costs are inflated and it is near impossible for the consumer to determine the fair value of a health care service.

Second, the consumer is far removed from the negotiating process, so we do not have a good sense of the fair, free market value of one particular service in comparison to another. All you need to do is look at any EOB (explanation of benefits) report for your last trip to the hospital.

Billing codes are used and assigned through various service departments and the insurance carrier then decides which services are covered and at what rate. They use the terms like “Reasonable and Customary Rates” and then choose to pay 80% of that. Therefore, by definition, that 20% must be built in to the billing rates to adjust for the actual (and expected) rate of reimbursement.

Such complicated billing procedures and methods are so complicated and technical that the end recipient of services (the consumer) really has no idea if an X-ray costs $90 or $73. Add into that a separate fee for the radiologist, and sometimes a charge just to use the facility, and even smart people find it difficult to understand.

The bills are then processed by an insurance adjuster who must determine primary and secondary (supplemental) plans and determine who is responsible for what, the end cost and intricate design is truly “priceless.”

Good luck to those people who actually purchased supplemental plans they saw advertised on TV, you have been duped. Giving people (especially the infirm and the elderly) a false sense of security is unfair and unjust.
Without regulation, intervention and enforcement, many people will continue to believe they are prepared and protected from that ultimate for “just in case” scenario that results in major, catastrophic medical loss.

The administrative cost alone on the part of the “Responsible Party” is probably more costly than the initial service they received at whatever hospital for whatever condition.

You cannot apply basic economic theory and free market principles to health care. Health care is fundamentally different and should be considered a public good.

Elyssa Durant, Ed.M.
Nashville, Tennessee

Health Economics 101: What Most Don't Know

You cannot apply basic economic theory and free market principles to health care. Health care is fundamentally different and should be considered a public good.

First, health care is completely self-regulated and controlled. A person does not have free choice when choosing a provider. Due to an unholy alliance of provider networks, insurance underwriters, pharmaceutical conglomerates and private for profit hospital corporations such as HCA.

By negotiating with providers and developing one-size-fits-all prescription formularies and treatment protocols, we remove the ability for the consumer to make independent informed decisions about the value of various treatment options.

We rely upon one the ratings of physicians who have a self-interest in controlling access and information to accurate information through their reliance upon Certification and Licensing Boards. By limiting access into the profession, health care costs are inflated and it is near impossible for the consumer to determine the fair value of a health care service.

Second, the consumer is far removed from the negotiating process, so we do not have a good sense of the fair, free market value of one particular service in comparison to another. All you need to do is look at any EOB (explanation of benefits) report for your last trip to the hospital.

Billing codes are used and assigned through various service departments and the insurance carrier then decides which services are covered and at what rate. They use the terms like "Reasonable and Customary Rates" and then choose to pay 80% of that. So by definition, that 20% must be built in to the billing rates to adjust for the actual (and expected) rate of reimbursement.

Such complicated billing procedures and methods are so complicated and technical that the end recipient of services (the consumer) really has no idea if an X-ray costs $90 or $73. Add into that a separate fee for the radiologist, and sometimes a charge just to use the facility, and even smart people find it difficult to understand.

The bills are then processed by an insurance adjuster who must determine primary and secondary (supplemental) plans and determine who is responsible for what, the end cost and intricate design is truly "priceless."

A false sense of security is unfair and unjust. I would rather have nothing than false expectations and disappointment.

Without regulation, intervention and enforcement, many people will continue to believe they are prepared and protected from that ultimate for "just in case" scenario that results in major, catastrophic medical loss.

Yeah, right. The administrative cost alone on the part of the "Responsible Party" is probably more costly than the initial service they received at whatever hospital for whatever condition.

The bottom line is this, we can pass laws, we can file injunctive, pass symbolic legislation, and spew feel good if oration about public programs that fall short if their promise to assist those in crisis. However, unless we demand accountability from state and federal agencies (1) demanding a timely response; (2) create and external entity to do an independent audit to ensure compliance, (3) enforce those laws through whatever means necessary; we have no recourse.

As more and more people continue to lose their benefits, and their unemployment benefits run out... the state will continue to be overburdened, and people in crisis can only go so long without before it is too late. Social Security and DHS MUST be held accountable, and we must pressure our legislators to create a separate entity to conduct external reviews IMMEDIATELY.

I would write more, but I have some forms that MUST be filed out and faxed immediately to appeal the termination of my benefits. Since the Dept of Human Services only have 20 days to appeal, they should be required to respond in a timely fashion.

It is on us to see that this happens. Regardless of whether we chose a public or private option, without regulation, accountability and strict enforcement... we have no recourse. Please fix it. I can't do this alone!

Click to call your member of Congress and demand quality, affordable health care!

Elyssa Durant, Ed.M.
Nashville, Tennessee

Monday, August 24, 2009

Recruitment & Retention of Qualified Personnel in Metro Nashville Public Schools

This Tennessean released data on July 5, 2008 reporting disparities in teacher salaries for Metro employees. The article, “Poor kids' teachers earn less in Metro: Hiring bonuses, other incentives target inequities” raises questions about the hiring practices in Metro Public Schools, and reports that teachers earn less in schools that are not meeting the No Child Left Behind benchmarks. This article glossed over the magnitude of this desperate situation in Metro schools.

The basic fact that students are not making adequate progress is a reflection of the top-down policy failure by MNPS and the Board of Ed. Students are not making adequate progress, and teachers are being shuffled around in a desperate attempt to fix a problem that they do not fully understand.

In order to fix our broken schools, we need to look at schools that work. There are in fact public schools in urban neighborhoods that are successfully educating the students despite limited budgets, supplies, and adequate funding. So what is it about these schools that allows them to successfully educate disadvantaged, at-risk students and how can we replicate their success?

Unfortunately, this article does not offer any new insights into the inner-workings of our neighborhood schools. MNPS does not have the answers, nor does our newly elected Mayor who recently launched an aggressive media campaign to recruit new teachers willing to work within the constraints our over-regulated, under-funded public schools.

As an educator and a Metro employee, I earn $10.46 / hour (without benefits) teaching at-risk students, I am offended by the way teachers are treated in the schools, in the community, and by the press.

They are strangely unfamiliar with the political process, and teachers are expected to implement and carry out policies that were designed by academic professionals or educational consultants.

The state Department of Education could not offer any realistic solution to the simple fact that I cannot afford to pay the fees associated with the application fees certification requirements. If the Mayor really needs applicants, perhaps the city should comp the application fees necessary to be considered for employment.

