Hospice: 10 Things Patients and Families Need to Know

Hospice is a care philosophy that focuses on maximizing the quality of life as opposed to the quantity of life. Hospice may incl...

Thursday, September 14, 2017

Hospice: 10 Things Patients and Families Need to Know

Hospice is a care philosophy that focuses on maximizing the quality of life as opposed to the quantity of life. Hospice may include services such as medication/pain management, medical care, spiritual care, and social services. 

As a medical social worker, my job is to handle all aspects of hospice discharge planning. This includes connecting patients to a hospice agency, ordering equipment, providing resources on care facilities (i.e. board and cares, assisted livings, non-medical custodial nursing homes), and arranging transportation for hospital discharge. Additionally, I provide support to patients and family members during an stressful and emotionally draining process.

What's not publicly discussed about the hospice process is the immense pressure put on hospital employees to discharge patients quickly and efficiently. Insurance companies only pay if hospitals can medically justify a patient's stay. Once a patient goes on hospice, there is no reason for that person to be in the hospital and therefore must leave as soon as possible or the insurance company stops paying. This is often a challenge, especially when trying to provide compassionate care to patients and their families.

The purpose of this blog post is to give an honest and blunt take of hospice, what it entails, what's covered, and what happens when one elects hospice care. This information may come off as insensitive, mostly because I am feeling burned out and angry that this is how our medical system treats the dying. In addition, as the messenger who has blindsided countless patients and families with bad news, I strongly feel that it's better to know now than when it's too late.

Hospice: 10 Things Patients and Families Need to Know

#1 Hospice is NOT a place, but a care philosophy.

A common misconception is that hospice is a facility where one goes to pass away. Unfortunately, standing hospice facilities are exceeding rare, with hospice care typical administered in the home, assisted living/board and care, or custodial nursing facility. As mentioned above, hospice is not a location but a care philosophy that focuses on maximizing and individual's quality of life.

#2 Medicare pays for hospice, but does NOT cover room and board at a care facility.

In order to meet Medicare criteria for hospice, an individual must have a medical diagnosis with a prognosis of 6 months or less. Yes, Medicare covers hospice care, which includes visiting medical professionals (i.e. nurses, social workers, chaplains, caregivers), certain durable medical equipment (i.e. hospital bed, oxygen), and medication. However, Medicare does not cover room and board costs at a non-medical custodial nursing home, board and care, or assisted living. The only exceptions are if you are enrolled in your state's Medicaid program or have long-term care insurance.

#3 Hospice does NOT cover a 24 hour caregiver.

Depending on the hospice agency, you might be able to get a caregiver to come out twice a week for an hour each visit. Even individuals enrolled in a state's Medicaid program will not get 24 hours of care. The only possibilities are via family support, long-term care insurance, or private pay through a caregiver agency.

I've lost track of the number of times I've had to tell patients that they have to deplete their live savings to pay for a care facility or caregiver. The other option is to stay in the hospital and go into medical bankruptcy when insurance stops paying for their stay. And I thought I went into this field to help people.

#4 Hospice patients CANNOT stay in the hospital until they pass away.

Once the hospice decision is made, every effort is made to discharge the patient from the hospital as quickly as possible. The only exception is if a patient is actively dying with a life expectancy of 1-2 days. If a patient is expected to "linger" for 1-2 weeks, they are then transferred to a medical skilled nursing home under "comfort care". Otherwise, they are discharged to home, assisted living, board and care, or a non-medical custodial nursing home under hospice care.

#5 Patients and family members have LIMITED time to make home or care facility hospice arrangements.

I typically tell my patients and family members that once the decision to go on hospice is made, they must be discharged home or to a facility in less than 24 hours. While not every social worker does this, I feel that families and patients need to have an idea of how quickly things happen. In some cases - depending on the hospital and aggressiveness of the nurse case managers/management - I'm ordered to discharge patients the same day they enter hospice care.

The logic is as follows: Hospitals are places for individuals wanting aggressive treatment for their medical conditions. By opting for hospice, a patient is deciding to forego curative treatments in place of comfort-focused treatments. Hence, there is no medical reason for a patient to remain in the hospital. If a hospital cannot justify a medical reason for a patient to remain in the hospital, Medicare and other insurance companies do not pay.

As a medical social worker, hospice patients are my top priority due to the urgent need to get them discharged. The moment I get hospice orders, I immediately reach out to family members to confirm their wishes and determine equipment needs. Depending on the hospital's expectations and hospice agency's availability, I can get equipment delivered and a patient discharged home via ambulance by the end of my work shift. The hospice agencies I work with typically see a patient the day after discharge unless there is an urgent medical need that requires a "same day open".

If a family needs to find an assisted living facility or board and care, that may buy them an extra night or two in the hospital. Any longer and case management gets sent in to inform them that unless they leave, they will be liable for all hospital charges going forward.

#6 Most doctors know very little about the hospice discharge process.

Doctors are the experts when it comes to all things medical related. It's why they go to school for so many years and get paid more than us social workers, nurses, and other allied staff.

However, one of the most common questions I receive from doctors after they order hospice is "What do you need me to do now?" At that point, it's the social worker or nurse case manager that takes over, coordinating discharge with a hospice agency, telling doctors what equipment to order, providing support to family members, finding facilities for patients who cannot go home, and arranging ambulance transport. Doctors assist by signing off on orders, talking to patients/family as needed, completing necessary discharge paperwork, and prescribing medication (though there have been instances where I've been asked "What meds do I prescribe?", to which I respond "You're the physician").

While the physicians I've worked with are generally really helpful, there are instances where they complicate hospice discharges by telling patients and family incorrect information. This may include promising patients things not covered by insurance such as certain medical equipment or caregiving services. In worst case scenarios, I've had physicians tell family member that patients could stay in the hospital when they needed to be discharged that day. This had led to heated arguments when I or the case manager where ultimately sent in to say, "Sorry, but the doctor was wrong." In the end, when it comes to hospital discharge matters, the insurance companies call the shots.

#7 You can pick your hospice agency.

