The Professional Geriatric Care Manager’s Blog

I cannot tell you how happy I am for my client J. J is probably one of the most intelligent and talented individuals that I have met as a Geriatric Care Manager. She has been well educated, with a double masters, and has been actively involved in her community through various organizations. She has recently been asked to display her photos at a showing this Spring. Her photos are amazing and capture the essence of individual subjects. Her recovery from her illness almost 1 year ago has had some bumps along the way but all in all she, at 83 years young, has almost fully recovered. She is resuming most of the activities that she so enjoyed prior to her illness. Way to go, J!

There are many times that we know what is best for our clients given their medical history, knowledge of who they are as individuals and their families. Our plan of care that we coordinate for them should reflect all of these considerations and as many Care Managers do I try my best to keep all of these personalized needs in mind when moving forward with my plan. It seems that often even with my client on board with these plans they can be sabotaged knowingly or subconsciously by their children. This is frequently while their children genuinely love their parents. This past week it happened twice! I gave a lot of thought and consideration about what was needed in two cases where my client’s needs were not being met. One is H- whose daughter was on the phone every other day concerned, worried and genuinely caring. H is charming, bright, and cute as a button. She has been extremely independent till now. Called in by her daughter due to some of H’s lapses in memory, an assessment was made and recommendations were given quickly. Yes H. still drives and takes care of all her needs independently, but the accuracy of her medication administration was seriously questionable. It took 5 visits and lots of conversations with H’s daughter and finally she is viewing us as an advocate for her mom. Her medications have been set up in her med minder and I will keep you posted on how she does.
The second client who a similar situation occurred with is R. I have been R’s Care Manager for some time and although he finds it difficult to express his feelings he has improved with this over the past several months with the assistance of our Geriatric Care Counselor, Bobbi. Bobbi just has a way about her and a lot of knowledge to add to this. R had shared with me previously that he had enough of his visits to the Emergency Room for recurrent resistant seizures. This was in spite of his frequent calls and visits to the Neurologists. His visits to the Emergency Room were lengthy, draining and stressful for not just him but his family as well. He did not want to go. The question arose many times- “Do you really need to go with each and every seizure?” I had suggested discussing with his children and he asked me to become involved which I had. However his children ever lovingly trying to do the very best – continued to take him to the Emergency Room with the onset of his next seizures. EEG’s were done, medications adjusted, precipitant conditions noted and R was sent home after many hours of anxiety for all. Our discussion occurred last week after his most recent seizure and subsequent visit to the ER- He was upset and told me “Six times I’ve been brought to the Emergency Room” and held up his hands with six fingers extended to punctuate his point.
He was scheduled for a visit to his Neurologist the following day. I clearly stated- “Ask your Neurologist on your visit tomorrow if it continues to be necessary?” Well R did and basically as we Nurse Care Managers know- unless it is extended with symptoms of anoxia – “No a subsequent visit to the ED is not necessary”. R will be happy- he wants to be home with his wife and Care Givers.

In the business of caring for Geriatrics, it goes without saying that our clients will more often than not be with us too short a time. Last week we lost our long time client and friend – R. Without more than one statement clearly making this anouncement I felt it. That old familiar pain when you lose someone special who has always been there. R was not my client but the client of my colleague, however I had visited with R on more than several occasions. Although he was not demanding and extremely pleasant to be around, R could be difficult with his Live in Care Giver. She was extremely dedicated to him in spite of this. This is simply a goodbye to “R” and acknowledgement that even if clients are not ours personally we know them, care for them and ultimately miss them when they are gone.

This past week I made my usual visits to my clients and all seemed to be status quo. Except for when I visited R. R had progressed to his maximum level following a stroke this past summer. Physical Therapy and Occupational Therapy were ready to discharge him. R was doing well in many ways and was beginning to resume some of his more enjoyable activities; a Christmas Party at his office and lunch with some business friends and family.
The beginning of the New Year presented an opportunity for conversation about what R wanted to do about his frequent visits to the Emergency Room. R continued to have seizures that were thought to be due to his stroke and were being managed on a twice daily dosage of Kepra. The frequency and the duration of these seizures were lessoning yet his family continued to call 911 and bring him to the Emergency Room. Seldom was there anything more than a brief examination by the ED MD and then a call to R’s Neurologist with an adjustment to his Kepra dosage. R expressed frustration as his most recent visit to the ED this past weekend was being described by him to me. He emphasized that it was the 5th time in 5 months with his right hand in full extension exaggerating the number 5! We talked about his option of not going to the Emergency Room for seizures that resolved more quickly and what that might mean. I suggested that he discuss this with his children and then with his Neurologist.

We then at R’s request began to discuss options to continuing Physical and Occupational Therapy at home. R could continue privately or could continue to work with the program that had been designed for him with his Caregiver from a schedule that was logged and tracked. R was actively participating in decisions about his care. He was considering what made sense to him based on personal choices of comfort and stress experienced. He clearly did not want to deal with the winter weather participating at outpatient physical therapy sessions. He also did not see the need for more in home instruction when he clearly had a prescribed regimen that he participated in daily.
The goal was to keep R and his wife at home together as long as possible. That goal was being realized and R was ultimately in control of attaining this. He was managing his situation with the coordination of care from our services with the support and input from his family. R had been in control of his life until his stroke and now he was back in control with quality of life choices that were being made by him.

As a Geriatric Care Manager I often reflect on my visits to my clients at the end of the week.  I am quite fond of all of them.  There are one or two who seem to dominate my thoughts at one time more than another and A is on my mind this week.  She is a wonderful 94 year old who has led an adventurous life and now feels tired and saddened by her aging.  Her family is present via photos, phone calls, and occassional visits for lunch at her home.  A is very quiet about her feelings, however she  nods her head at me when I identify what is visible to me.  She is always receptive to my visit but does not want the assistance of our geriatric counseler.  “I used to talk to someone years ago, but I did not find them helpful”. In spite of this A states “I know that I am very lucky to be living in my home and have such a wonderf ul family”.  I concur verbally and by nodding my head.  We smile and I wonder what A was like as a young woman.  How quickly time passes and steals youth away.  For A I imagine a beautiful blonde haired aristocratic demeanor with a sterness yet a softness in dealing with others.  I imagine that she knew how to get things done and probably did just that.  I will make a point to ask A more about herself, her life, and who she was.   Last week I told A that she was special and meant it.  I suspected that she does not think this about herself anymore.  It is important to me that I make certain that she knows it to be true once again.

One of the things that I enjoy doing as a GCM is using my skills from various previous work settings to assist  the patients that I now care for.  Once a Utilization Review and Audit RN, I recently had the opportunity to assist a family member in the filing of a Long Term Care Insurance claim that included care for their mom for  the previous year.  The time and work involved often leaves family members frustrated and drained.  Including it as part of what we do for a loved one can make life so much easier for everyone- the children and the client.  Often times as is the case now the insurance companies do not make this process easy and multiple pieces of information need to be included.  Once the information is submitted and a claim number has been given the bulk of the work is done.  This is all part of the process of obtaining the best care for a client.