My graduate degree in education is from the very same university that Mayor Dean attended in New York City. When I called HR and the “Certificated Office” to inquire about obtaining a provisional teaching license and alternative certification, I was simply told that I was not eligible for alternative certification and without additional coursework, and tuition and fees, I was not deemed qualified to teach in Metro.

I find it difficult to believe that a city so desperate for teachers is not willing to bend the rules jus a little or waive the application fee for anyone who is willing to work in such a hostile environment.

I am not qualified to teach in Metro since, apparently, Metro “does not teach education.” What a joke. To make matters worse— I had to pay them to find out that I was not even qualified to work with Head Start. I went to Head Start! Shouldn’t that be enough?

If MNPS truly wants a better-qualified staff, then the Mayor, the Board of Education, and school administrators need to take a closer look at the methods used to recruit, retain, and reward qualified individuals willing to sacrifice their financial stability for a career in public service.

Now that I realize my education was a complete waste of time and money, is it any wonder that I am ready to give up on teaching and maybe even ready to leave Nashville for good. The local hardware store has more to offer including benefits!

The high rate of student mobility is compounded by the constant shifting of school personnel. Many schools may just lose the few experienced, dedicated teachers they still have left have, to surrounding districts, cities, and states.

Such instability in the system may even prompt the younger set to leave the profession all together and discourage future teachers from applying for jobs in Metro.

Everything we know about the positive outcomes in neighborhood schools is their strong reliance upon community buy-in and parental involvement. One thing that makes magnet, lottery, charter schools, parochial, and private schools so good is the fact that parents, teachers, students, and administrators fight to get in, and fight to stay there. The act of choosing, in effect, leads to an enhanced sense of community and builds a supportive, consistent, and structured environment. Calling this project “Fresh Start” is ridiculous-- it would be more accurate to call it a very bad ending!

Sunday, August 23, 2009

Applying Federal Law to the Public Option Debate

The Problem Statement

As health care costs climbed exponentially in the 1980's, so did the cost of health insurance plans. As a result, employers began to enroll their employees in managed care organizations, and many Americans were forced to leave their traditional indemnity type plans. With the advent of the health maintenance organization, there is a financial incentive for the underutilization of care. (Blumstein, 1996; Davis & Shoen, 1996).

In order to reduce financial risk, health insurance companies have restricted enrollment to individuals in poor health. By covering the minimal standards of treatment and excluding high risk groups altogether, major US insurance companies have realized that the health insurance market can a be an extremely profitable industry. The public sector absorbs the cost of unreimbursed care for chronic care in America (Robert Wood Johnson Foundation, 1996). Based upon these findings, it seems clear that the money being removed from the health care marketplace is fattening the pockets of CEOs and majority stockholders.

Recent trend towards localized government leaves individuals without a financial safety net. This is the least efficient manner to handle health care costs, and evades the premise that medical care is a natural right in a civilized society. Few Americans feel secure within the current system. The rising costs of medical care contributed to the recent market changes in both the administration and delivery of health services. The financial incentive to cover only the healthiest individuals ignores the fact that medical care is a social good.

Health Insurance Portability Act of 1996

Two years after the Clinton Health Plan was defeated in Congress, Senator Ted Kennedy and Nancy Kassebaum introduced the Kennedy-Kassebaum Bill in response to growing concerns about selective enrollment procedures used by health insurance companies in the private sector. In the final version of the Bill, insurance companies must limit preexisting condition clauses to twelve months. It has been estimated that this provision of the Bill will help an estimated 150,000 Americans obtain health insurance coverage.

There are many levels of the underinsured, including those without any coverage; effective policy must address the needs of the total population without shifting costs from one disadvantaged person to another. Kennedy-Kassebaum fails to address the cost issue—the primary concern for those at risk for losing their health insurance. It does nothing to help the uninsured acquire a decent health policy, and then provides no solution to the critical issue at hand— cost

Since Kennedy-Kassebaum does nothing to control the cost of health insurance and medical care in America, the Bill fails to respond to the issue of greatest concern to the citizens of this country: the cost of medical care. The Bill looks towards the states to develop consumer protections and weakens the regulatory role of the federal government. The majority of the American public is unaware of the fancy footwork involved with this legislation, and the demographics of the population it is intended to protect. In order to assess the utility of this Bill, it is critical to identify the populations at risk for loosing health insurance coverage and the underinsured.

Kassebaum-Kennedy focuses on a slim portion of the uninsured population, and those who would be eligible for COBRA continuation (Consolidated Omnibus Reconciliation Act of 1974). Of the 41 million uninsured Americans, only about 150,000 are expected to benefit from this legislation. The Health Insurance Portability and Accountability Act of 1996 is really nothing more than smoke and mirrors since it fails to address the true issue at hand—the simple fact that the cost of quality health care in America is becoming a privilege that only the wealthy can afford.

The Cost of Care for Pre-existing Conditions

An individual with high blood pressure may just require prescription medication. Cancer patients in remission may require chemotherapy, and a person suffering with a degenerative disease may be involved in treatment studies. Each condition requires individualized treatment that cannot be based upon the simple economic/cost-benefit analysis used in the utilization review process by large insurance companies. Clearly, the most effective treatment for one patient may not be the best for another. The time required for utilization review may present additional health risks and complications to a patient suffering from a chronic health condition.

Twelve months without insurance coverage may be financially devastating to some patients, and 63% of Americans have already forgone some type of medical treatment within the last year due to financial constraints. Publicity surrounding Kennedy-Kassebaum has hailed the bill as the "be all and end all in progressive legislation, however, in actuality it will only help about 150,000 people.

Recent studies have found that the majority of the uninsured population simply cannot afford to pay the premiums (Donelan et. al., 1996; Hoffman & Rice, 1996). According to their data, only 1% of the Uninsured population is due to current health status and exclusionary preexisting clauses, yet an overwhelming number of insured respondents reported an inability to receive medical care for chronic conditions. The majority of Americans with chronic illness are covered by some type of insurance, yet they are still subject to the utilization review process and access problems that deny or delay medically necessary treatment (Donelan, et. al., Hoffman & Rice, 1996).

Underwriting the Solidarity Principle

Traditional forms of insurance underwriting required that the contract explicitly state which illness or services are not covered by the policy, in advance. If the underwriter did not specifically state a certain condition in the contract, the insurer was held to the terms of the contract and required to pay for services utilized by the policyholder (Stone, 1994, as cited in Durant, 1996).