Hospitals and other care facilities might try to push for certain hospice agencies. However, Medicare mandates that patients be given a choice on the matter. While most have no preference, there are a few who've had family members on hospice in the past and want the same agency.

While social workers and other hospital staff are technically not allowed to promote one agency over another, we have an idea of which ones are the most timely and responsive, which is key during the time-sensitive discharge process. Don't be afraid to ask us! The worst that happens is we tell you the required, "We're not allowed to recommend one over another" and give you brochures of our favorites. 

#8 You need to get recertified as terminally ill to continue to receive hospice services.

A patient needs to be recertified as terminally ill by a physician in order to continue receiving hospice services. Recertifications can be completed up to 15 days prior to the start of a new benefit period, but no later than two days after the start of a new benefit period. A hospice benefit period consists of two 90-day periods and an unlimited number of 60-day periods.

Sometimes, individuals do so well that they are no considered terminal. We call this "graduating from hospice". Even though a patient "graduates" from hospice, they always have the option of reenrolling should their condition deteriorate in the future. 

#9 You can disenroll from hospice at any time.

Opting for hospice care is not a lifelong commitment. As stated above, some patients actually improve and "graduate" from hospice. 

On the flipside, some patients decide that want to try aggressive treatments again and disenroll from hospice as a result. There is always an option to enroll again at a later date. 

#10 You have the right to refuse hospice care.

Hospice is widely accepted in the medical community as the humane approach when aggressive medical treatments no longer work or are causing suffering. Many of our patients disagree with this philosophy due to religious, moral, or personal beliefs. As hospital employees, we are required to respect patient/family wishes, even though we may not agree with them.

However, this does not mean we will not try to convince you otherwise. In my short career, I've had elderly late stage cancer patients who've declined hospice and opted for all life saving treatment, including CPR. The doctors would then have lengthy conversations with patients and family about prognosis daily, to no avail. I would have numerous futile "quality of life" discussions with the family, only to get sent in for more by my superiors who were frustrated at my attempts to advocate for people who are in a "state of denial" and "torturing the patient". Ultimately, after many weeks to months, these individuals would pass away, usually while receiving chest compressions in an attempt to revive them.

If you are an elderly patient with a terminal illness who wants everything done, as I social worker I will respect that and fight for your wishes. However, prepare yourself for frequent discussions from medical staff who disagree with your decision.

Final Thoughts

As a medical social worker, my job is to advocate for and support patients and family members during this painful process. However, as a hospital employee, I'm required to follow the rules and regulations set forth by management and insurance companies in order to keep my job. This may include our aggressive approach in getting hospice patients discharged as quickly as possible. While I understand the logic of a hospital not being a holding facility for people who don't need it, the social worker in me can't help but advocate for patience and compassion for people already having to grapple with the dying process.

Hopefully this post gives better insight on hospice and the discharge process. While this information is blunt, I feel that it's better that patients and family members know now rather than be blindsided in the hospital. Lately, I've had an abnormally high number of hospice cases and what's increasingly apparent is how little patients and family members know about hospice care and what's covered. 

If you remember two things from this article, it's that 1) hospice does not cover a caregiver/room and board, and 2) once the decision is made to go on hospice, every effort will be made for hospital discharge to happen in 24 hours of less. And yes, many of us working behind the scenes will feel like terrible people for causing extra stress during an already devastating time. Ultimately, like it or not, we hospital workers can only do much as the insurance companies run the show.

Wednesday, September 6, 2017

Pinterest Group Board for Social Work Bloggers

Recently, I learned of Pinterest Group Boards and how they allow for communities of like-minded people to share pins with one another. Given the lack of places where social workers can gather to share their blog posts, I've decided to go ahead and start a Pinterest Group Board specifically for social work bloggers: Social Work Bloggers

To be added to this group, you'll need a Pinterest account and I'll need to know your pinterest name. You can either post it here, DM it to me on twitter (@CheapMSW), or email me at cheapsocialworker@gmail.com.

There are so many talented people in our profession. My hope is for this group to grow and become a centralized place where social workers and anyone interested in social work can share and learn from each another.

Tuesday, August 8, 2017

Racial Profiling of Patients By Healthcare Providers

I hate having to write yet another post on discrimination against patient by healthcare providers, but I think it's important.

Recently, I was called to investigate an abuse incident. The only evidence based on chart review and talking to the staff was "the nurse heard the family member yelling at the patient". As a result, this family member was essentially banned from seeing the patient, who was confused at the time.

To avoid violating HIPAA, here is a super abridged version of what happened next:
-The family member returned to the hospital asking for the patient's location and an explanation for the ban. I received a phone call from the nurses station, claiming that the family member was on the verge of aggression.
-I was with the family member in minutes, and the person was completely appropriate with me. The family member acknowledged speaking loudly due to the patient's confused behavior and seemed apologetic. The explanation was sound, and added details not included in the nurse's report. I sent the family member home to await my call.
-I spoke to the administrative team gathered at the nurses station, who reiterated that the family member nearly became aggressive. When asked how the family member was approached, staff members stated that they were non-confrontation, but that there was also a group of them for security reasons.
-Despite no record of abuse in the patient's chart and my personal opposition, I was ordered under the guise of "due diligence" to call the local police station to request abuse history. As expected, "yelling at the patient" was not enough evidence to get information from the police.

By this point, I had noticed that the nursing and administrative staff was predominantly one ethnicity, while the family member was another. I brought this up to my boss, along with my suspicion that the family member was being racially profiled.

Later, I received a phone call from my boss telling me to call the family member to let them come back and to apologize on behalf of the hospital. The family member was gracious enough, but expressed embarrassment at being treated like a criminal.

The longer I'm in the first, the more I notice blatant discrimination against patients by healthcare workers. While I've already posted this in a previous blog post, I think it's worth reiterating the findings of a study by the Agency of Healthcare Research and Quality:
  • Blacks and AI/ANs received worse care than Whites for about 40% of measures.
  • Asians received worse care than Whites for about 20% of measures.
  • Hispanics received worse care than non-Hispanic Whites for about 60% of core measures.
  • Poor people received worse care than high-income people for about 80% of core measures.
As healthcare providers, we are mandated to provide non-biased care to all our patients. Being a member of a disenfranchised or minority group (like the staff at my hospital) does not excuse discriminatory behavior. Imagine being provided subpar care because of your race, gender, religion, illness, sexual orientation, etc. The thought makes me ill and makes me terrified to be hospitalized.

