Services from care managers should be something that every
family takes advantage of, but in reality very few families use them. Qualified
managers could go a long ways towards helping the family find better and more
efficient ways of providing care for a loved one.
The concept is simple. The family hires a professional adviser
to act as a guide through the maze of long term care services and providers. The
care manager has been there many times. The family is experiencing it usually
for the first time.
Hiring a care manager should be no different than hiring an
attorney to help with legal problems or a CPA to help with tax problems. Most
people don't attempt to solve legal problems on their own. And the use of
professional tax advice can be an invaluable investment. The same is true of
using an experienced manager.
Unfortunately there are too few care managers and the public
is so poorly informed about the services of a care manager, that valuable
resources that could be provided go lacking.
The irony of not using a care manager is that most families --
when given the opportunity to use these services -- think they can do it
themselves and will not pay the money. Yet the services of a care manager most
likely will save them considerably more money than do-it-yourself. The cost of
the care manager might be only a fraction of the savings the manager could
produce. Care management services can also greatly reduce family and caregiver
stress and help eliminate family disputes and disagreements.
Below is a partial list of what a care manager might do:
- Assess the level and type of care needed and develop a care plan
- Take steps to start the care plan and keep it functioning
- Make sure care is received in a safe and disability friendly environment
- Resolve family conflicts and other family issues relating to long term care
- Become an advocate for the care recipient and the family caregiver
- Manage care for a loved one for out-of-town families
- Conduct ongoing assessments to monitor and implement changes in care
- Oversee and direct care provided at home
- Coordinate the efforts of key support systems
- Arrange for services of legal and financial advisors
- Manage a conservatorship for a care recipient
- Monitor the care of a family member in a nursing home or in assisted living
- Assist with the monitoring of medications
- Find appropriate solutions to avoid a crisis
- Coordinate medical appointments and medical information
- Provide transportation to medical appointments
- Assist families in positive decision making
Let's look at two hypothetical examples to see how a care
manager could be used .
Here is the first example:
Mary is taking care of her aging husband at home. He has
diabetes and is overweight. Because of the diabetes her husband has severe
neuropathy in his legs and feet and it is difficult for him to walk. He also has
diabetic retinopathy and cannot see very well. She has to be careful that he
does not injure his feet since the last time that happened he was in the
hospital for four weeks with a severe infection. She is having difficulty
helping him out of bed and with dressing and using the bathroom. She relies
heavily on her son who lives nearby to help her manage her husband's care.
On the advice of a friend Mary is told about a care manager,
Susan Brown, who helped the friend's family cope with the care of a loved one.
The cost of an initial assessment and care plan from the care manager is
$300.00. Mary thinks she has the situation under control and $300.00 for someone
from the outside to come in and tell her how to deal with her situation seems
One day Mary is trying to lift her husband and injures her
back severely. She is bedridden and cannot care for her husband. Her son, who
works fulltime, now has two parents to care for. On the advice of the same
friend he decides to bring in Susan Brown and pay her fee himself.
Susan does a thorough assessment of the family's needs. She
arranges for Mary's doctor to order Medicare home care during Mary's recovery.
Therapists come in and help Mary with exercises and advice on lifting. Susan
advertises for and finds a private individual who is willing to live in the home
for a period of time to help Mary with her recovery and watch over her husband.
Susan makes sure the new caregiver is reliable and honest and that taxes are
paid for the employment. Susan enlists the support of the local area agency on
aging and makes sure all services available are provided for the family. Susan
also calls a meeting with Mary's family and explains to them the care needs and
how they need to commit to help with those needs. Susan makes arrangements to
purchase medical equipment for lifting, moving and easier use of the bathroom
facilities. Medicare will pay much of this cost.