Increasing numbers of for-profit and non-profit insurance companies began to control costs by refusing to insure individuals who they felt would utilize more services. Insurers began to require health survey status questionnaires (refer to attachment A), and even began implementing AIDS and genetic testing to identify high-risk individuals (Brunetta, as cited in Gutmann & Thompson, 1996). In the 1980s, large insurance companies began including sexual orientation as a high-risk category, by using actuarial sound criteria. Such criteria concluded that gay men were a higher risk for contracting AIDS virus and refused to write policies for anyone believed to be homosexual, (Stone, 1994 as cited in Durant, 1996).

By limiting enrollment to the healthiest members of society, selective enrollment undermines the solidarity principle of health insurance (Davis & Shoen, 1996; Snow, 1996; Stone, 1994). By eliminating those who were suspect of using more services than their healthier counterparts use, insurance companies are able to offer rock bottom prices for young, healthy individuals. By excluding preexisting conditions and requiring certain individuals to purchase high-risk policies, the number of uninsured and underinsured Americans continues to grow exponentially (Durant, 1996).

More individuals are choosing not to purchase insurance simply because they cannot afford it. Even among those with employer based health coverage, the policies frequently exclude coverage for long-term illness or care of chronic conditions (MSNBC News Forum, 1996). Without a standard definition of preexisting conditions, these clauses serve as "wildcards" since they allow insurers to deny coverage for any illness that "manifested itself before the issuing date of the policy (Stone, 1994 as cited in Durant, 1996).

This statement allows insurers to deny treatment for benefits and services for the policyholder for undiagnosed illnesses or conditions of which they were unaware. As a result, the insurers began to demand medical histories of applicants and their families in order to identify high risk individuals (please refer to attachment A).

Legitimacy of Distributive Justice

While there is a legitimate role of government to distribute scarce resources among the nation's neediest individuals, sadly this is not the cause for the mismanagement of medical dollars in the United States today. There is a big distinction between an individual being denied prescription medication at their local pharmacy due to a cost-effective formulary developed by their Managed Care Organizations (MCOs), than an individual being denied a liver transplant because healthy livers are a scarce resource. While both may have equally devastating consequences, it is more difficult to rationalize a lost life based upon rigid cost benefit analysis and utilization decisions made according to formulas and cost-benefit analysis of treatment protocols.

"The political controversy over the distribution of health care in the United States is an instructive problem in distributive justice. Good health is care is necessary for pursuing most other things in life. Yet equal access to health care would require the government to not only redistribute resources from the rich, healthy to the poor, and infirm, but also restrict the freedom of doctors and other health care providers. Such redistributions may be warranted, but to what level, and to what extent?" Gutmann & Thompson (Page 178).

Blendon and his colleagues have reported similar findings in public opinion polls from 1992 and 1994 (Blendon et. al., 1992; Blendon et. al., 1994). A recent study by the American Medical Association found cost to be of paramount concern to an overwhelming number of Americans (Donelan et. aI., 1996). Of the 40 million uninsured Americans, only 1% attributes their failure to acquire health insurance coverage to their preexisting conditions. Among the uninsured, cost is cited as the primary obstacle in obtaining health insurance coverage. Only 1% of the uninsured attributes their lack of coverage to a preexisting condition.

Based upon these democratic principles of distributive justice, consistent opinion polls demonstrate the legitimate role and public desire for government regulation of the health care industry. It has become obvious that the federal government must intervene in order to protect natural law rights, the social contract, and the Constitution of the United States. Regulation is needed to protect the individual freedoms, liberty, and the pursuit of "health, happiness, and the American Dream."

If America is to be the "Land of Opportunity," then clearly individual health and wellness should be an ideal to reach for. Current models of distributive justice emphasize public consensus as a legitimate role for government intervention. According to a number of studies by Blendon and his colleagues, the public has reported an overwhelming general concern about health care in this country, (1992, 1993, 1994, 1995, 1996).

State civil courts are backed up with cases where HMOs have violated the First Amendment (gag orders), the Fourteenth Amendment (due process), and the rights of protected classes under the Americans with Disabilities Act. Countless examples of "anecdotal" evidence appear as headlines everyday across the country. (New York Times, 1996; The New York Daily News, 1996; Long Island Newsday, 1996; LA Times, 1996; Picayne Times, 1996; Columbia Spectator, 1996; Columbia University Record, 1996; US News & World Reports, 1996; Newsweek 1996; Healthline, 1996; The Tennessean, 1996; The Albany Times, 1996; The Nashville Scene, 1996). In their entirety, these case reports represent the human tragedy that lies beneath the web of the very worst of American capitalism: corporate greed.

Identifying Populations At-Risk

A study by The Lewison Group in 1996 reveals insight into the private individual health insurance market. Clearly, individuals choosing to purchase health insurance policies for several hundred dollars each month expect their health care needs and expenditures to exceed that amount Regardless of health status, a young healthy 25 year old who purchases an individual health insurance policy can expect to pay well over $300.00 monthly for a health insurance policy with Empire Blue Shield Blue Cross (based upon 1996 rates, current rates available from the New York State Insurance Department).

Since individual policies are not addressed in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), an individual policy with Blue Cross Blue Shield of Tennessee excludes preexisting conditions for 24 months (enrollment booklet available upon request). The critical markets in need of reform are the adversely selected individual insurance market, and the state's most vulnerable populations: children; the elderly; the chronically ill; the uninsured; and the underinsured.

For the millions of individuals who have lost their employer based coverage, the cost of private health insurance is prohibitively expensive. Many individuals opt out of the individual market and apply for public assistance when the need arises. Those who have retained their health insurance coverage through their employers are being moved into managed care despite their efforts to retain their indemnity style plans (Davis & Shoen, 1996; The Lewison Group, 1996).

Access to Medical Care

As routine practice, HMOs deny or delay care for all services that are not outright medically necessary. Growing numbers of individuals have suffered irreparable harm, and many have died awaiting approval from their HMO's (The New York Times, 1996; Long Island Newsday, 1996; The Tennessean, 1996; Healthline, 1996). It is hardly a secret that HMOs have fallen short of their promise to provide comprehensive health care for the "whole" individual by emphasizing preventative medicine, using medical management to coordinate care. There is substantial evidence that individuals with chronic conditions receive substandard care in HMOs.

A four-year longitudinal study of medical outcomes found that the elderly, the poor, and persons with chronic conditions were in better health when covered by fee-for-service plans compared with a control group covered in HMOs (Ware et. al., 1996). New statistics released in Washington, DC by the American Medical Association and the Robert Wood Johnson Foundation revealed the direct costs of individuals with chronic conditions account for 75% of direct medical expenditures in the United States (Hoffman & Rice, 1996; based upon the National Medical Expenditures Survey; raw data available on CD from the Department of Health and Human Services Washington, DC). 45% of the American population suffers from at least one chronic illness.