In the case of this family member, I was the last line of defense against an organization too eager to use the "abuser" label. As long as I am a social worker, I plan on advocating for my patients to ensure they get the best care possible regardless of circumstance.

Thursday, June 1, 2017

A Day in the Life of a Medical Social Worker

Medical Social Work
One of the problems of being a medical social worker in a hospital is that my work is so varied that people get confused as to what I actually do! To give you a better idea of my job functions, here's a rundown of a typical day at work. At some point, I may write different versions based on what unit I'm working on and what model of social work the hospital uses. For a comprehensive overview of the medical social work profession, please go here: About Social Services at a Hospital

A Typical Day in the Life of a (not so) Cheap Medical Social Worker

 6:20am: Alarm clock goes off. I hit the snooze button.

6:30am: I drag myself out of bed, wash up, throw some clothes on, and slap my makeup on my face.

7:00am: I run out the door and proceed to sit in traffic for the next hour.

8:00am: I arrive at work, clock in, and head to my desk to print out the hospital census. After figuring out who all the new patients are, I go through each one to determine if they need to be "triggered" for a discharge planning and/or social services assessment.

Most common discharge planning triggers include:
  • High fall risk
  • Chronic illnesses prone to hospital readmission (i.e. congestive heart failure)
  • Patients discharged and readmitted within the past 30 days
  • Difficulties with activities of daily living (i.e. bathing and toileting)
  • Patients likely to have medical discharge planning needs such as skilled nursing placement, durable medical equipment, and/or home health 
Most common social services triggers include:
  • Financial issues (i.e. uninsured, homeless)
  • Mental health problems (i.e. depression, anxiety, 5150)
  • Substance abuse
  • End of life concerns (i.e. hospice, comfort care, advance healthcare directive education)
  • Lack of family support
  • Abuse (child or elder)
  • Domestic violence
8:30am: After identifying my triggers, I start putting together my to-do list for the day. I usually divide my list into the following categories:
  • Discharge planning assessments
  • Social services assessments
  • Social services follow-up visits (i.e. support needs, community resources/referrals
  • Patients being discharged and needing skilled nursing placement, home health, or durable medical equipment
  • Patients needing a copy of the Important Message from Medicare Letter reissued (must be done within 48 hours of discharge)
8:45am: Time for rounds with the charge nurse and nurse case manager! Here, we go through every patient on the floor with a focus on barriers to discharge. The charge nurse gives updates on the patient's medical condition and whether they are medically stable for discharge. The case manager provides leadership on what needs to be done from a multidisciplinary standpoint to address barriers to discharge. I (the social worker) give input on potential social barriers to discharge and take note of potential discharges to add to my to-do list.

9:00am: I start working on my to-do list by prioritizing cases in the following order:
  1. Any crisis situation that may arise during the day (i.e. code situation, sudden death, etc.)
  2. Patients needing immediate placement (specifically those under involuntary psychiatric hold)
  3. Patients with acute safety concerns (i.e. abuse, domestic violence)
  4. Patients with discharge orders who have immediate needs (i.e. skilled nursing transfer, home health care, hospice, durable medical equipment, transportation assistance, homeless shelter placement, follow-up doctor's appointments for high risk patients)
  5. Reissuing Important Message from Medicare Letters to patients with discharge orders
  6. Social services assessments of new patients
  7. Discharge planning assessments of new patients
  8. Reissuing Important Message from Medicare Letters to patients who may discharge in the next 48 hours
Typically, I spend my mornings working on assessments while waiting for physicians to come in to write discharge orders. As I start getting orders, the assessments get set aside for later. If you are to survive in hospital social work, the ability to multitask and set priorities is key!

1:30pm: Lunch (if I have time)! By this time of day, I should have everything set up for my patients with discharge orders. This includes transportation for patients transferring to other facilities, home health orders faxed to the appropriate agencies, and durable medical equipment issued to patients needing it.

2:00pm: I come back from lunch and start working on the rest of my to-do list.

3:30pm: Around this time of day I start getting physician orders for the next day's discharges. Typically this involves arranging nursing home placement, home health care, or hospice. My role is to inform patients of the discharge plan, see if they have a preference for a facility/agency, and make arrangements.

4:00pm: If I'm having a particularly bad day, I'll get last-minute orders to transfer a patient to another facility or arrange post-hospital care. Otherwise, around this time I start typing up a "handoff" for the next day's social worker, which includes a summary of what I did for each patient and a list of what still needs to be done.

4:30pm: Barring a crisis or super last-minute orders, I can clock out and go home!

5:30pm-8pm: Arrive home, eat dinner, clean up, watch baseball, play video games, blog, etc. To be honest, I don't do much on weekdays because I'm too drained after work.

10:30pm: Bedtime! Usually I end up going to bed much later because I lose track of time. I know, it's something I need to work on!

Hope this gives everyone a better idea of what I do at work. Please feel to ask questions in the comments section.

Sunday, January 29, 2017

Discrimination Against Patients by Healthcare Providers

Recently, I was speaking to a nurse (whose identity will remain anonymous for her sake) regarding President Donald Trump's travel ban on seven Muslim majority countries. This nurse is an immigrant from another country and has been working in the United States for roughly 30 years.

This nurse expressed her support for the travel ban against Muslims, saying that it's "for the better". Her support was not based on any fear of terrorists. She stated that having been a nurse for 30 years, she's encountered a number of people who come to America and "mooch" off the system. With regards to the seven banned countries, she stated that she's had a number of "birth tourist" patients whose purpose is to give birth to American citizen babies and take advantage of the system. She described the patients as "demanding", "knowledgeable of the system", and not knowing how to speak English. In her opinion, banning Muslims would prevent these "birth tourists" from entering the United States and stealing our tax dollars and free money given away by hospitals.

