Save Your Sanity: Planning During a Health Care Crisis

A health care crisis can hit without warning, leaving you both nursing the patient and mired in seemingly endless bureaucracy. When my elderly uncle suffered a stroke and could not return to his previous home, a long series of complications ensued, including assisted living, rehab, a nursing home, and Medicaid. This was further complicated by the shaky state of his finances and my unfamiliarity with them.

I started by writing a to-do list in a spiral-bound notebook dedicated to my uncle’s needs. Within two weeks, this method had failed miserably. A few tasks had proliferated into dozens of items with rapidly shifting priorities. Every stone I turned had half a dozen stones beneath it, often crawling with unpleasant life forms. Keeping track of what I should do next felt impossible.

I turned to a method that I had been using in my lean consulting business: the visual planning board.

Visual Planning Board to the Rescue

Figure 1. To-do List

First, I wrote each task from my to-do list on a sticky note (figure 1). Then I laid out all the sticky notes on a large piece of cardboard. I drew one column for each week. Then I put each task into the column for the week in which that task needed to be finished. All the tasks that didn’t need to be finished in the first month went into a box called Later. (figure 2).

Figure 2. Tasks from Week to Week

Now I had a better picture of what needed to be done and by when. Each week, I could work on the tasks for that week only. The job didn’t seem quite so overwhelming. However, this picture wasn’t entirely reliable because some tasks would take longer than a week. Those needed to be started earlier, but how much earlier?

Figure 3. Splitting a Big Task into Smaller Tasks

To simplify the tracking, I looked over the first few weeks and found the tasks that would take longer than a week. I split each big task into a set of smaller tasks of a week long or less. For example, “Find a permanent home” was split into the likely steps for finding a home (figure 3). The final task was placed in the week when it needed to finish, and the earlier ones were distributed over the weeks leading up to it. (I didn’t bother to split up the big tasks that were farther out than four weeks because they were likely to change before I got to them.)

At this point, the sticky notes for the current week were a pretty good picture of what needed to be done that week. This helped me avoid starting more than I could realistically finish. I could also see where the plan was simply not feasible (indicated by a huge pile of sticky notes in a single week) and decide how to adjust it.

Avoid the Dead Ends
Splitting up the larger tasks often revealed that I didn’t really understand one of the steps. When I investigated what I didn’t know, that often changed (or eliminated!) an entire group of tasks.

Figure 4. New Set of Sticky Notes

For instance, what were the criteria for determining “likely” adult foster care homes? After some digging, I discovered that the process for Medicaid patients isn’t the same as the process for private-pay patients. My uncle’s Medicaid case manager explained the process, and I replaced the set of four sticky notes shown previously with the set shown in figure 4. The exercise of writing out the smaller tasks saved me from going down a dead end more than once.

Keeping Up with the Storm
As I completed tasks, I checked them off with a green felt marker. When I finished a task, I tried to start another one in the current week that didn’t have a green checkmark. The huge number of things to do didn’t feel as overwhelming because now I wasn’t looking at all of them all of the time, but rather only at the tasks that were the most urgent.

Figure 5. Board of Tasks with Second Column

However, I soon found that I couldn’t tell the difference between tasks that hadn’t been started and tasks that were waiting for a response from someone else—my uncle’s bank, doctor, insurance company, etc. This annoyed me because I couldn’t tell how much I still had to do. I made a second column on the board for tasks that had been started and were now waiting for a response (figure 5).

The Winds of Change
Every Sunday, I sat on the floor in front of my board and planned the next week. I moved the unfinished tasks from last week into the new week. I looked over the tasks not yet started to see if they were still sensible. I checked three weeks ahead to see if any large task needed to be broken up. When I ran out of room to put another week on the board, I got a second board. When I reached the end of the second board, I took everything off the first board and reused it.

Every couple of weeks, something major happened that radically changed the plan. For instance, a second stroke threw the arrangements for assisted living out the window because my  uncle now needed a nursing home. Each time something big came along, I sat in front of the board, pulled off all the now-irrelevant sticky notes, and wrote new ones for the new tasks.

Eventually, the contents of my board shifted from nursing homes to funeral planning, and then to closing up the estate. Throughout the process, using the Visual Board allowed me to spend less time struggling to keep track of the flood of tasks and more time visiting with my uncle in the last months of his life.

Some Practical Tips
Your sticky notes will be moved around a lot, so super-sticky rather than “regular” sticky notes will work better. Neatly writing on the sticky note with a felt marker is important—you want to be able to read them easily. A visual planning board can be created on the wall or on large sheets of paper. I prefer three-by-four-foot trifold foam display boards. The sticky notes stay in place well, the board can be moved around the house, and it can be folded up to hide the sticky notes when you need an evening off from thinking about it.

Dedicated to the memory of Uncle Jim, who passed away November 30, 2013.