If managed healthcare has been found to deliver inadequate care to this population, then we are looking at 100 million individuals who are potentially facing personal and financial crisis as they are moved into managed care. The public already accounts for the largest payment of direct medical expenditures, which means the millions of dollars being made by for-profit insurance companies are not being circulated into the economy to assist in public health costs care. The industry made a 14.8% profit in the 3rd quarter of 1996, however these medical dollars were removed from health care and used to fatten the pockets of CEO's and majority stockholders (Healthline, 1996).

Based upon a new report from the Robert Wood Johnson Foundation, the direct costs for persons with chronic conditions represent 69.4% of national expenditures in personal health care (Robert Wood Johnson Foundation, 1996). Their direct medical costs are estimated at $4672.00 annually compared with $817.00 annually for individuals with acute illness (Hoffman & Rice, 1996; based upon National Medical Expenditures Survey 1987, not adjusted for inflation). This population is the most vulnerable to complications in their health and with their source of payment. Large insurance companies only provide adequate coverage for acute illness (Donelan et al., 1996; Hoffman et. al, 1996).

Medicaid Managed Care

Following Tennessee's lead, many states have enrolled their medically indigent populations in Medicaid Managed Care Organizations (MCOs). In Daniels v. Wadley, (926 F. Supp. 1305), the court held that TennCare violated the Due Process Clause of the Fourteenth Amendment since such procedures eliminate fair hearings and independent medical review of disputes. The court found the pattern of routine denials of care by MCOs participating in the states TennCare program to violate the Medicaid Act since it compounded the problem of institutionalized waiting periods for medical appeals pending independent review by the Medical Review Unit (MRU), (42 U.S.C. § 1396 (a)(8)).

Furthermore, the court ordered federal injunctive protection to participants and beneficiaries because no state law may preempt federal law by depriving individuals of their constitutional rights. The Department of Health and Human Services (HHS) was ordered to revise its utilization review procedures for TennCare recipients in keeping with the Medicaid Act (42 U.S.C. § 1396 (a) (8)) ensuring due process protections for all covered beneficiaries by requiring "services are provided with 'reasonable promptness,'" (926 F. Supp. 1305).

This case is one of 543 civil suits pending in the state courts for violations of the Medicaid Act (based upon a Lexis-Nexis search performed December 26, 1996). With the passing of H.R. 3507 into public law, (The Welfare Reform Bill) private citizens will find little reprieve in the federal courts, so any attempts to hold states accountable for violations of federal law will be feeble at best (Denkeret. al., 1996).

Managed care has shown itself to be a farce of "medical management" in light of all the condemning evidence to the contrary. Timothy Icenogle, a medical doctor in the state of Arizona commented in 1981, "We play sort of an advocacy role. I think the public demands something more from physicians than to just be a blob of bureaucrats, and I think we have to take a stand now and then. Our role essentially as patient advocate, is to tell them, well, just because the insurance company is not going to pay, that is not the end of all the resources," (Icenogle, as cited in Gutmann & Thompson, 1996). Never has this statement been needed more than it is today. Unfortunately, as more insurance companies refuse to pay for medical treatment, fewer resources become available for patients in desperate need of financial assistance. As Judge Kessler eloquently stated as she handed down her decision in Salazar v. District of Columbia, No. 93-452, December 11, 1996, "behind every fact found herein is a human face and the reality of being poor in the richest nation on earth, (936 F. Supp. Slip op. At 3).

Perhaps most distressing is the lack of accountability for mismanaged healthcare and improper denials of medically necessary treatment. HMOs claim immunity under ERISA, and leaving individuals without recourse in a sea contractual language and lengthy court calendars. It is evident that individuals protected under the Medicaid Act are not fundamentally different from other populations entrapped in the maze of managed care. They are simply those who have "had their day in court."

Due Process Protections

Since all Americans are theoretically entitled to due process protections under the constitution of the United States, it seems the federal courts are long overdue for making such a public statement. We are wasting precious time and losing millions in valuable human resources as we await decisions to be handed down from state courts. The Supreme Court of the United States has agreed to hear New York's request for an ERISA (Employee Retirement Income Security Act of 1985) waiver, making health maintenance organizations liable for medical malpractice in the state of New York.

When HMOs deny care from patients, it is ludicrous to hold individual physicians liable for the utilization decisions made by decentralized corporate review boards. It is time to take a serious look at tort reform, and demand action by the Supreme Court as they approach the date of New York's ERISA hearing. A blanket court ruling upholding Daniels v. Wadley, and Salazar v. District of Columbia is desperately needed to avoid an avalanche of liability suits filed in state courts. The court must uphold Daniels v. Wadley, and Salazar v. District of Columbia if further lives are to be saved in medicine rather than wasted away in the utilization review procedures. While we wait patiently for District of Columbia circuit court to order injunctive relief, the number of individuals suffering irreparable harm due to the systematic denial of medical care grows larger each day.

The history of Medicaid Managed Care does not provide a very optimistic look into the future of TennCare recipients and Medicaid beneficiaries in states around the country. Dating back to the implementation of the Arizona Health Care Cost Containment System (AHCCCS) in 1981, there are documented cases where "people reportedly died for lack of medical treatment before their eligibility was determined," (Varley, as cited in Gutman & Thompson, I 996). This leaves me to wonder why the states continue to enroll their most vulnerable populations into a system of managed care that has proven to be a disaster.

Perhaps worthy of comment is that Arizona is the only state to have voted Republican in every election since 1948—certainly provides insight into the conservative morale of the state. Although Arizona was the last state to accept the Medicaid cost sharing incentive proposed by the federal government in 1966, it was the first state to force its medically indigent population into managed care in 1981.

Violating Federal Law

Rigid pre-certification requirements and nonspecific utilization review procedures place strategic barriers to access medical treatment and services in Health Maintenance Organizations (HMOs). Pre-certification requirements are strategic barriers incorporated into the "black box" of utilization review that institutionalizes exclusionary waiting periods and routine denials of medically necessary treatment. According to federal law, "care and services are to be provided in a manner consistent with the simplicity of administration and the best interests of recipients," (42 U.S.C. § I 396a (a) (19)). Clearly, such rigid pre-certification requirements that complicate administrative processing and paperwork on the part of the enrolled beneficiaries is a violation of United States Code.