Obviously, I questioned the logic of her arguments, specifically the "free money" given away by hospitals (because that would make my job so much easier) and the "birth tourists" being mostly from Muslim countries. Her response is that she's been a nurse for 30 years and I've only been a social worker for 7 years, therefore she knows more about social services than I do. I promptly ended my discussion, as I knew it was not going to get anywhere.

There were a number of things that bothered me about my conversation with this nurse, but I for the sake of this post I will focus on one. What really bugged me is that this nurse works for a hospital in one of the most socioeconomically diverse places in the United States. If this nurse has such views of Muslim immigrants in general being demanding and out to take advantage of the system, then how does this affect how she cares of them?

Reflecting on my limited 7 years experience in the social work field, I have observed numerous instances of both overt and veiled discrimination in the hospital setting. Here are some examples:
  • Nurses complaining about having "another African-American/Mexican/Middle Eastern/Medicaid/non-English speaking/etc." patient. This is not limited to Caucasian nurses. Knowing a second language, I have heard the same complaints from nurses speaking to each other in their native language in the break room.
  • Patients with too many questions or requests being labeled "demanding" during morning rounds. At times, I've been sent in to talk to families because doctors "don't want to deal with them anymore".
  • Complete scorn for families not wanting their loved ones to enter hospice care due to cultural or religious reasons.
  • Healthcare providers attributing their problem patient's behavior to ethnicity or culture.
I realize that when it comes to challenging patients, there is going to be some grey area. Perhaps that "demanding" patient is indeed a narcotics addict hopping emergency rooms for more meds. Maybe that nurse is being treated like a personal servant by her patient. Abuse of hospital staff happens all the time.

However, the patients we see represent a small fraction of the entire population. It's certainly easy allow frustrating patients to reinforce our personal prejudices, but we must remind ourselves that one person should not represent an entire culture. Our patients come to the hospital because they need help, and otherwise would not be there if they didn't have any problems.

My social work education emphasized the need to check our biases at the door so we can provide optimal care to our clients or patients. While I hope that non-social work healthcare workers do the same thing, a study by the Agency of Healthcare Research and Quality reflects the following:
  • Blacks and AI/ANs received worse care than Whites for about 40% of measures.
  • Asians received worse care than Whites for about 20% of measures.
  • Hispanics received worse care than non-Hispanic Whites for about 60% of core measures.
  • Poor people received worse care than high-income people for about 80% of core measures.
As healthcare providers, we are in this field to help all people. I will not deny that our jobs are emotionally draining, physically taxing, and often thankless. However, if we healthcare providers cherry pick who we are able to provide quality, compassionate care to, then what does this say about our society as a whole? As the cliché goes, we are a reflection of how we treat our most vulnerable populations.

Saturday, January 7, 2017

How to Plan a Wedding and Stay Sane

wedding self care
In my previous post, I discussed the various cost saving measures my husband and I used during our wedding planning process. This was by far the easiest part of planning our wedding!

Today, reflect on our wedding again and provide tips on how you can survive with your sanity intact! My husband and I made it, so you can too!

Tip #1: While wedding planning, insignificant details suddenly become significant. In the end, they really don't matter.
When we started planning this wedding, I was well aware that it would be lots of work. What I failed to realize was the amount of detail involved. Right from the start I was told that I "needed" things from floor length tablecloths, wooden dance floor, uplighting, Chiavari chairs, knee length or floor length bridesmaids dresses (depending on who I was talking to), matching bridesmaid accessories, Catholic Ceremony, etc. Such advice was often accompanied with warnings if I didn't listen (i.e. "Your pictures will look bad!" "You decorations will look cheap!" "You'll look ugly/fat/old/young/90s/tacky/dated!" "Your guests will be bored/angry/hungry/confused/annoyed/hot/cold/sober/drunk/thirsty/etc!" "People will judge you!" "You'll convert to another religion!" "You'll regret it!")

Thinking back, there were so many hours wasted debating people on and researching insignificant details like tablecloth colors, napkin folds, decorations, makeup colors, uplighting, and seating arrangements. These are certainly hours of my life I certainly would like back, as in the end I'm sure 95% of the people at our wedding didn't notice/care about these things.

Tip #2: When you're told, "It's your wedding, do what you want," there's always going to be with a caveat. Ignore the caveat and trust your abilities.
While I was frequently told, "It's your wedding, do what you want," I often feel like people were really telling me, "Do what you want as long as I personally find it aesthetically pleasing." For instance, I was told that my wedding dress of choice was too simple and looked like a "bridesmaid dress", then asked to try on a gaudy sequin covered gown 10 sizes too large for me and being told it was a perfect fit. Later, I was told my attire looked "dated".

Keeping our wedding true to us was certainly a big challenge, and never in my life have I felt so insecure because everything from my decision making abilities down to my looks seemed to be under the magnifying glass at all times. At one point, I was even told that my demeanor was "too calm". It really felt like the world had their doubts and wanted us to fail.

In the end, my husband and I dealt by taking an "us against the world" approach to our wedding and not allowing unwanted opinions to change what we wanted. If anything, the doubt motivated us even more to throw the most enjoyable event possible for our loved ones. I learned to confident in my decisions and ignore any person, forum, or blog that told me that my tastes were tacky, ugly, and/or dated. While our wedding isn't exactly Pinterest worthy, I'm happy with how everything looked and felt great in my wedding outfit. Yes, I'm some people did have nitpicks (with other probably still waiting to tell me their "feedback") about the wedding, food, and my looks/attire, but so what? In the end, I'm glad my husband and I didn't cave to trends and conventions and can proudly say that we had a wedding that was true to ourselves.

Tip #3: Find support from different sources
Weddings certainly have the ability to teach you about the people in your social circles. While there were a few outlying incidents, I was generally wowed by the positivity and support from many of my family members and friends.

