Yes, it has been awhile. We continue to use Therap daily. We are gearing up for tracking training in Therap, and almost have it ready to go. As an oversight agency – a Community Centered Board providing case management and contracting services for individuals through a number of agencies, some of whom are using Therap and some who are not – we were exploring the possibility of having everyone enter GERs into Therap, regardless of whether or not they use Therap. It would certainly help when looking at trends, saving a great deal of time over our current method of trend reporting. I have gone so far as creating a GER entry super role, and played with it, but there are some significant barriers.

We have both a service agency Therap account, through which our internal provider agency completes all of their documentation and through which we route all billing, and we have an oversight account, through which case managers can view activity involving clients served by providers using Therap. If we began requiring all providers to enter Therap GERs, I believe they would have to enter them into our oversight account to enable us to pull data across all agencies. The difficulty is that I believe we would then need to import all of the IDFs for those clients in our oversight account, creating alot of extra work. I need to explore further if it would be feasible to enter outside agencies’ GERs into our provider account without them then interfering with the internal agency GER reports. As I write this, I think it would be possible; we have IDFs entered anyway, so as long as they are assigned to the correct program, it should work. Once I figure that out, it will likely be more challenging to talk service providers into entering them online rather than creating and sending paper copies. If anyone else has done such a thing and has suggestions, I would welcome them.

Some personal updates: In July, my position changed. I stepped down from Case Management Director after 14 years, and am now doing Compliance and Quality Monitoring. I am also continuing to be our agency administrator for Therap and two State data systems, a Supports Intensity Scale Trainer and Interviewer, and I serve on various work groups as they crop up. Also in July, my big, sweet, 6.5 year old black lab mix, Jack, passed away from a mast cell cancer that grew above his heart. That was so very difficult. We had little warning.

I am nearly a hypochondriac when it comes to my pets, and Jack had been to the vet frequently during the year, beyond annual shots updates. He had bloodwork in April and in May to look at the effectiveness of a supplement I was giving him. Later in June, I noticed Jack acting lethargic, panting more and eating less. As we were experiencing extremely hot weather, I figured that was the cause, but took him in to be checked out anyway on a Friday. As I had not noticed any vomiting or diarrhea when I was with him – he spent stretches outside with our other dog – the vet barely looked at him, commenting that his respiration seemed fine and he was looking good. That weekend, I followed him around every time he was outside, collecting samples. I took him back again Monday, providing the samples and again telling them he was lethargic, not eating at all, but still drinking plenty of water. The vet checked the samples, proclaimed him to have an overgrowth of a bacteria in his colon, and prescribed an antibiotic. Again, the vet did not touch him and commented on how great he looked. On Friday, I was back again – he was still not eating, I was having to force-feed him the antibiotics, he was now drinking less, and his breathing seemed even worse to me. The vet stated that since his bloodwork looked so good, she just did not know what to tell me. I argued with her that she had not taken any bloodwork since looking at the effectiveness of the supplement early in June. She insisted that bloodwork had been drawn the previous week. I had to insist that she look again because she was mistaken.

When she returned to acknowledge her mistake, she approached it as if she would have to talk me into allowing the test with the costs involved. I told her I had been asking her to run a full panel, and that was what I expected that day. When she returned with the results, she noted that there were concerns and sent me immediately to the Pet Specialty/Emergency clinic 30 miles away. Of course I went. After a late night there, and a full day the next day, costing over $1600, I learned my Jack had cancer. They recommended further diagnostics to pinpoint the specific type of cancer – a mass above his heart, which was either mast-cell, requiring cracking his chest open and extensive recovery time if it had not metastasized and they were able to get it all, or lymphoma, requiring 6 months of chemotherapy, which may extend his life a year – and I needed to make a decision about treatment. Having experienced a CCL tear, surgery, and therapy/recovery just over a year earlier, I knew I could not put Jack through that again, and opted to take comfort measures, only. They told me we would have a few weeks with him.

We took him home Saturday evening, notified our kids and grandkids who also loved Jack enormously and who came to see him Sunday, and he passed away waiting by the front door for me to come home from work on Monday. So much for a few weeks. Needless to say, after 16 years of using the same veterinary clinic, I will not return. I had an especially difficult July, trying to figure out why I did not notice that he was ill much earlier. On the other hand, our other dog, who pretty much always followed Jack around, going out when he did and just being a very playful, fun-loving dog, also went through a period of mourning, during which she also had to teach us her communication system. She would not alert us to her needs as Jack always had, and never had to because Jack took care of “speaking” for both of them. So we have had a period of re-bonding and re-training, and discovering what a bright, unique dog Sophie is. The photo is of Jack with our granddaughter, Danica, on his last full day with us. He was always lovely with kids.