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A list of 3 things: A blue truck. A gold watch. A yellow rake. (A requiem)

This will be my Year in Review post for 2017. It is also a requiem. (If you have never heard Faure’s Requiem performed live, you really should, by the way).

A requiem for my Father.

He died yesterday afternoon.

This post will be raw and rambling. I have shepherded it a bit, like a drunken sheep being nudged by a more drunk shepherd through rocky crags and valleys. But for the most part I wanted you to see this as it is. If Faulkner perfected stream of consciousness, I have refined (butchered?) stream of consciousness and compounded with ADHD.

Last year’s Year in Review mixed reflections on my personal life and thoughts on Medicaid industry happenings. This one is pretty much just thoughts on personal life. So if you are here for the Medicaid insights only, probably a good one to skip.

 

Last chance to stop reading. Tears ahead. Bridge may ice in winter.

 

Long time readers will know I gave up long ago trying to disentangle the “personal” from the “professional.” We are people: whole, integrated people comprised of a million different parts and hats and roles and desires and heartbreaks and dreams. Fearfully and wonderfully made. We choose which parts of ourselves to show in certain situations, such as work or LinkedIn. But to choose the same parts to show and the same parts to hide every single instance depending on the setting is strange. That is called acting. And I am not an actor. At least I hope not.  Let us not be actors. Let us sometimes show each other our humanity.

If you read my end of year message last year, you know it was also a sort of requiem for our dear dog Keegan.  If you are a glutton for punishment and just want to cry, here’s a link to that one – https://www.linkedin.com/pulse/saying-goodbye-2016-year-review-clay-farris/

 

But onto the Goodbye to 2017.

 

People’s lives sometimes are often symbolized and summarized by objects they used. Or gave. Or held onto. Or coveted and gave all their precious life to possess. Don’t be one of those people to whom the latter sentence applies.

This list of three things are what summarize my thoughts on my Daddy this morning. There was of course so much more to him (there’s so much to any person), but I like threes. And you need to stop reading at some point eventually, so we will stick with three.

A blue truck

As far as I know this was the only car (vehicle) Daddy ever bought new. It was a 1986 Ford F-150, dark blue and gorgeous to this day as it sits in my yard. Sure, now its rusty and has a window that won’t roll down. But that model is still a popular one 31 years later- I had someone just the other day stop at the driveway and ask if they could buy it. Dozens of people have asked that over the years I have driven it. I assume they are people – like myself – who sold a car they loved (mine was a 1964 ½ Ford Mustang) and regretted it and forever chase it on the wisp of a hope to catch that feeling of having it again. Of driving it again. And having all the feelings they had when they had it the first time.

My wife complains about The Truck sitting in the yard. But she is not from here and she does not know that having an old truck sitting in the yard in Alabama is an important status symbol. To not have one is to be of apparent low-class and not be aware of the rules of your culture. When in Rome.

And besides, I know the truth. When whatever beater of a car I had would break down, Daddy would let me borrow the truck for months at a time. Girls in college used to think it was cool.

But the thing about The Truck is not The Truck itself. Its what it was used for. And the memories I have being in it.

Like the time when I was 10 or 11 and Daddy, my grandfather (PawPaw) and me were all 3 riding in it on our way to a primitive island off South Carolina to go fishing.  As we drove 50 miles an hour on some country highway, a lawn mower threw a rock through that little triangular smoker’s window right in front of the main window. Little pieces of glass shattered and it made a terrifying noise. But we were all ok. It became a vivid memory that a small child held onto as he became a man.

Or family vacations we took in it, with the three kids riding and sleeping in the bed of the truck in a campertop. 2 things – that seems so insane in today’s age. When was the last time you saw someone riding in the back of moving truck? Yes, I know its unsafe. But it is glorious. When was the last time you rode in the back of a moving pickup? Don’t you want to? You cannot deny it is fun. And #2- I am glad he got rid of the camper years ago. I have always thought they were nerdy.

One time the truck was converted into a diamond engagement ring. I had known my wife for all of four or five months before I couldn’t take it anymore and I had to get a ring on her finger. Problem was I had a yellow sports car. And between the payment on it, insurance (I used to get lots of tickets), costs to park it in downtown Hotlanta and the 93 octane it just had to have – there was no ring money left over. So – yet again – I sold a car I loved. But this time it was because of a woman I loved and I still have the woman so I don’t miss the s2000 as much as I miss the Mustang.