I also found support through online forums like Weddingwire.Com, which allowed me to ask questions and commiserate with fellow brides. What I liked best about the site was that most brides there provided honest and constructive feedback in a manner that was supportive, understanding, and non-judgmental. This extra outlet kept me from overwhelming my own social circles, as their lives are busy enough without me burdening them with my wedding woes.

Tip #4: Treat your wedding party and vendors with respect
Just because someone is your bridesmaid/groomsman does not mean that you own them until after your wedding day. Most likely, there are people you've selected because they're you're closest family/friends, so I find it just wrong to treat them like personal assistants. While our wedding party did offer to help out, my husband and I tried to keep their tasks to a minimum so they could enjoy the day. Ultimately, this wedding is just one day our of the (hopefully) many we will spend together in our lifetimes.

Similarly, while providing paid services, don't forget that vendors are people too. Treat them well from the start and they will return the favor. Also, don't forget gratuity always and positive online reviews for good service! My husband and I were lucky enough to work with wonderful vendors over the course of a year, and one of the saddest parts of this wedding being over is no longer getting to interact with them regularly.

Tip #5: Something will go wrong on your wedding day, but it will be okay!
My coworker relayed these words of wisdom to me on my last day of work before the wedding. Indeed, despite months of painstaking planning, there were still things that went wrong! While there were no major disasters, there were definitely a few near misses and rough patches throughout the day. However, our wedding day didn't fall apart, plenty of things went right, and I haven't heard too many complaints.

Tip #6: Don't expect your wedding day to be the best day of your life
Not only is there so much expectation for weddings to be "perfect", but there's the myth that it's supposed to be the "happiest day of your life". At this point, it's safe to say that the week leading up to the wedding was miserable and exhausting. While our wedding day was great, it was far from the happiest day of our lives as there was so much organized chaos happening around us. In fact, it took several weeks and the arrival of wedding photos for the adrenaline to fully wear down, though these series of blog posts has caused some of those old feelings to resurface.

It's okay if your wedding day isn't the best day ever! If fact, that was my expectation going into this event, as how sad would it be if my life reached its peak on my wedding day? Now that I'm married, my desire is to make even happier memories together with the hope that our best days are yet to come.

Tip #7: Don't forget your relationship...and yourself!
With all the work surrounding weddings, it's sometimes easy to forget the reason for having one! From the beginning, I knew that my husband didn't care as much about "the convention of marriage" as in his mind, we were already committed to each other. I accepted this and hence did most of the planning work. However, as the work increased and the wedding date approached, our lives and free time became consumed with everything wedding related.

Realizing that we were increasingly exhausted and miserable, we made changes like evening walks where no wedding talk was allowed and date nights at our favorite restaurants. Feeling my body start to to break down between the stress of work and wedding planning, I made concerted efforts to sleep early, stay hydrated, and relax when I could. While I'm already familiar with the importance of self-care thanks to my career, I had to be even more mindful of my physical and emotional health during this taxing wedding process. No wedding is worth sacrificing health.

For those who had relaxing wedding experiences, I congratulate you on being extremely lucky! For everyone else, please remember to stay true to yourself, trust your abilities, and that this is only one day out of an entire lifetime! While I'm thankful to have had a wonderful wedding, my husband and I are ecstatic and relieved to have moved on from that part of our lives, and mostly to have some free time again!

Tuesday, December 13, 2016

My (not so) Cheap Wedding

When I turned 18, my parents threw me a Debut Party, which is essentially the Philippine version of a quincinera. It was a lavish event held in a local hotel ballroom and attended by 200 of my closest family and friends.

While I am thankful for the experience, I've known since then that if I were to get married, I'd want a smaller, simpler, and less costly wedding. What I didn't realize was the amount of work it would take to accomplish that.

According to costofweddings.com, the average wedding in the United States costs $26,645, with couples in my area spending between $31,112 and $51,853. While not enough for a house down payment in the Bay Area these days, this is money that could easily be spent on vacations, house renovation, and college tuition for any future children. My husband, who still isn't a fan of the pageantry and societal expectations surrounding marriage, preferred to elope or have a courthouse ceremony.  Coming from a culture that places extreme importance on marriage, I knew my family would never forgive me if we did either.

Thus, we went ahead with planning a "standard wedding" (I use the word "standard" loosely because we did not adhere to my culture's tradition of getting married in a Catholic church). Through it all, we kept the following in mind:
1) Keep to the budget as much as possible, but don't stiff the guests and vendors
2) Treat this as a thank you party for family/friends who've supported us through the years and are willing to attend (see #1 below)
3) Stay true to ourselves, only compromising on things we don't care about much

How did we manage this without blowing our budget? Here are some (sometimes controversial) cost saving measures we enacted:

Wedding Cost Saving Measure #1: Have a destination wedding outside the Bay Area
Recently, I was lucky enough to attend a relative's wedding in the Philippines. This relative had a wedding at a resort and rented rooms for the guests. It was more like a mini-vacation with my family, and I wanted that sort of feel for my own wedding.

After vacationing there two years ago, we opted to have our wedding in Mount Shasta, a beautiful mountain town roughly 4 hours away from the Bay Area. Thanks to the lower cost of living in Mount Shasta City, we were able to find an affordable venue/caterer that would have easily cost twice as much locally. The other plus was cabins on site!

Mount Shasta City California
Mount Shasta

Wedding Cost Saving Measure #2: Cut the guest list
Next to having a low-cost wedding, what was important to my husband and I was that we had a wedding with no more than 100 guests. While my parents advised me to simply "not invite people", we knew that this was completely unrealistic and a local wedding would likely result in 200+ guests.

Having our wedding 4 hours away helped keep our numbers well below 100. The only down side is that the guest list was heavily skewed to my side, while only a few of my husband's family could make the drive. I suppose having a destination wedding may have worked too well in cutting the guest list!

Wedding Cost Saving Measure #3: DIY (Do It Yourself) everything
When I first started planning the wedding, I was told that details and decorations were how I could really personalize everything. To be frank, elaborate decor was the least of my priorities and wanted to spend as little as possible on it. Since my mom loves that sort of thing, I purchased artificial flowers in bulk and let my mom take over the decorating.