Furthermore, using primary care providers as a mechanism to limit access to specialists not only complicates administrative processing, but limits enrolled beneficiaries choice of health professionals beyond what is available to the general public in the geographic area (42 U.S.C. § 1 396a (a)(30)(A)). Certainly referral procedures do not "assure that recipients will have their choice of health professionals within the plan to the extent possible and appropriate," (42 U.S.C. § 434.29). Under this provision, it seems that any individual, especially those with chronic health conditions or disabilities should be allowed.

Saturday, August 22, 2009

The Write Words

When I first started posting this blog shortly after my 35th birthday, it was a gift to myself so I could live my life without being too scared that I might be discovered for being a little bit crazy, a little bit lonely, and making a whole lot of noise.

I started by disclosing my deepest secrets, often exposing to my deepest fears. Initially I chose the motto: "Too old to start over, Too young to forget."

Eventually that moniker evolved into something a little more challenging and inspirational, "Too old to start over, Too young to give up."

Now that my 36th birthday is now behind me, I plan to spend this anniversary celebrating my new age demographic bracket uncovering some the essays I have written that still need a little tweaking, and a whole lot of twacking! So be prepared to find a few typos, a few disconnected thoughts without making an obvious transition. Because I am naming the next phase of my life, you know, the "35 and up" phase, "Chapter II: A Little Bit Older, And a Whole Lot Bolder."

I have enjoyed the feedback I have gotten from so many people from all walks of life who have written in response to something I have written. Women I have never met, from places I do not know.

Women like Joy and Cat who encourage me to keep writing even if they disagree with some of my core values or excessive use of profanity. Women (or men) who have somehow managed to stumble across my writings in one of their many raw forms without realizing that just by contacting me, much of the fear and hesitation I once felt about publishing my collection of personal (and professional) essays have been replaced with a new found sense of pride and accomplishment. Fear and uncertainty have are quickly evolving into confidence and proliferation.

Personally, professionally, and spiritually, I hope to continue "kicking ass and taking names," because at this point in my life, it seems to be working. Maybe we should all start doing that a little bit more.. .holding ourselves and each other accountable for our actions... and at times our decision not-to-act.

You will notice that I am reclaiming my name and uncovering the many aliases I have used over the years... I am done hiding.

I'm am not perfect, and I will always struggle with my obsession to find just The Write Words, but I'm guessing it is probably good enough. Probably good enough so that most people will won't even notice if I forget to capitalize a proper noun or if I end a sentence with a preposition. So be it. How ironic that I happened to discover just today an essay I wrote for an application posted online? Sample of personal statement for pharmacy school -

Grassroots Advocacy. An interview with Stand for Children in Nashville, Tennessee. Content Producer: Elyssa Durant Published: Jan 10, 2008 ...

Sample of personal statement for pharmacy school -

Funny, because they didn't think I was good enough at the time. Subsequently... neither did I. Maybe they should consider retunrning returning the application fee.

You may also notice that I am reclaiming my name, and will be using try to cut down on the number of anonymous postings I listed under an alias because I was afraid I would be embarrassed if my work was not well received.

I am ranges from the less obvious accounts I have created to maintain a bit of distance between myself and my classmates, peers, and colleagues, but in addition to "Miss Elyss" or "Lyssie D." I am even willing to admit that I have created so many login accounts and user names to post anonymously, that I have forgotten most of the passwords to access my own content. But I am rather proud of the creativity I demonstrated when I came up with two of my personal favorites, "I.M.Phobic" and "EyePhobic." I never could get into that whole IM thing, webcam or chat rooms! The way I see it, it is bad enough i need to put on clothes and make-up to leave the house-- I'll be damned if I have to put on make-up to send an e-mail!

Yes, they were all me. They are a pert of me, because like so many women-- no... like so many people... I'm a little bit of everything... so for those of you who are listening and even to those of you who just wish I would shut the fuck up already; be careful what you wish for! The more content I create, the easier it becomes to let go... and the more I let go, the more I can heal. The more I can heal, the more I can focus on the academic issues that will always be my first and primary area of interest. However, it seems rather obvious to me now that the only way out is through. So, I will continue to write through the dark and hope that it I can become more present minded rather than being trapped by memories from the past.

To Joy, Cat, TA James, and a few others, thanks so much for the gift. I hope I can make you proud!

Tweet y'all later.... I really need to get some rest. The battle is still far from over.


Severely Disturbed

The correspondence below, along with many others who just pretend I don't exist.

Now I know exactly how much I mean to this City. PAY ME TO LEAVE!!!!!

There is nothing quite so disturbing as being invisible. Yes. I am homeless. I have lived through a shooting, an assault by a security guard at a medical facility, and with no other place to go, I rented a room in a house for low income adults who are SEVERELY FUCKING DISTURBED!!!!

Now I am deeply disturbed too. I am deeply disturbed that this is the best we can do.

At least I know I need help, and when to get it. Despite being owned by a CMHA [Community Mental Health Agency] and the recipient of both state and federal funds, the only rule in this house is don't call 911. In other words, when locked out or assaulted by one of the 3 other house mates, Mobile Crisis is OFF LIMITS. Now I know better than anyone that Mobile Crisis sucks, but when you are standing beneath a 6 foot woman holding a waffle iron over your head, 911, mobile crisis, IDGAF who intervenes, just someone do something!

I called the crisis hotline the other day. In all honesty, I just had no one else to talk to, my internets had been disconnected and sabotaged, the house phone locked up. I was just lonely (and locked out during a tornado warning)

But trust me, there is nothing quite like sticking me in a house with SSPMI (super severe persistent mental illness) that make me look almost normal and and a landlord with a no-call policy against Mobile Crisis and mental health helplines.

I have lost everything near and dear to me since I first offered to participate with the local police department after the shooting downstairs. That was in February.

Next, I lose Spotty because not a single person in Nashville has enough compassion to rescue an innocent animal that I rescued from one of clients several years ago. And you wonder why I'm so angry?


Don't worry, I know you want my silence, that message came through loud and clear.

You can take everything from me [actually, you already have] but you will not take my voice. And I can promise you this, my memory is long, and it is hot. Look it up assholes, hot memory.

Yeah... you did this. Now it's my turn.

Continue to sneak a peak every now and then.... your e-mails will appear on this page. Fuck you, and fuck you right back. Happy Anniversary, Elyssa. You have officially been a resident of this fine fucking state for exactly 13 years.

Kicking ass, not so much... taking names... you can bet your sweet ass I am!


Legal Aid / or pro-bono refused to will represent me since my parents are attorneys. They told me I would have to get the money for court fees and a court reporter from them. That just ain't gonna happen.

I am 36 years old.

I don't mean to be rude or disrespectful in any way-- you have been extremely kind and gracious towards me, I am just exhausted by this process and I think it is pretty easy to see that I am stuck between a rock and a hard place.

