(continued from part 1)

Last month, you were introduced to Maria.  Just to recap, Maria, 84 years old, was struggling in many areas of her life, and her three out of state children panicked, wondering how to best help their Mom.  They involved a Care Manager in her situation. In August, we reviewed five roles for the Geriatric Care Manager:  Assessment, Care Planning/Coordination, Physician Coordination, Medication Management and Crisis Response.  This month we will continue with the remaining five reasons to partner with a Geriatric Care Manager.

Reason #6 Transition planning. Transitioning from hospital to home, or from rehabilitation center to home, can sometimes be a precarious experience, especially related to medications. About half of adults experience a medication error after hospital discharge.  When Maria was preparing for her discharge from her rehab center, the Geriatric Care Manager (GCM) noted that she was prescribed a new blood pressure medication, and her instructions for home stated “Continue all medications as previously”.  Since she was already on a medication at home to lower her blood pressure, adding a second medication may have caused serious problems.  When asked for clarification, her physician concurred that she only needed to be taking one medication.

Reason #7 Recommendations in housing.  Is Maria able to be at home?  Does she need some type of assisted living?  Memory care?  Maria’s Care Manager really felt she would be safe at home at this time with the support of a daily caregiver for a few hours.

The 8th Reason to involve a GCM can be a local presence for check-ins. This service is invaluable for those adult children who don’t live nearby.  A monthly or bimonthly professional set of eyes looking in on Maria can really bring peace of mind.  Maria’s children could breathe more easily knowing that they would be notified of any problems – as well as a solution!

Reason #9 is a GCM can act as an extension of the family in a professional role.  Maria’s son recently said “you become me”.  And that is so true.  But as I told her son, we are really better than you, as we don’t bring years of relationships (good or bad) to the situation.   Care Managers are very objective and can truly advocate for the best decisions for the client.

Reason #10 is that we all need help.   Navigating the aging process is not easy.  Often we face crises without any kind of time to prepare. It is OK to ask for help.

The National Association of Professional Geriatric Care Managers (caremanger.org) is a wonderful resource to locate a Care Manager in any part of the country.
For a complimentary consultation in the Phoenix area by a Villa Home Care Geriatric Care Manager, please contact us at 602-957-9300.

We find Maria, 84 years old, living alone with her two cats in south Scottsdale.  Her husband died six months ago, and she has three children, all living on the east coast.  One day her son received a phone call from a Gilbert police officer.  His Mom was sitting in her car in the Safeway parking lot in Gilbert, she had no idea how she got there, nor how she was going to get home again.

Her children were scared to death – the son made call to the family attorney asking for help.  “What can we do?”  This trusted adviser contacted a Villa Home Care Geriatric Care Manager.

Reason #1) Assessment –With the goal of preserving Maria’s dignity, independence and resources, the Geriatric Care Manager met with Maria.  She found a very lonely lady with definite memory loss, mismanagement of medication, poor nutrition, at risk for falls, and, of course, driving problems.  While in the home, the mailman showed up with stacks of envelopes from her mailbox.  The Care Manager went through the mail with Maria and found two photo radar tickets and a cancellation from her LTC policy for no payment of premiums.  An assessment was also completed of Maria’s financial status, including a review of her Long Term Care Policy, qualification for VA benefits, and eligibility for the State Medicaid program.

Based on the above findings, the Geriatric Care Manager completed an individualized “stay-at-home” plan with recommendations for a caregiver for three hours daily to help with personal grooming, meal preparation, medication reminders, transportation, and socialization, as well as ongoing services from a Geriatric Care Management to set up her medications monthly, and accompany her to MD appointments – communicating updates with Maria’s children.

Reason #2) Care Planning/Coordination with others – Geriatric Care Managers are a resource for families.  Referrals are frequently made to Hospice, Medicare Home Health services, home physician services, assisted living communities, Meals on Wheels, transportation services, or even dog walking.  A Geriatric Care Manager can figure it out!

Reason #3) Coordination of Care with physicians- As Maria was declining, she would tell her children following her MD appointments that “all was fine – don’t worry about me”.  She was also not able to provide her physicians a real picture of her status.  The Care Manager was able to share with the doctor what really was transpiring, and again communicate with the family.  Maria had 5 specialists as well as a primary physician.  Unfortunately each of those physicians were concerned with just a piece of her health care – the Care Manager served as the central link to coordinate each plan, functioning as the central repository.

Medication Management is Reason #4)-  Maria had 8 prescription medications.  Two were for high blood pressure, two were for memory, one was for depression and two other medications to aid in digestion.  The Care Manager had serious concerns if she was 1) taking at all, taking as ordered (doubtful) or 2) double or triple dosing.  A system was set up in Maria’s home using an automated medication dispensing system that alerted the Care Manager if she did not take her meds on time.

Reason #5) Crisis Response- Families have someone to call in the middle of the night or on Sunday afternoon when they receive that panicked call from an older adult or that daughter out of state.  It happens.  It happened when Maria fell in her backyard. Villa’s Geriatric Care Manager met Maria in the hospital Emergency Room and learned the Maria had fractured her hip.  She arranged for a caregiver to stay with Maria until her son could arrive, and surgery was over.

(To Be Continued)

For a complimentary consultation by a Villa Home Care Geriatric Care Manager, please contact us at 602-957-9300.

Helping people understand the role of a geriatric care manager

Karen Jeselun, RN, CCM returns on KXXT Radio Phoenix on 08/19/2010. Radio show “Your Long Term Care Show” with Ralph Norman and Michael Anastos.

Click on the link below to listen to the Audio Clip:
Karen Jeselun returns on KXXT Radio Phoenix

This next statement may surprise you, especially coming from the owner of a homecare company with a large staff of caregivers. Families who call us for help may not always need caregivers. In fact, often, families call looking for professional expertise to help manage a situation in which they have no experience.

We have positioned Villa Home Care to be that expert – to partner with our family members and their loved ones – and walk alongside of them through the continuum of the aging process.

Initially that older adult may only need bimonthly visits from the Geriatric Manager with ongoing communication through our secure on-line family portal. These visits may or may not include medication management, accompanying the individual to physician appointments or other necessary activities.

As the continuum moves along, the GCM’s ongoing assessments may pick up on a decline in the functional abilities of the client, perhaps physical or mental abilities. In these situations, the GCM would be in a position to recommend the implementation of technology or some assistive devices. Perhaps a few hours of caregiving might be appropriate at this stage.

Lastly, as the client’s deficits increase, outside resources may be utilized such as hospice, home health or alternate care settings, such as assisted living facilities or group homes.

We are finding that this approach helps to conserve precious financial resources and yet meets the need for independence and dignity for our older clients.

For more information on our continuum of care, call Villa Home Care at 602-957-9300 or 888-880-6588. Email us at contact@villahomecare.com.

AI would venture to say that many of us are aware of older adults who could benefit by some assistance at home but refuse. The reasons given vary. “I don’t want a stranger in my home.” “It costs too much.” And the most frequent reason – “I don’t need any help!” As adult children of aging parents and as professional Geriatric Care Managers, we would like to provide an easy answer to this dilemma, however there isn’t one. Often what must happen is that the older person has to fail living at home independently. That sounds a bit harsh, and we don’t want them to fail by getting injured or harmed. But they have to come to the realization themselves that in order to remain in their own home, they must have assistance. Sometimes that assistance can be as little as one hour once or twice daily, or six hours once a week. Once a “foot in the door” is accomplished, trust is established, and a positive relationship begins with the Caregiver, services can be enhanced to better meet the needs of the individual and achieve their goal of staying at home!

Karen Jeselun, RN, CCM, CEO