This freed up time for my husband and I to focus on details we cared about, like printing our own invitations and making personalized favors for our guests. While ambitious and time consuming, there was definitely a sense of accomplishment knowing that we were able to pull it off. In the end, my mom did a wonderful job with the decor and our guests seemed to appreciate the personalized favors.

diy do it yourself
Pumpkins grown by my parents

Wedding Cost Saving Measure #4: Buy instead of rent.
Wedding planning opened my eyes on the costs of renting things like table linens, chairs, and tables. While doing some comparison shopping, I realized that it was cheaper to buy cloth table napkins than to rent them, plus I get to keep the napkins. I am now the proud owner of 100 burnt orange cloth napkins to use for future Thanksgiving and Halloween dinners!

Wedding Cost Saving Measure #5: Shop early and shop around!
Next to crafting, most of my time was spent comparison shopping. I would definitely recommend booking venues and vendors as soon as possible, as you'll likely be competing with other couples with the same wedding date. Though my husband and I started looking less than a year before our wedding, we were fortunate enough to find a reasonably priced photographer, videographer, cake maker, and DJ. Make sure to check multiple sites as we found our videographer through WeddingWire.com and our photographer through Craigslist.

Once our venue and vendors were booked, it was time to focus on clothing and decor. Bridesmaids dresses were ordered from Weddington Way during a sale. We watched Slickdeals regularly waiting for sales on gift cards and wedding necessities. One trick we used was to buy gift cards for places like Macys, Ebay, and Sephora at a discount, then use said gift cards during a sale. My parents and I lost track of the number of times we visited various craft stores, each with a 50% Off One Item coupon in tow.

Wedding Cost Saving Measure #6: Take advantage of cash back websites and credit cards.
We not only purchased things on sale, but also made sure to use cash back sites for additional savings. To decide which cash back site to go through for a particular online store, we used CashBackWatch.com, which compares rates at the major cash back sites.

Credit cards often offer cash back as well. My husband was fortunate enough to have a credit card which offered 5% cash back on all restaurants during our wedding. This saved us a decent amount on rehearsal and wedding dinner costs.

Wedding Cost Saving Measure #7: BYOB (Bring your own bottle)
When deciding what wines to get, we realized that bringing our own wine and paying the corkage was cheaper than using the wine provided by the venue. Shopping for wine was one of the funner parts of the wedding planning process as we would hunt for bargain wines at places like Bevmo and Grocery Outlet and try them with our dinner. Bringing our own wine worked out pretty well since all our wines cost less than $5 each, including a Woodbridge by Robert Mondavi Moscato which proved to be a hit with our guests.

Wedding Cost Saving Measure #8: Pay for what's important to you, not for what is expected
When we first started wedding planning, we were frequently told that we "needed" things like a wedding planner, wooden dance floor, chair covers, ceiling drapes, doves (the birds), aisle runner, 10 appetizers per person, open bar, etc. We had none of these and didn't miss it. Every wedding is different, but if you find that the sole reason you've paying for a service is because you think it's expected, then you can probably put that money towards something else.

Wedding Cost Saving Measure #9: Ditch the wedding planner
Early on, we were advised to get a wedding planner so we could be "relaxed" on our wedding day. Unfortunately, even the most affordable wedding planner started in the 4 figures. Could we justify the cost?

I'm a social worker and a discharge planner. I like to help and the type of person that would prefer to do things herself instead of burdening other people. I wanted to find my own vendors, come up with a timeline, delegate tasks, and be involved during my own wedding day. These things make me happy.

One of the most hilarious parts of my wedding day was the look of horror on the vendors' faces when I tried to do something like move a chair or pick up trash off the ground. Like I said, it's the social worker in me. Would hiring a wedding planner and making our wedding party do more work have been less stressful?  Of course, but I would have felt immensely guilty about the extra money spent and making others do work I could have easily done myself. Plus with the money saved we were able to hire a videographer and get extra beer/appetizers.

Wedding Cost Saving Measure #10: Know your guests
Lots of wedding websites have calculators on the amount of alcohol and appetizers to serve. While they were valuable for planning purposes, what's most useful is knowing your guests' preferences and habits.

For instance, the calculators advised us to get 6-8 appetizers per person. I was also advised to up the appetizers because "people overeat at weddings". My parents - knowing that our family does not eat a lot - advised me to serve fewer appetizers to avoid paying for wasted leftovers. In the end, we cut down to about 4 appetizers per person and even had some leftovers.

When deciding whether to have open bar, we looked at our guest list and realized that most of our family and friends are beer and wine (specifically sweet wine) drinkers. We opted for having a beer/cider/wine-only bar with a variety of choices. No one seemed to miss the liquor and our guests seemed to especially like the sweet wine.

In the end, our wedding cost well below the United States average. While this isn't saying much, considering I know people who've had weddings for under a thousand, our guests were well-fed and seemed to genuinely have a blast, which was most important to me. Of course we could have saved much more by eloping or having a courthouse ceremony, but ultimately, there's still something to be said for throwing a party for all your favorite people.

Friday, November 18, 2016

A Return to Blogging 2016

Wow, it's been over a year since my last post! I'm still here, but had to take a blogging hiatus due to my time being consumed by other things. Here's a brief synopsis of my past year:

Got Married.

After seven years, my now husband popped the question that would result in one of the most whirlwind years of our lives. I'll be blogging about our wedding in subsequent posts, but in short, all of our free time was consumed by wedding planning and other related wedding events for most of 2016.

In other news, I've finally moved out of my parents' house and am adjusting to living with my husband. Job-wise, I'm still working as a medical social worker, but am looking into part-time income streams such as blogging and even crafting (thanks to skills acquired while wedding planning).

I have no idea what direction I want to take this blog, but right now the most important thing is that I start writing again. We'll see where this goes!

Tuesday, July 28, 2015

Road Trip 2015: San Diego Comic-Con!

It's been an amazing month!

This past weekend, I returned from a road trip to Comic-Con and the Southwest United States. While I'm sad that it's over and exhausted from all the driving, I'm thankful to have been able to take this vacation and am already planning my next one! Over the next few weeks, I'll be recapping my trip, starting with San Diego Comic-Con!