Susan suggests using a geriatric care Physician she works
closely with to help Mary in the care of her husband. The geriatrician meets
with Mary and her husband and spends a great deal of time explaining the proper
treatment and care of elderly with diabetes. He rearranges medications and puts
Mary's husband on a new insulin regimen to better control his blood sugar. He
starts a strict diet and insists on weight loss and exercise. The previous
doctor seemed more interested in treating symptoms than in changing lifestyles.
In contrast to this attitude, the geriatric Physician feels that Mary's husband
has a chance of improving his health with proper treatment.
Susan also works closely with an elder law attorney and a
financial planner who specializes in the elderly. The attorney prepares
documents for the family including powers of attorney, a living will and advice
on preserving Mary's remaining assets. The financial planner recommends a
reverse mortgage specialist to help Mary and her husband tap unused assets in
their home's equity. In addition, an income vehicle is put into place to convert
assets into income in order to provide for Mary for her life when her husband is
gone. And finally, with the help of the financial planner, an application for
veterans benefits is made for Mary's husband who is a veteran. Depending on the
monthly cost of care this additional income could provide up to $1,800 more a
month in household income.
With the help of the care manager, Mary's life and future have
been significantly improved. Her husband as well, if he adheres to the care
plan, may end up having a better quality of life for his remaining years.
Here is another example of the value of the
Michelle is a single divorced mother with two teenage
children. Her mother, Martha, has a stroke which apparently causes some memory
loss as well as some disability in being able to fend for herself. Michelle
decides to move in with her mother and take care of her. In return, Michelle who
is temporarily out of work, has a place to live and share her mother's
Martha is anything but easy to take care of. She has mood
swings and often forgets what she is doing. She seems to display a lot of anger
and takes it out on Michelle, calling her all kinds of horrible names. She is
never happy and is constantly calling for attention. In trying to take care of
her own children as well as her mother, Michelle is quickly being drained of her
physical and emotional strength. In addition Michelle's brother and two sisters
are happy she is taking care of her mother since they are now absolved of the
responsibility, but they treat Michelle terribly. They also call her awful names
and accuse her of being a "leech". On the other hand they have plenty of advice
on how to deal with their mother but never offer any of their own time to help.
After all, they reason, Michelle is receiving benefits from caring for her
mother and logically she should be responsible for all the care.
On the advice of a friend, Michelle hires a care manager,
Brent Smith, who comes highly recommended in solving family disputes. Brent is a
certificated mediator. Brent first does a care assessment of Martha and comes
away suspecting there is more to her personality disorder than a stroke. He
makes arrangements to take Martha to a geriatric Physician who does a complete
physical assessment and recognizes that Martha's mental state is due more to
improper medications and severe depression. Martha's medications are reduced and
changed and she is put on antidepressants. In addition her diet is upgraded, she
is to receive more fluids, more healthy foods and especially receive vitamin
supplements. Particularly important is a prescription for vitamin B12 shots.
The doctor insists on as much exercise as Martha can handle.
Brent, the care manager, helps convince Martha of the need for her new care
program and helps oversee her following through on the exercise program. Over
the ensuing months Martha's lack of memory and abusive behavior become less
severe. She is also better able to care for herself without Michelle's
In addition to the assessment, one of the first things Brent
does is to contact Michelle's older brother who is the family leader. He has a
long talk with her brother and gives the brother a different perspective on the
issues. With a better understanding of the situation, the brother calls a family
meeting and Brent mediates a successful resolution of the family mistreatment of
Michelle and the ensuing bad feelings. Everyone including Michelle is called
upon to do their part in managing the care of her mother and to work on better
family relations. The issue of Michelle "sponging" off of her mother is
addressed and an adequate solution is agreed to by all. Brent will follow up in
a month to make sure everyone is following through on his or her commitment.
These two examples concentrate on care in the home but care
managers are also actively involved in helping families with the selection of
facilities and any appropriate care services. Finally, care managers are
indispensable in helping coordinate and arrange for care for a loved one living
far away from family members.
Give us a shout today by calling Omega Care Planning Council at 919-552-3111 ext 110, Kimberly