When I sold it, I started driving The Truck. But since my wife (fiancé at the time) didn’t know the backstory then, all she saw was this guy who used to have a fast, sexy yellow car now was pulling up in a very old truck.  But that all turned out ok (see comment above about how The Truck wins girls over).

The Truck cost $6,000 brand new in 1986. There is no way it hasn’t saved $30,000 in moving fees alone. All the times I used that truck to move me, or my roommates or friends. The times he did the same. Over and over and over.

I love the dent it has in the door from Mrs. Jackie, Daddy’s neighbor 4 doors down who loved him so much and is so sad at his dying. I love how hard it is to drive (except for me, and that’s the truth. My little brother David never could drive it without grinding the gears), and that I will have it to teach my children how to drive a stick. I love that he gave it to my son Caleb (when he was 4) to fix up when he is older (he’s 7 now, so it will be sitting in the yard a while, honey).

I love how its got at least 300,000 miles on it, but we are not sure because the odometer wasn’t working for a few years in the early 2000s.

I love the Old Blue Truck.

A gold watch

Daddy was a preacher. And part of being a preacher (usually) is not having much money. This is important in a paragraph or two, so hang on to it.

I am an overeducated fool. I have two – count em’, too!- masters degrees that are basically unrelated to each other. And I took out student loans for both of them that took me ten years to pay off. (So maybe there are other ways to be broke besides preaching. But this is not the sentence you need that other sentence for. Just hang on to it a bit longer).

When I walked for my masters in history, I flew back to Birmingham from Baltimore where I was finishing my masters in public health. And Daddy gave me a gold watch with the UAB insignia on it. I will never forget how proud of me he was. And I will never forget what he said when he gave me the watch – “I wish I could give you more, but I don’t have a lot right now.”

(That was the sentence).

That was in 2002. For a few years I did not wear the watch. It just did not fit whatever silly fashion style I was trying to pull off back then I guess.

But when he started to get sick a few years back, I pulled it out. I wore it whenever I could. And when I would go to see him I made sure I was wearing it.

And as much as I generally hate possessions, it has become precious to me. I often think of Bruce Willis’ storyline in Pulp Fiction when I think about this watch. If you haven’t seen the movie, Bruce Willis is a boxer who has gotten mixed up with the mob. He throws a fight and is rushing to get out of town when he remembers he left his watch. You learn that it was his father’s watch. I understand now why Bruce Willis risked his life to go back and get it.

I love my Gold Watch. Though Daddy thought it was a pauper’s gift when he gave it, it became priceless to me.

A yellow rake

We moved back to Birmingham 5 years ago to be near my parents for when they started to need help. And having gone through the last 2 years of Daddy’s depression, then brain cancer, I am so grateful and praise God for doing whatever He did to put that burden to return home on me / in me.

When we moved back we bought an old 1970s brick ranch with 2 acres. For me the main feature was a large garden that had been used by neighbors (it still is) and the previous homeowner.

One of my first memories is of a garden Daddy made at the first church he preached at. Like all things Daddy did (and that I do), he way overdid it. The garden was ridiculously large. And he loved it and tended it with a passion.

Another of my first memories is running away. I was about 7 and was upset for whatever reason a 7-year-old gets upset, and I packed my suitcase full of books and went and ran away. To the end of one of the rows of corn.

But back in the present (or 3 years ago, the recent present if there is such a thing), we bought this house and started a garden. My ulterior motive was to lure Daddy up to our house (we live on a mountain a few miles from them. Or from Momma, now. I guess). You see, once a preacher, always a preacher. And even though he hadn’t had a church for decades, he still spent all his free time doing something to help somebody. Like lots of somebodies. And usually the undesirables, who are never conveniently located. So Daddy was gone a lot. To nursing homes or mental institutions or prisons or bridges under the interstate. But he was also around a lot. The trick to increasing the ratio in your favor of more time with him was to involve fishing or Auburn football.

Or maybe a garden.

I had dim memories of him loving that huge garden way back when and thought if I made a garden he would come.

And he did.

He planted 2 rows of beans two years in a row. And when I say planted, what I mean is he spent 3 solid days crafting a hundred or more perfect little hills of dirt to plant them in. And another 2 days constructing a support system out of bamboo and garden wire for them to climb.