I want it all can make sure it on the record before I loose my section 8. When I called Metro Crisis, they told, "well, you are just fgoing to have to accept the fact that you are going to be homeless."
I'm not quite sure how one prepares to do that, but I'm trying.

Friday, August 21, 2009

Who Do You Trust?

No money to refile my app with Metro Public Schools. I don't have the application fees or the fee Metro charges all applicants to pay to process the application fees; the fees for fingerprinting, the FBI background check, or to update my transcripts with the certification office.

Since my Masters degree is an education, I am not qualified to do anything more than substitute at $10,46/hour. No benefits. No security.

The application fee is non-negotiable.
Once dedicated toward empowering youth through education, I was also drawn toward misunderstood children and adolescents when I went to work as a therapist, and crisis counselor in what my job with Department of Children's Services [DCS.]

I have a knack for connecting with the lost: I speak their language.


Voter Apathy: January 7, 2008, p. 2
[Available in full:

Monday, August 10, 2009

Things That Keep Me Up at Night Twenty Questions

Twenty Questions

1. Can I buy a cemetery plot in cyberspace?

2. Why is it illegal to commit suicide?

Correction: It is not illegal to commit suicide, it is only a crime if you are unsuccessful. Perhaps we should make attempted suicide a capital offense?

3. Can I get course credit for traffic school?

4. Who do you call when 911 puts you on hold?

5. Will the Department of Education ever realize it would be cheaper to hire me than harass me?

6. Shouldn't my financial planner be required to have good credit?

7. Why can't I find the word "synonym" in the thesaurus?

8. Have you ever needed a map to find items inside your own home?

9. Does Walt Disney have a death certificate since if he is indefinitely suspended in a cryogenics lab?

10. Why is it so much easier to lose my keys when I put them in an obvious place?

11. Is an accidental life insurance policy really an appropriate graduation gift?

12. Why buy life insurance to pay my final expenses? Who gets paid first: The tax man or the funeral director?

13. Have you ever received a check in the amount of 31 cents?

14. Have you ever been *69'd by the suicide prevention hotline?

15. Why do I have to make copies of documents I wish I could destroy?

16. Would you rather witness your own birth or at your own funeral?

17. Which would you rather be: a homeless person with agoraphobia or a claustrophobic inmate?

It is far better to be a homeless person with agoraphobia than a claustrophobic inmate. The homeless person could always commit a crime and get locked up. Problem solved!

18. Why is it so easy to remember the things I would like to forget?

19. Have you ever used a map so you can't find your way home? Have you ever felt lost when you finally get there?

20. Have you ever just asked yourself, "What the F*ck???" (Tom Cruise, Risky Business)

Criminalizing the Poor

It deeply disturbs me that some states finger print Medicaid, Food Stamp and Social Welfare applicants.

I was shocked to witness this first hand in New York State while I was a graduate student at Columbia. My health insurance would not cover due to pre-existing conditions and I went bankrupt (financially, morally, and in every way that counts) spending over $152,000 in student loans trying to maintain my health so I could finish my PhD in public policy. A pipe dream now... I ran out of money (and faith in the system) the last semester of my degree.

As if they don't treat those living in poverty bad enough in America, must they send an underlying message that we are criminals as well? They sure treat us that way.

Please tell me what crime I committed. I would be happy to serve my time. At least I could count on being fed, housed, and govt. healthcare!

Elyssa Durant, Ed.M.
Nashville, Tennessee
United States of America

On Not Being Able To Write

Membership has it's Privileges

[On Not Being Able To Write: Recovered File July 14, 1995]

I am writing this letter because I simply do not have the strength or courage to say these words outloud.

I did not lay when I told you that my father was denying insurance coverage, or when I told you that my mother felt that my illness did not justify her early return from Bermuda. I neither lied about these things, nor in my recollections of similar incidents in the past simply because I do not believe that a child could make such things up. I do not believe a child comes into the world innately evil deserving of such memories, and I will no longer take responsibility of the actions of two very bright, but very cruel individuals.

When I brought you the first draft of my Cornell essay, you told me there was much more to talk about than a learning disability, and indeed, there was. I wrote over one hundred copies of that essay, each version trying to explain some kind of failure.

Through each graduate application, I heard my father’s words echoing throughout my mind bringing me back to a sadder time. I will never forget these words:

“If you don‘t go to an Ivy League school, it doesn’t matter where you go...”

“These schools don‘t like to see kids who went to so many schools, they want kids who will stay there for all four years... “

The first letter I received was from Cornell. My first letter of rejection came from the graduate program in Health Policy Analysis at Cornell University. Yes, it represented failure, but I do not believe it was my own.

It was the failure of a society with rigid social norms. One that demands the sequence and continuity so many us lack in this modern day society of step families once, twice, three tines removed... yes, children of divorce, children like myself lack . A society that is afraid to see; afraid to hear; and afraid to speak. A society allowed a child like me to feel as though their entire self-worth is based solely upon the judgment of four strangers at an Ivy League Institution.

It is a society made up of individuals taught how to think, how to feel, how to conform, and how to hide. It forces us to place the world into simple categories so that we may understand the complexities around us. We are taught that a spirit is our savior and the law is our sanctuary.

We learn to recognize good and evil; black and white; blessed and damned. We are forced to choose good or evil; black or white; blessed or damned.

It is a society that allows us to believe in fate and destiny and blame failure and injustice on circumstance and gods.

It teaches hatred and intolerance and breeds complexity and anger. It is a society that I neither respect nor believe, and a society that needs careful evaluation and gentle handling.

There is no order, there is no justice, there is no comfort. It is the society of a people, and people in need of a soul.

There is a theory about psychologists that claims many people choose to study the field of psychology in an effort to understand their own mind. I have spent so many hours contemplating the source of my insecurities and fears.

Eventually I came to the fields of sociology and education, since I feel it was the combination of the two that facilitated my belief that a degree from Harvard or Princeton or Yale would make my problems disappear

The day I was accepted at Columbia was one of the most difficult days of my life because it was something I was told I would never accomplish (even though Columbia is only “the doormat of the Ivy League”).

I chose to go to Vanderbilt since it represented freedom. Freedom from the confused ideals of my parents, and marked a clear boundary between their world and my own.

In the hours before I left to drive to Ithaca for my first interview, my first interview, my mother told me I did not deserve to get into Cornell.

Because I was only 21 at the time I applied, I was being claimed as a dependent child on my mother’s tax returns and my father placed on the payroll that had enormous consequences even to this day.

