The SeniorBridge Blog

Rona S. Bartelstone

LCSW, BCD, CMC, C-ASWCM

Traditionally, physicians have been the point person for primary care. But with diseases today being mostly chronic illnesses requiring a range of health, social, emotional, environmental and physical services in addition to medical care, private care management has emerged as a leader in guiding families through the caregiving process.

A successful partnership between the care manager and the family, as illustrated below, facilitates the coordination of appropriate care, at the appropriate time, in the right setting and in accordance with individual needs and resources.

Care Management at Work
Living away from their family, Mr. and Mrs. Chasser (not their real name) were beginning to deal with multiple care decisions. They were a worldly couple who had saved enough money to meet their retirement needs.

Though relatively healthy, Mr. Chasser was beginning to experience some memory loss and asked his wife to take over the daily money management. Mrs. Chasser, 80, had a heart condition as well as osteoporosis; she was becoming increasingly anxious that her husband was becoming senile. Mrs. Chasser had never been responsible for money management, investments or legal issues and was afraid to ask her husband for guidance, fearing she might upset him.

After a trip to visit their grandchildren, Mrs. Chasser had a stroke, causing her to become weak and unable to speak. Although she would regain some of her mobility and speech, she would never be as active again. While Mrs. Chasser was in the hospital and rehabilitation center, Mr. Chasser realized he could not manage at home alone. He was unable to take care of the shopping, meal preparation, laundry or housekeeping. He also had difficulty dressing himself and frequently became frightened, knocking on neighbors’ doors at all hours.

A concerned neighbor called the couple’s son, Brian, who was unaware of the extent of his father’s memory loss and his inability to manage at home alone. When his mother was going to be discharged from the hospital to a long term care facility for rehabilitation Brian flew in to visit his parents. Upon arriving at their home, Brian found his father sitting in the dark crying because he could not remember when his son was coming and he thought his wife had already been moved, though he could not remember where. In the unkempt house, Brian found no food and dirty clothes; he suspected that his father hadn’t bathed in several days.

While a hospital social worker was able to assist Brian with his mother’s care, she was unable to help with his father because he was not a patient. She suggested hiring a private care manager who would be able to help coordinate the care of both parents. A care manager could also help integrate the different services and payer sources to provide the optimal plan.

Brian hired a care manager who soon discovered there were several levels of need and sources of support. After a comprehensive assessment, she helped Brian determine the best short term and long term plan of care for his parents.

At the rehab facility, Mrs. Chasser’s care was covered by Medicare and supplemental insurance policies for two weeks. If more care was deemed necessary, the couple’s long term care policy would cover the cost.

Mr. Chasser needed extensive care as well. The care manager felt his cognitive losses and anxiety were being exacerbated by the stress of his wife’s illness. She arranged for a complete neurological and psychiatric work-up, resulting in a diagnosis of probable Alzheimer’s disease. The diagnosis qualified Mr. Chasser for home care benefits under his long term care policy.

The care manager placed a temporary, 24-hour aide in the home. She also arranged community services for Mr. Chasser, including a daycare program with stimulation and socialization, and brought a medication dispenser to the Chassers’ home to assure compliance with medication routines. Grab bars and a shower seat were added to the bathroom and a personal emergency response system (ERS) was installed that could eventually reduce the hours the aide was needed. The care manager worked with Brian to help him understand how the long term care policy would work and how to allocate its use so that the pool of funds would not be depleted too quickly. This was a particular concern since Mr. Chasser could live with his dementing illness for many years.

The care manager worked with the family to bring Mrs. Chasser home after rehab. With the ERS in place, the couple could be alone for 14 hours each day. Gradually, as Mrs. Chasser became more frail and Mr. Chasser more forgetful, 24-hour care was reinstated. Eighteen months later, when Mrs. Chasser died, the care manager helped support Mr. Chasser through his grief and eventually helped move him to an Alzheimer’s-specific assisted living facility. After a brief adjustment, he began to flourish in the new residence.

Brian was grateful to the care manager for helping his family navigate a complex, fragmented system of health and social services. He also was relieved that in spite of using his parents’ financial resources to pay for their care, there were still financial resources that would help pay for his children’s college education. In fact, a result of the heart-wrenching experience, Brian began to work on his own financial, insurance and legal plans.

A Successful Partnership
The entire Chasser family benefited from the partnership with their care manager. Brian was able to visit his parents as planned, instead of always in a crisis mode. Mr. and Mrs. Chasser were able to be cared for in their own home using a combination of private insurance, community resources, entitlement programs and emotional support from the care manager. The physician, who received regular reports from the care manager, was confident that his plan of care would be carried out in the home to assure the best treatment possible in a safe environment. And finally, when it was appropriate, Mr. Chasser was able to move into assisted living that catered to his specific needs.