After he planted, he would again disappear off somewhere. Like out of town somewhere to see an old friend. But he would call. To check on the beans. “How are my beans doing? Have they sprouted yet? Have any started to climb? You know, there’s that one down at the end of the first row, I think it will be ready to climb in a few days if we get that rain.”

Once beans sprout you start to see weeds sprouting, too.

And that’s where the Yellow Rake comes in.

Daddy meticulously hand-weeded two 80 foot rows of beans. On his belly. Multiple times a summer. It took him days and days each time. And when he was done, he used this little yellow rake he picked up somewhere to sweep up the brush. That rake is now in my shed and I will use it come spring in the garden again. I will use it until it cannot be used any longer.

I got a Yellow Rake out of the deal- but I also got more time with my Daddy.

At the end

I don’t know if you have had a front row seat to death yet, but this was my first experience. And I feel the need to talk about that experience just a bit and maybe even provide others a little bit of what to expect if you haven’t gone through this yet.

Daddy was in in-home hospice for about two months. He got a diagnosis of stage IV melanoma with metastasis to the brain and it was all pretty quick from there. A few weeks ago, the decline really started and on Wednesday we were pretty clearly locked into the final path.

Tuesday morning, we realized we would run out of morphine soon. All day was spent frantically trying to work through health system paperwork and health system failures – until finally at around 9pm that night I found myself in the Walgreen’s drive through with my sister picking up new supply.

The hospice nurse came that night and checked vitals. She thought it was soon, but not tonight (its such a hard thing for them to be asked “when” by the way. They know it’s the only real question families have, but they feel so unequipped to answer this. So please ask, but understand how hard it is for them. Give them grace. And hug them, too). So I went home to be with my wife and kids. It has been hard on them because I have been gone a lot these past few weeks.

I went back down to Momma and Daddy’s house the next morning (yesterday) and there was no real change. I stayed a while and went back home to busy myself with a fireplace-painting project. Anything to distract from the waiting. To distract from When.

And then – just when I had painted white over the very first little strip of grout in that dark 1970s brick fireplace – my phone rang from across the room.

It was my sister. Using all the strength she could muster to hold composure to deliver that terrible message of two words, she said – “Dad’s dead.” And then her voice just fell apart and she could only cry and I said I was on my way.

 

It has all been a blur since then.

 

Within half an hour of me getting there, a team of people began arriving. First a sweet social worker named Sharita. Then the nurse Cynthia who cared for Daddy these last few weeks. Then a chaplain from hospice. Then the preacher from the church (you can never have too many preachers at a time like this. Counting Daddy that made 3 preachers in one house). Then police.

The house fills up quickly and it reminded me of how a labor and delivery room filled up quickly with the birth of my second child. When complications are expected, the delivery room can fill up with extra nurses and doctors within seconds. And I thought it was strange and ironic and symmetrical that, at the time of death, Daddy’s house filled up with people there to help him just like the hospital room filled up when Caleb (who is named after him in an interesting way, I will tell you that story at a conference sometime later) was born.

And just as all this activity happens in order to close out hospice processes and to make the death legal and to help the family in that initial shock, the family has its own tasks to begin. You have to start calling people to let them know.

I grabbed Daddy’s phone and just started going through his contacts. I made ten calls before I got through the “A”s. You see when you live a life like his, you end up knowing a lot of people. And those people loved him dearly because he loved them. And you have to tell them that he’s dead. But – and perhaps more importantly – you have to tell them that they mattered to him and that’s why you are calling them.

So many calls to be made.

About 20 percent of the entries were under nicknames (Daddy loved to give people nicknames), so that made it harder. “Have you called James?” “I don’t know, is he “Elmo”? Or “Skinny”?

 

And if you want to stop reading this right now and go through your contacts and tell those people they matter to you I won’t mind. Not one bit.

 

And then the hospice team and other non-family members start to leave one by one. And the house is quiet for a moment.

But almost immediately the stories of joy and old memories start to roll off the tongue. Laughter sets in quickly while the body lies in the next room. As statements of his current joy hanging out with his sweet Jesus are made, a clear sense of relief for the ending of the suffering is palpable in the air. Its startling (but wonderful) the resilience of the human heart. The grace that God gives us in moments like these.

 

The Widow has the funeral home staff laughing while they sit on the couch filling out the paperwork. “A traditional funeral (with or without a wake)?”