I could not complete the FAFSA financial aid application, or apply for need-based scholarships since neither parent would release financial statements to the Dept of Ed or anyone else.

I begged my father to reconsider and sign on as a guarantor. His exact words were, “I am not willing to gamble $50,000 on your future,” so I was on my own once again. I thought that if I could just make it through Graduation, everything would be okay. I would be able to pick up student insurance and my pain, stress, and anxiety would all disappear.

I would no longer be subject to my father’s conventions of checks and balances: the stress of dependency would all disappear—I would finally be free from the ghosts and voices echoing through my head.

Sunday, August 9, 2009

Thinking Outside The Box: A Case Study

Hint: There is no box!

I often wonder why other people can uncover more information about my life than I can... Medical, Financial, Employment... even my next door neighbors are not somehow linked through the tiny web we have weave in cyberspace.

I'm a digger. To be clear, that is "digger." I never use the "N" word, and I'm way too proud to marry for money. I love information. I love to find, I love to collect it, but most of all, I love to use it. I love to dissect it, analyze it, formulate new questions and ponder the answers. I love the journey of natural inquiry... never knowing where my racing mind will take me, often surprised surprised by the answer, but always, always intrigued by the things I encounter along the way.

I may set out to find one answer to one question; only to find myself asking a million more.

It keeps me up at night, and allows me to avoid the day. My life is not unexamined, and my thought patterns may be far from typical, but the things I have learned along the way are by far the most intriguing and most unique.

I am not afraid to ask questions, nor am I afraid that I don't have all the answers. But as a digger, I do know that it is the path least taken: the creative, atypical mind that is riddled with creativity, tangential thoughts and questions that often deliver the most interesting answers. But sometimes, it is the answers that deliver us to the most interesting questions.

We often think that questions drive the inquiry-- at least that's what they tell us in school. To use the "scientific method"

And of course, we are trained, and practiced to never, ever color outside the lines. But aren't the best discoveries the ones we weren't searching for? The unexpected gift... the non-occasion. Outside of the box?

Finding my voice has allowed me to appreciate the silence. The hours between dusk and dawn where the rest of the world sleeps and I dig. I dig and I write. I fill the lonely hours with my innermost thoughts, and my very best friend. So as the rest of the world sleeps soundly, surrounded by loved ones in a sanctuary they call home, I fill myself with books, journals and information. Lots and lots of information. I love knowledge. I love the written word.

The beauty is in the every day. The challenge is in the unexpected. Call me crazy if you like (and many have) but I can assure you that there will come a day when all of that R.A.M. will come in handy. I am definitely asking the right questions... and maybe one day you will too.

I never dreamed my life would turn out this way at the age of 35. It seems as though it was over before it even began. My birthday next month has pushed me a little further over the hill, and a little less tied to the past.

I have a strong voice. A powerful voice. I have a story that needs to be told. I am tired of being silenced by the Powers That Beat. I will not be ignored and I will not be forgotten.

And though I may be too old to start over; I am definitely too young to give up.

Identity Theft: It's Personal

There are a lot of things in the financial world I don’t understand. Some are due to my ignorance, such as retirement plans or hedge funds. Others simply don’t make sense.

One such example was having my tax return rejected from the IRS year after year after year. It was only recently that I learned this was due to the fact that someone had already filed a tax return using my social security number.

I made countless calls to the IRS, and although they were eventually able to identify the person who had been using my social security number fraudulently, they refuse to tell me who that person was.

Without that information, I was left spinning in a world of chaos. Without that information, I was unable to file a police report for identity theft or recover any damages. It took the IRS 9 months to send my refund, something that most people receive in less than 2 weeks.

So, after about a decade of this situation, and going through the motions year after year, to provide alternative forms of Income verification, I think I am well within my rights to be a little agitated.

This year I planned to file for an extension since it was my understanding that several other related issues are being investigation so I could finally put an end to this madness.

Now I don't have much money, in fact I don't have any, but I find white collar crime despicable and repulsive.

When taken into account the substantial cost to society, not to mention the havoc it wreaked on my life, I respectfully think that maybe you should not assume that someone is making false claims just because you don't think it sounds "right."

Lots of things don't "sound right" however that doesn't mean they aren't true. Gotta go now, I have a date with eBay to auction my social security card to the highest bidder. Clearly, it is not worth anything to me so long as the authorities fail to do their part in ENFORCING the laws associated with Identity theft. 

Sure, it is easy to blame the victim as being irresponsible or somehow negligent in these situations, however I will refer you to some fascinating research that has been done on the emotional consequences of Identity theft. The cost is far more than just an issue of financial discomfort; it is something that can ultimately leave you questioning your own identity.

It should be noted that Identity theft is a criminal matter, so whatever costs associated with such events, the victim is not reimbursed for any of the costs associated with having their life disrupted by something that is ultimately completely beyond their control.

It happens more often than you think, and it is a complicated, intricate, and time intensive to resolve such crimes... To be continued...

edd, edm.
Sent via BlackBerry from T-Mobile 

ORIGINAL POST 2009-08-09 12:45

Answering the Call in Nashville, TN

Answering the Call: Is there anybody listening?
Post From Ned V:
“Hey, sounds like me! I’m headed towards ruin quick. Hope all is well.”

Post From Ned V:
“I’m not good, Elyssa. Very depressed. I was such a different person when I knew you. But maybe I will be different soon.”

Reply from ElyssaD:

God, Ned, I wish we could talk. Based upon what I’ve read through your interviews and posts online it seems you are going through the same emotional chaos I was experiencing that first year we met in New York.

A friend just checked himself into a psych ward after a suicide attempt, and I feel so helpless. I care and respect you both so much. It is funny because I always thought if I could just finish that damn book I was working on ten years ago… or law school, my Ph.D.- any number of things- everything would be okay. I’m confused because you finished your book, Rob finished law school… yet I finished nothing.

A few weeks ago I “lost my shit”, so to speak. Then I read your interview and was completely blown away. I used to be the crazy one! Now I have my sanity back, but nothing else.

Having been through several crises myself, I formed the philosophy that when you see someone in crisis they become so overwhelmed and confused they do not know what to do, or how to dig out of the hole they have dug for themselves. I decided rather than asking, just figure out their first step and give it to them, no questions asked, no thank you necessary.

How many people have said, “Call if there is anything I can do!” and when you actually call, you receive nothing but disappointment and regret. I decided never to ask somebody what they need, mostly because even they don’t know.