Comic-Con Logo

Comic-Con: Preview Night

After months of anticipation and excitement, it was now time for one of my favorite weekends of the year: Comic-Con 2015!!! As veteran attendees are well aware, attending Comic-Con takes luck, good budgeting, lots of planning, and serious dedication. In fact, I started planning for this year's trip nearly a year ago, when I booked my hotel room (and 2 backups in case straggler friends joined me). Half a year later, I survived preregistration and ended up with a coveted 4-day pass with preview night. I consider myself extremely lucky and hope that this luck continues in future years.

My trip to Comic-Con started on the morning of Preview Night when I loaded up my rental car and left my house at 5am for the 8 hour drive to San Diego. Overall, it was a fairly smooth ride minus the traffic, construction, and aggressive drivers in Los Angeles. I've heard horror stories about driving in LA but didn't believe them until I was cut off and nearly struck by a Mercedes with a license plate that read "ACT FAST". Not okay!

Despite some Southern California traffic, I managed to make it to San Diego by 1:30pm. After refilling the rental car with gas, checking into my hotel, and returning the rental car, I boarded the shuttle bus for San Diego's Gaslamp District.

Gaslamp Quarter Archway
Gaslamp Quarter Archway
This year was my first year staying outside of the Gaslamp District. While I missed the proximity to the convention center and the action, the frequent shuttle bus pickups seemed to mitigate that. It also helped that I was paying less for my private hotel room than any Gaslamp hostel shared with 3-5 strangers.

My first order of business was going to the volunteer station at the Marriott Hotel to pick up a volunteer badge and my swag bag for the weekend. This year was my 2nd year volunteering for Comic-Con, which allows me to see the inner workings of the convention. Another perk of volunteering is that you get a free pass for each day you volunteer at least three hours, something I will take advantage of in the event of a sell-out during future Comic-Con badge sales.

Batman vs. Superman Comic-Con Swag Bag
My Swag Bag! Note: Check for any damage before you leave the room. I broke the middle snap after leaving and they would not exchange my bag for another!
Next, I made my way over to Sails Pavilion inside the main convention center to pick up my paid badge, then wandered around 5th Avenue collecting free stuff. I lucked our early as I ended up with some fun swag from Sharknado 3. Later, I joined the sea of people waiting for Preview Night to start. Surprisingly, they opened the doors 30 minutes early!

Shardnado 3 Handsaw
Sharknado 3 swag to add to my foam chainsaw from last year's Sharknado 2!
Typically, I spend Preview Night collecting as much swag as possible since popular booths tend to run out early. My first stop was the FOX booth, which was handing out poster tubes (which were round this year as opposed to the awful triangular ones which scratched everyone last year). Next was the Lionsgate booth, which was handing out posters and pins from the upcoming Hunger Games: Mockingjay Part 2 movie. After that, I made a beeline to the WB booth which was handing out movie tickets, magazines, and shirts/sweatshirts. I ended up with a sweatshirt from the show Supernatural.

After the mad rush for swag, I spent the rest of the evening wandering the exhibit hall. Due to its massive size, it's impossible to see everything in one day!  After having tacos for dinner from Valentines, I hopped the shuttle and turned in for the evening!

Comic-Con: Day One

After scarfing down a free hotel breakfast of waffles, eggs, and sausage it was time to hop on board the shuttle for Comic-Con Day Two! Today, my plan was to focus on the off-site activities.

My first stop was the Petco Fun Zone, which had a number of interactive exhibits including a virtual reality film screening, Snoopy Dog House, and drop tower ride. I didn't stay too long, but managed to get free sunglasses and some samples of pizza bites before I left.

My next stop was Adult Swim on the Green, which was basically a midway with a bunch of carnival games like ring toss, skeeball, and plinko. As much as I love carnival games, I hate having to pay to play, so I was definitely a fan of free games with prizes. In fact, I ended up getting a grand prize in the plinko game which I traded in for an Adult Swim water bottle. As much as I wanted a giant stuffed animal, I knew I was driving to Louisiana after this and didn't want to take up all the car space this early into my trip!

Adult Swim UFO
Adult Swim UFO display
Afterwards, I walked along the waterfront, passing thousands of people who were camped out to watch the next day's Hall H panels, headlined by The Walking Dead, Game of Thrones, and Star Wars. After swinging by a waterfront exhibit of drones you can now purchase, I walked past another group of  hundreds of people in line for a Lego raffle. 

Eventually, I made it to the Marriott Hotel and checked out the Nintendo Lounge, which had video game demos and places where people could rest and play on their handheld devices.

Upon leaving the Nintendo Lounge, I wandered around the Gaslamp for a while then ducked into La Fiesta on 5th Avenue, which had decent happy hour specials for margaritas and carne asada fries. I was treated to one of the best strawberry margaritas I've ever tasted.

Carne Asada Fries
$6 Carne Asada Fries
Next, I made my way to Nerd HQ, which is a small, free convention that runs in conjunction with Comic-Con. After playing some games and checking out the video game demos, it was back to wandering the streets of San Diego and an ice cream snack!

Scream Queens Ice Cream
Free Ice Cream!
While wandering the Gaslamp, I ran into promoters for the show "Vikings", who were giving away plastic drinking horns that get you discounts at different restaurants. After finding a restaurant that offered more than just Budweiser or Coors, I had a dinner of 50 cent chicken wings and a half-priced pint of beer at Eat Village Tavern + Bowl prior to hopping the shuttle to the hotel.

Comic-Con: Day Two

Knowing that I virtually had no chance of making it into Hall H without camping out overnight, I slept in and spent the morning exploring the exhibit hall and a "Fear the Walking Dead" exhibit at the nearby Hilton Hotel. Not wanting to miss the Marvel TV panels, I made my way to Ballroom 20 an hour and a half early and caught the latter end of "The 100" panel and "The Minority Report" panel (which treated us to a showing of the first 20 minutes of the pilot episode).