 

That’s when I realize the human heart can hold extreme sadness and bounding joy at the same exact moment. When your brain holds 2 conflicting thoughts its called cognitive dissonance. When the heart does it, it more resembles love or comfort or peace (or something I can’t name really, but it’s a good thing). Joy and sadness mixed together make you human. The mixture sustains you.

 

But then the people from the funeral home let us know there is one more thing to be done. Because there is one person who hasn’t left yet who must leave.

They take the body.

And there is a new void. One you didn’t fully appreciate just moments ago when you were laughing. A hole. A sense of weight pulling at you.

Just before you have a chance to fall into despair, your phone starts ringing again. People who you left voicemails an hour ago are now returning your call. And some are crying. Some try to comfort you. But all are telling you how your Daddy impacted their life.

 

A brief bio of Bill Farris

I realize that my Father’s life was one of extremes and passion. Eerily similar to mine.

He went into the Navy to pay for school on the G.I. bill. Became an auditor, then an accountant, then a preacher, then worked at a hardware store, then a tire shop then became an accountant again. But at no point (except for the 3 times he was completely way-laid with depression for 9-12 months every 10 years or so) did he ever stop tirelessly loving people and telling them about Jesus. He told them with words but mostly he told them by fixing their cars, or bringing them groceries, or visiting them weekly in a mental institution, or cutting their grass, or moving them cross-country or being the only person standing up for someone wrongfully accused and then housing that person in his own home when that person was finally let out of jail. And a million other ways. If you ever met him (and you may have – he talked to every single stranger he ever met, and he drove all over the Southeast to see one of his kids or his beloved Auburn Tigers), then within five minutes 3 things happened: 1) he knew your life story, 2) you knew his, and 3) you had heard the name of Jesus.

He lived a life of passion and extremes. But in a good way.

Then he developed melanoma in lymph nodes in his scalp in 2016. He became depressed again. Had multiple other health issues. In early October this year he had melanoma tumors removed from his brain. He started hospice in November. And he died yesterday at the age of 68.

I always called him Daddy, no matter how old I got. Up to the end. Like a child. Never dad, or father. Daddy.

 

Closing Up

 

That was a lot to read, I know. Thank you for reading it.

Let’s close out with a few quick thoughts.

The death of one’s father is a turning point in everyone’s life. Both a hardening and a softening of the heart. A quickening of the plot. I do not know what 2018 holds, but I hope and pray it holds change and renewal. I pray that for you and for me.

If you pray for me, pray for me to find a path that involves evangelism. I have resumed playing music recently. If you suddenly don’t see Mostly Medicaid you may be able to find me singing old hymns in people’s homes, nursing homes, prisons or under a bridge somewhere. Let us hope. One can dream.

Write to me @ clay@mostlymedicaid.com. If you want to share, I want to listen.

If you would like, send donations in memorial to Bill Farris through the Gideons .

 

Thank you for reading this. You didn’t have to. And I really appreciate all of you who read week to week and let me know it.

 

I am reminded of one of Daddy’s favorite songs (he sang a lot):

This is my story

This is my song

Praising my Savior- All the day long.

 

I can’t end it better than that.

 

 

Clay Farris

December 29, 2017

Birmingham, Alabama

Onward and Upward!

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Medicaid Acronym of the Day – BRFSS

The Behavioral Risk Factor Surveillance System (BRFSS) is a United States health survey that looks at behavioral risk factors. It is run by Centers for Disease Control and Prevention and conducted by the individual state health departments. The survey is administered by telephone and is the world’s largest such survey. In 2009, the BRFSS began conducting surveys by cellular phone in addition to traditional “landline” telephones. The BRFSS is a cross-sectional telephone survey conducted by state health departments with technical and methodological assistance provided by the CDC. In addition to all 50 states, the BRFSS is also conducted by health departments in The District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. [1]

Individual states can add their own questions to the survey instrument, which consists of a core set of questions on certain topics like car safety, obesity, or exercise. States get funding from the federal government to administer these questionnaires, and they pay for the additional questions themselves.

The U.S. federal government can then compare states based on the core questions to allocate funding and focus interventions. The states themselves also use the survey results to focus interventions for the public and to decide what is worth their while to focus on. City, county, tribal, and local governments also rely on BRFSS data for information about their jurisdictions.

Further reading

https://www.cdc.gov/brfss/index.html

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Medicaid Acronym of the Day – BCRA

The Better Care Reconciliation Act of 2017 is an amendment in the nature of a substitute proposed in the Senate on June 22, 2017 and revised on July 13, 2017, as a plan to repeal and replace the Affordable Care Act (ACA) and make fundamental changes to Medicaid financing through the Fiscal Year 2017 budget reconciliation process.

