Do Unto Others as You Would Have them do unto You!

If you are reading my blog, I feel it is safe for me to conclude that you live by the Golden Rule.  Similarly, I suspect you can recite the ten commandments. We instill these beliefs subsequent generations in the way we live and things we say. There’s a sense of orderliness to this. As Rabbi Kushner writes we can’t help but believe that God will protect good people from suffering, pain, and tragedy if we live a proper life.

Did you read Rabbi Kushner’s 1981 best-selling book When Bad Things Happen to Good People?  I did as a young social worker hoping I would find the right words of comfort to “fix” the pain of my patients.  I mean, who deserves to get cancer?  What parent deserves to lose a child?  Fast forward to today’s conflicts played out 24/7 on television and social media. How are we to make sense of why a loving all powerful, all loving God ‘allows’ these events to happen?

Puritanical Logic

Good deeds equal good karma equals prosperity and a happy life, right?  Caregiving is a prime example we care for family and friends, why? I suspect most of us are banking on the kindness of the next generation to offer care in the future. Only you can articulate your motivation however, it is human nature that we do it for self-referential reasons (me included).

The Hazard of Cause and Affect Thinking

How do we respond when bad things happen to good people?  Consider this, the world is experiencing a rise in natural disasters. For example, a flood or drought that destroys a community. Or how about the sun exposure from the summer day at family picnics, trips to the beach with the grandkids, or working outdoors is the same sun that cause skin cancer or heart failure from excessive heat exposure.  It is not limited to climate disasters.  None of us can make sense of the mass shootings or accidents.

It is so hard to accept that events can be random.  Most of us like the illusion of being in control.  My actions lead to my earned reward or punishment. Be honest, when you hear someone was diagnosed with some horrible life-altering disease, does you mind start to create a pretty linear narrative for why that happened? A friend diagnosed with lung cancer “oh, she was a smoker.”  A child diagnosed with a rare disease “well they live near a power plant.”  See how linear and clean this can be?  We have it all figured out.

Medicaid HCBS Policies Changes Underway

The Kaiser Family Foundation (KFF) conducted a survey of Medicaid HCBS officials to understand what PHE policies will change this year. Keep in mind CMS offered states the right to accept a PHE extension till year 2025. Taking an extension gives state administrations the ability to incorporate new programs and approaches used during the PHE.

Reduce Services and Reimbursements

KFF reports that twenty-seven states will continue to utilize virtual eligibility assessment which enables staff to process more applicants without traveling. Twenty-one states intend to reduce client services below the PHE level. Prior Authorization restrictions will return in eighteen states which, like limiting utilization, is a cost cutting measure without disenrolling a client. Provider payment rates will be cut as well in nine states despite the ongoing labor shortage that HCBS continues to experience. KFF reports that eight states will cut home delivered meals services expanded under the PHE.

HCBS Labor Shortage Ignored

As we reported during this crisis, workforce shortages directly impacts the effectiveness of HCBS and residential care. State policy makers have short attention spans to the cries of burnout and rising mental health conditions rising in both workers and clients. Unfortunately, KFF survey reports that eleven states will cut payments to spouses, parents of minor children, and legally responsible adults from being paid. Moreover, five states are ‘firing’ family caregivers.

The Pendulum Swings Too Far

The demand for Medicaid funded services is set to explode in the coming decades. Americans are living longer and sicker than any generation in our history. I believe PHE was a fire drill for the future, yet many states are content to return to old practices rather than innovating and expanding less expensive HCBS programs to service the increasing demand.

Work, Retire, Happiness

The generations currently over age sixty-five grew up an industrial mentality of work hard for decades, retire with a pension and savings, and then live out years of leisure in absolute happiness. How is that working out?  Then a curve ball ends up on your bat your feel resentment, jealousy, anger, and likely self-pity (my personal favorite). It feels like a betrayal. I mean, you held up your end of the bargain by working hard and sacrificing to get this pay-off; and then wham you strike out.

Randomness Rules Our Lives

Have you heard of the athlete that wears the same underwear for every game? How about people who are superstitious and carry out their rituals as the shield against bad karma. I am as guilty, If not more, of wanting to feel I am in control and eliminate the potential for unforeseen events.  Our brains crave order and a coherent narrative for our actions and motivations.  These rituals do not influence the outcome but don’t ask those of us who believe we are in control to accept that randomness rules our lives.

Are You Job?

I am no biblical scholar however Job’s story stuck with me.  Forgive me for over-simplifying his journey but here it goes.  Job was a faithful man. He raised his family, worked hard, and lead a holy life. Satan tested Job’s faith with a series of horrible tragedies.  Ok, my sketchy (maybe slightly inaccurate) telling of Job has a purpose. He suffered miserably and probably hurt to his very core. You could say that Job had horrible luck.  The guy lost his family, home, he was left alone and penniless, but his faith remained strong. What was his secret sauce?

How Will You Respond to Suffering?

Can you free yourself from self-blame when random tragedy hits?  Can you overcome the instinct to say, “why me and not him?” Normal, average humans, not Job (teacher’s pet) will lash out when misfortune happens (count me in on this one). I want an explanation. Tell me something that makes sense to my pea brain that  despite my good deeds and hard work and am now suffering from pain and disappointment.

Out of Tragedy We Need to Rally Hope

Rabbi Kushner’s young son suffered a horrible disease and died.  Kushner used his experience to write this important book to teach us to focus our energy not on why this happened but how will we gather the physical and emotional resources to overcome this pain.  Not to go down another rabbit hole, but remember Elizabeth Kubler Ross’ Stages of Grief?  In the end after all the crying and anger and self-pity, our grief turns to acceptance.  As a social worker I knew my role was to focus on acceptance.  The journey there can be rough because bad stuff does happen to good people.