B20 Panel
Ballroom 20
Next were the panels for "Agent Carter" and "Agents of S.H.I.E.L.D."! While we didn't get any free swag or exclusive previews (since they haven't started filming this season yet), it was great to see the cast interact with each other and tease possible spoilers!

After a disappointingly small happy hour/dinner at a downtown tapas restaurant, I went over to the hospitality suite in the Manchester Grand Hyatt. Here, I was treated to free chips, garlic dip, vegetables, candy, and soda!

Snacks from Comic-Con Hospitality Suite
Free snacks from the hospitality suite!
Later, I walked over to the Midway Museum for a free party hosted by CraveOnline. I'm not a big fan of partying, dancing, and paying full price for drinks, so I pretty much just checked out the museum and left. It's not every day you're allowed aboard a carrier vessel!

View of San Diego from USS Midway
View from the USS Midway

Comic-Con: Day Three

Today was the day I designated as my volunteer day so I could be guaranteed a spot on next year's volunteer list. After checking in for my shift, I was sent to a room filled with volunteers to await assignment. Later, I was sent to another part of the convention center as "standby" in case my services were needed. In the end, I wasn't needed and completed my volunteer shift without having to do much. Not too shabby for a free day at Comic-Con!

After wandering the exhibit hall and grabbing more swag, I went to Lou and Mickey's to grab a free drink for downloading the Webtoons app. Afterwards was happy hour dinner at the Coyote Ugly. Next was the LA Digital Party at the Altitude Sky Lounge.

View of Petco Park
View from Altitude Sky Lounge!
Thanks to some luck and persistence, I managed to get into a William Shatner event at a Gaslamp art gallery! While I wasn't able to talk to him or get autographs, it was worth it being in the same room as him. For those of you who don't already know, I'm an avid Star Trek fan and actually cosplayed in a TOS uniform!

Star Trek TOS Uniforms
I wore a blue version of the red uniform. I work in the medical field after all!
Saturday night of Comic-Con is when the Masquerade takes place, showcasing the best cosplays made by people all over the world. While many people crammed into Ballroom 20 to watch the event, I opted for the live stream from Sails Pavilion. Influencing my decision was that the Sails Pavilion showing had free food, including fancy cupcakes!

Chips, Cupcakes, Cheese
Masquerade Party Food!

Comic-Con: Day Four

Day four is typically my least favorite day of Comic-Con. By then, most of the main events are over and everyone is packing up to leave. I pretty much spent the day wandering the exhibit hall and grabbing last minute freebies from vendors clearing stock.

Unlike previous years, I left the exhibit hall an hour early. This was to stake out a window spot at Dublin Square Irish Pub for happy hour and watch the massive exodus of people once Comic-Con ended.

View from Dublin Square Irish Pub
Awaiting the end of Comic-Con
As down as I get when Comic-Con ends, this year's sadness was tempered by the fact that I was headed to New Orleans next! Additionally, the end of Comic-Con 2015 means that it's time to plan Comic-Con 2016! As of now, I've managed to book lodging for next year and am actively looking for better deals. The planning and anticipation are half the fun!

View from San Diego Convention Center

Tuesday, June 30, 2015

Same Sex Marriage Legalized in the United States

Rainbow Piggie Bank
Welcome to the 21st century, America.

Last Friday, the U.S. Supreme Court ruled in a 5-to-4 vote that the Constitution guarantees a right to same sex marriage. In the words of Justice Anthony Kennedy, "No union is more profound than marriage, for it embodies the highest ideals of love, fidelity, devotion, sacrifice and family. In forming a marital union, two people become something greater than once they were." While I'm somewhat disturbed that the ability to determine a group's rights hinged on a single vote, I'm pleased with the final result.

It's been a long road to finally get same sex couples the rights they deserve. In 2008, I took to the streets to protest when California voters legalized discrimination by passing Proposition 8. Four years later, a U.S. appeals court ruled Proposition 8 unconstitutional ultimately leading to the issue being sent to the U.S. Supreme Court for a final decision. Hard to believe that it's been 7 years, but in this country change is slow.

While we've finally eradicated this dark mark of legalized discrimination against same sex couples, the battle is not over yet. Since Friday's ruling, I've observed numerous individuals (mostly religious) around me and on social media express disagreement with the ruling, along with derogatory and stereotypical statements about LGBTs in general. Additionally, certain states and counties have already made efforts to deny marriage licenses to same sex couples (though I'm sure their efforts will be futile).

As a social worker, I have to be understanding of others' cultural and religious beliefs. However, I struggle when those belief systems involve supporting legislation that segregates and treats certain populations as sub-human. My hope is that with further education, these people will open their eyes and realize that we are all humans and hence should be treated with dignity and granted the same rights.

Congratulations, America! You did well this time!

Monday, June 29, 2015

Burnout Prevention: Epic Road Trip 2015!

Road Trip 2015
July is fast approaching, meaning it's time for my third annual trip to San Diego for Comic-Con! Thanks to convention scheduling, Comic-Con is extra early this year (July 8-July 12). I'm not ready!

To add to the July excitement, my friends at TSG.tv are hosting a Mario Marathon from July 17-24 to benefit St. Jude Children's Research Hospital. Initially, my intention was to Amtrak down to Texas after Comic-Con. However, after finding out that a number of my friends are road-tripping south, I decided to take advantage of the time between Comic-Con and Mario Marathon and take a road trip of my own!

Here's my itinerary thus far:
  • San Diego (for Comic-Con)
  • El Paso, Texas
  • San Antonio, Texas
  • New Orleans, Louisiana
  • Dallas, Texas (Mario Marathon)
  • Santa Fe/Albuquerque, New Mexico
  • Flagstaff, Arizona
  • Santa Barbara, California
In the next few weeks, I'll try to post about my planning process from packing, arranging transportation, to booking the cheapest lodging possible (including some free hotels). This is probably one of my most ambitious trips yet, and it's certainly been a learning experience. It's also been an exhausting one as I've spent most of my free time and many late nights working on my itinerary and packing. Travel planning is a lot of work, but I'm hoping that it all pays off next month!