Further reading

http://files.kff.org/attachment/Summary-of-the-Better-Care-Reconciliation-Act

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Medicaid Acronym of the Day – NAMD

The National Association of Medicaid Directors (NAMD) began as an independent, bipartisan, nonprofit professional organization in 2011. NAMD represents the leaders of state Medicaid agencies across the country. Established in 2011, NAMD’s mission is to support Medicaid Directors in administering the program in cost-effective, efficient and visionary ways that enable the over 70 million Americans served by Medicaid to achieve their best health and to thrive in their communities.

Further reading

Home

 

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Medicaid Acronym of the Day – LTSS

Long-term services and supports (LTSS) are defined as the services and supports used by individuals of all ages with functional limitations and chronic illnesses who need assistance to perform routine daily activities such as bathing, dress- ing, preparing meals, and administering medications.

Further reading

https://www.medicaid.gov/medicaid/ltss/index.html

 

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Medicaid Acronym of the Day – IMDs

Institutions for Mental Disease – In 1988, P.L. 100-360 defined an institution for mental diseases as a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged
in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services. This definition is in §1905(i) of the Act and in 42
CFR 435.1009. The regulations also indicate that an institution is an IMD if its overall character is that of a facility established and maintained primarily for the care and treatment of individuals
with mental diseases.

Facilities with fewer than 17 beds that specialize in treating persons with mental disorders can provide the types of services discussed in item 1 if they meet the regulatory requirements to
provide these institutional benefits, but these facilities are not technically IMDs. Because IMDs are defined to be institutions with more than 16 beds, the IMD exclusion applies only to
institutions with at least 17 beds.

Further reading

http://dhhs.ne.gov/medicaid/Documents/4390.pdf

 

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Medicaid Acronym of the Day – BIP

The Balancing Incentive Program provided financial incentives to States to increase access to non-institutional long-term services and supports (LTSS) in keeping with the integration mandate of the Americans with Disabilities Act (ADA), as required by the Olmstead decision and was created by the Affordable Care Act of 2010 (Section 10202). The Balancing Incentive Program authorized grants to serve more people in home and community-based settings, from October 1, 2011 to September 30, 2015. Thirteen States continue to participate in the program by spending the grant funds to increase access to new or expanded services and infrastructure.

Further reading

https://www.medicaid.gov/medicaid/ltss/balancing/incentive/index.html

 

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Menges Group 5 Slides Series for July, August and September 2017

The Menges Group puts out these great analyses and insights each month. And is kind enough to let us repost them for the MM audience. Check out themengesgroup.com to learn more about the work they do. 

The July 2017 edition tabulates Medicare’s per capita costs in each state and U.S. territory, showing the level of cost variation that exists between jurisdictions.  These figures are from 2015 and represent costs in the fee-for-service setting for Part A and Part B services.  The August edition tabulates information from the Medicaid MCO financial statements we collect and compile, showing the overall profitability among plans whose revenue is primarily (and often entirely) obtained through serving Medicaid populations.  The September edition provides suggestions for making Medicaid managed care optimally effective.

August 2017 Medicaid MCO Financial Performance 2011-2016

July 2017 Medicare Per Capita Costs by State 2015

September 2017 Optimizing Medicaid Managed Care — Input from Musicians

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Medicaid Acronym of the Day – TANF

The Temporary Assistance for Needy Families (TANF) program provides grant funds to states and territories to provide families with financial assistance and related support services. State-administered programs may include childcare assistance, job preparation, and work assistance.

In order to qualify for this benefit program, the applicant must be either pregnant or responsible for a child under 19 years of age. Also the applicant must be a U.S. national, citizen, legal alien, or permanent resident; have low or very low income; and be under-employed (working for very low wages), unemployed or about to become unemployed.

Each state and territory decides the benefits it will provide. Each state and territory also establishes the specific eligibility criteria that must be met to receive financial assistance payments or other types of benefits and services. Thus, you must check with the TANF agency in the area that you reside to learn whether you are eligible to receive financial assistance or other TANF benefits and services.

Further reading

http://www.tanf.us/

 

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Medicaid Acronym of the Day – AHRQ

 

The Agency for Healthcare Research and Quality’s (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.

Further reading

https://www.ahrq.gov/