Aug 03, 2019
How to Help Clients Struggling with Elder Care Issues
Aug 03, 2019
By Kira Reginato
When clients come to you because they are struggling with care for an aging parent or other relative, disentangling legal, medical and family issues can be challenging. Addressing the legal issues may often be difficult because the family is in crisis around care. Referring the family to a geriatric care manager can relieve pressure on you to solve problems your legal education did not envision and allow you to focus on helping resolve their legal issues. In this article, I give an overview of the type of help a care manager can bring to the table and I discuss some smartphone-based applications that can also help.
Geriatric Care Managers
According to aginglifecare.org, “An Aging Life Care Professional, also known as a geriatric care manager, is a health and human services specialist who acts as a guide and advocate for families who are caring for older relatives or disabled adults.” After an initial call to a geriatric care manager (“GCM”), help typically begins with meeting family and/or the elder, sometimes together, sometimes not. One of the GCM’s first tasks is an initial in-home assessment to find out what the older adult needs, which includes their own goals and desires.
During an assessment, a GCM can review some or all of what I call the “Seven M’s”:
- Medical condition
GCMs also look to see if clients have a trust, will, POLST form, and powers of attorney in place, but that doesn’t start with the letter “M.”
Working with the family and sometimes legal counsel and medical professionals, GCMs usually develop a care plan, better referred to as an action plan. The plan recommends what is needed and when, who can do it, and sets out the costs. Having a plan in place not only provides a map for action but also peace of mind for everyone involved. When followed, the plan often results in fewer crises and hospital stays, which are always top goals of a care manager.
Using the plan, the family and the elder can then decide what they want to do themselves and what they may want help implementing. The action plan often includes getting better organized, which may include anything from legal documents, finances, schedules, medications, or all of these. I recommend families get a smartphone app to help. Then they can easily share information and tasks among trusted family members. GCMs often work with families daily during a crisis but may also consult weekly, monthly, or as needed, depending on what everyone needs and how much the elder’s situation might be changing. Sometimes all that is needed is a one-time consultation.
Keys to Care Management Work
Providing support and guidance to the entire family is a mainstay of a care manager’s work. Having an experienced, neutral elder care consultant to speak with is one of the most valuable services they offer. They listen to how families are coping so they can provide education and help manage expectations and family dynamics during a difficult time.
The foundation of effective work comes from building rapport and trust. GCMs can come in to do a quick assessment and make recommendations but often they are not heeded without trust. Sometimes that trust is from the elder themselves when a care manager is the only person visiting the elder. Other times it must be from a family so that the GCM can keep them moving forward.
Case Study: The Reappearing Client
An attorney asked me to visit a client who was repeatedly showing up at his office without an appointment, seeking help. He explained to his client his scope of service and that her legal documents were in place but she continued to show up, so he suggested she meet with me.
I met with the client and learned there were some cognitive and personality issues affecting her ability to live alone. I worked with her for several months on solving a variety of problems, from reordering medication to bringing in home help to other housing options. The good news is that she decreased and then stopped her visits to the attorney.
Case Study: The New Patient Transitioning Care
An attorney called me to be a care manager for a client who had a devastating stroke that left her depressed and unable to speak. I helped her transition from a skilled nursing facility to an assisted living home and then continued to visit to ensure good care. Her only relative was her conservator but did not live in the U.S. He constantly expressed his appreciation for having a professional to ensure good care. Part of ensuring good care involved managing the behavior of the significant other, who tended to be overprotective of the client as well as domineering with staff caring for her. I monitored her care and made sure her needs were met until she passed away 18 months later.
Care managers are connected to an extensive network of professionals and other resources to help their clients. Sometimes something as simple as a smartphone or computer application can help manage the tasks of caregiving. A few of the things apps can help clients do are:
- Maintain a current medication list and quickly access the refill numbers needed to reorder medications.
- Create a daily schedule so family can keep track of what’s happening and when, and who might be providing the transportation.
- Store a medical history in the app so they are prepared when they accompany their loved one to a doctor’s appointment or the emergency department.
- Efficiently ask for help from siblings or friends to lighten the load. One can email their community of helpers a “to-do list” from a phone or tablet and let folks choose a task to complete.
- Keep track of the hours and money spent caregiving. Statistics show that caregivers spend about $5000-7000/year of their own money buying incidentals for their loved one.
- Easily access solutions to daily concerns as they arise.
It takes some time to input data initially, but since the typical caregiving journey lasts about four years, the effort is well worth it with the convenience and time and money saved in the long run.
I recommend one of the following apps (Full disclosure: I helped design the first one and have a financial interest in it):
https://www.apps4caring.com/apps/caring (Note that Caring does not have any advertising on its app.)
- Dementia Solutions:
- Lotsa Helping Hands:
https://carezone.com/home (Note that affiliate ads come up when using this app.)
As an elder care manager and consultant, Kira has served hundreds of older adults and their families in a variety of settings, including hospitals, residential care facilities, skilled nursing places, hospices, Alzheimer’s adult day care programs and Meals on Wheels. Using two decades of experience, Kira uses her skills at her elder care management firm, Living Ideas For Elders, opened in 2007.