When I came to the realization a few weeks ago that my transient existence is so tangential no one would notice if I never took another breath, I tried to figure out what I needed. I started going through my old journals to see if I could identify the missing element of my life. That “thing” that would simultaneously make it all goes away and come together so I could be a whole person again.

That thing is a figment of my imagination. I used to think it was being loved by a man. I had that, and it wasn’t it. Then I thought it was having money. I had that, but it wasn’t it either. I thought it could be having health insurance- still, no. Perhaps it would be having that “oh-so-critical” Ivy League degree. I have that, and it still wasn’t the solution. None of those things could have been “it.”

In truth, the thing I need most I lost long ago.


Perhaps I never really had it at all. I guess some things can’t be bought, learned, earned, or acquired.

I think of the long twisted road, and I remember one of my favorite childhood movies with a girl named Dorothy so determined to find her way home after a great storm. Disillusioned and distracted, Dorothy would not yield to the many obstacles that had been placed in her way. Determined to meet the great Wizard, she stuck to one path.

Yes, there were detours, obstacles, and the Wicked Witch of the West. Each of these obstacles may have taken her, yet she never once lost sight of the road home. She believed in one thing: The Wizard, and his ability to bring her home. Having great faith and determination, she never strayed far off the path of righteousness. Dorothy had a clearly defined goal, a means to get there, and a bright yellow brick road to guide her. Through her determination and unyielding faith, Dorothy never once doubted she was on the right path.

In the Wizard of Oz, the yellow brick road may have been Dorothy’s path, but her determination and blind faith was able to bring others along the road to enlightenment. The lion found his courage; the tin man got a heart. The scarecrow got some brains. Even Dorothy got what she needed most.

Dorothy began her journey looking for one thing: To get back to where she began, to find her way home. Dorothy teaches us a valuable lesson. Yet she was lucky enough to know what it was she so desperately longed for... home.

I can’t click my heels three times to find my way home, for sadly I know not where home is. They say, “Home is where the heart is”. Perhaps that is part of the problem. For some of us, our childhood homes were not places of happiness for which we’re nostalgic. They are places from which we run, endlessly seeking our own magical place, hoping we come across a road that clearly guides us toward our destination.

Of course we will encounter challenges that take us off course, and it is up to us to find our way back to the path. Unfortunately, if you stray from the path too long, there is a point at which we lose our direction and faith. As I grew older, I realized my feelings of detachment went far beyond a dysfunctional childhood or a broken family life in which my sister and I never even lived in the same house for more than a year, only in the summertime.

No matter how long I have been in Nashville, in many ways I am still a stranger. A stranger, because homeless is a state of mind. In my mind, I think home is a place of acceptance, shelter, forgiveness, comfort and recognition. For most, going home means to reconnect in a way you are reminded you have something or someone, who will always have your back. Home represents more than a structure; it represents a strong foundation always available whenever you need to safety and comfort, and protection.

So this is my home. I don’t necessarily feel safe here, but I do feel consistent. I do not have to worry that I will be forced to switch schools, neighbors or friends every six months because my parents could not get it right. What they failed to realize is just how very wrong it really was. Changing schools, friends, siblings… even myself- just enough to fit in each time. But after 16 years of constant change, I never got the opportunity to find out anything real about myself. Even my name was changed when I moved--- my dad called me “Liz,” and my mother called herself any number of last names as she desperately sought to hold on to her youth, beauty and delusional fantasies of entitlement and sacrifice. I think she may actually believe her lies to be true.

I never had plastic surgery- couldn’t afford it anyway- but I do have a clear memory, vivid nightmares, and a place of my own. I also realize that until I can live free from fear and dependence I will never be able to know what it feels like to be at home. If home is where the heart is, homelessness is just a state of mind. Today I have some hope I might someday no longer feel as homeless as I do at home. Now I know more than ever that home is far more than a concrete structure or family property.

I will always feel a bit homeless at home. Knowing you are that which remains constant, regardless of any dreams I may have, I will never feel constant enough to bring a child into this world, despite my desire.

I envy those who feel they have so much in their lives they can trust without reservations that the world is a loving enough place to share with a child of their own. My mother told me long, long ago that I can never have children. She also told me last year I could not have a dog. My own mother does not think I am capable of raising a puppy.

Maybe she’s right- she put her fears into action when she donated my cat of 14 years to an animal shelter under someone else’s name. I adopted him back from the animal shelter 40 miles away after learning of her use of another person’s name so I could not find him on my own. I was without any ties, and here we are again.

Only a few days left to come up with a plan to take the two of us far away, to a place where we could be safe and live free.

I will not look elsewhere to find the essentials things healthy children receive that makes them healthy adults. I will never be “healthy” but I do wish I could give more than that which I’ve received. I regret not being the kind of community member I believe I could have been, and I’m not sure I will get over the sheer humiliation of having to live this way for so many years when I could have been doing many great things for society that I believe I could have accomplished.

I can’t regret needing constant reassurance, recognition, or validation. However, I will always question if things would be different if just one person took the time to show me I was worth it. To say I deserved more than that I could afford and recognize I do give so much in so many other ways.

Ways people cannot calculate, or see how badly the recipients needed my gifts. It’s the little things. It’s Cody, its Desiree- but above all, it was me.
Setting goals. The feelings knowing I was no longer subject to biannual custody disputes. The realization that homelessness is merely a state of mind. You see, it is that I doubt myself; I just don’t trust people won’t do horrible things, even if that simply means doing nothing at all.

I do have much love to give, perhaps too much. So much it often pours out of me in inappropriate sentimentality. I know when I need to keep to myself, when my anxieties start rub off on others and make them a bit anxious. I know from seeing the reactions to my anxiety, and it only makes me worse. It can be a curse; can be one of my worst attributes, but sometimes that sensitivity is a wonderful and god given gift.

Should that prevent me from getting out into the world? Just because how other people think I should be take a disliking to me? That’s not my job. I have spent more than half of my life in self-imposed isolation, and the other half wondering how I can be less annoying and high strung so others would want me around. The truth is, I am annoying, but I am also perceptive and very aware. Sometimes it is even on purpose.

I should not have to live in isolation because I have nervous tics or sometimes say the wrong thing. But regardless of what people seem to think about welfare recipients being lazy bums, guess what? Fuck you. Because of attitudes like that, I have chosen to keep to myself in case I really am so horrible to be around. So horrible my own parents think I would be better off dead.

It would be easy to withdraw. To leave everything behind and simply go live an isolated life, dismissing those around me and the constant judgment by societal standards from those who have no understanding. But, where would I go?

Ten years “down the road” and now more than ever, I realize I am truly and deeply “homeless at home.”

Sent via BlackBerry from T-Mobile