ASSESSING & INITIATING SERVICES

The physical and mental challenges that accompany aging often make seniors increasingly dependent on community resources such as senior centers, health and social services departments, and other agencies that specialize in elder care services.

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Aging Care Managers (or Geriatric Care Managers) make it their business to know what resources are available locally and how they can best be accessed. Based on what’s specified in your loved one’s Aging Quality of Care Plan, their Aging Care Manager will identify the appropriate resources and determine who will follow up to initiate the needed services. If a certain resource isn’t available locally, your Aging Care Manager will problem solve to track it down.

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Initiating services involves making phone calls, filling out applications, signing up on waiting lists, coordinating schedules, ensuring those who will be using the resource get the proper training, and updating the senior and family on what is happening. Aging Care Management can do all of this, and more, to ensure your loved one can start taking advantage of needed services as quickly as possible.

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Knowing Community Resources

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Experienced Aging Care Managers are deeply rooted in their communities, with a keen understanding of the health, mental health, and social services systems. Not only are they aware of what is available, but they are also able to differentiate between each local resource to decide which are best for your elderly loved one. Because Aging Care Managers are part of a larger team, they are able to get feedback from their colleagues, honing their knowledge and understanding of available resources.

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Housing

 

Most older adults have to grapple with questions about housing at some point. Your elderly loved one may be wondering:

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• Where will I live if my care needs change?

• Do I need to move?

• If I do need to move, what are my options?

 

Aging Care Managers know how to answer these questions with sensitivity and compassion, and they are well-versed in alternative living arrangements. They can explain the pros and cons of the entire senior housing continuum, from locked facilities, skilled nursing, assisted living, memory neighborhoods within assisted living, and residential care facilities (small group homes), to retirement communities and independent living.

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Medical

 

Aging Care Managers specialize in working with seniors who have multiple physical diagnoses. They work closely with physicians, nurses, home health, and hospice professional staff to ensure that your elderly loved one will receive all needed medical services, which may include:

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• Post-hospitalization care to manage the transition home

• Coordination with Home Health / Hospice

• Coordination with an MD

• Durable medical equipment

• Outpatient rehabilitation services

• In-home rehabilitation services

• Coordinating medical appointments

• Medication oversight (use of a pillbox, reminders, follow up

• Nutrition oversight

• Home monitoring of blood sugar, blood pressure, temperature, weight, etc.

 

Social

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Aging Care Managers know that social well-being impacts physical health, mental health, and all other aspects of life. As a result, they will determine which factors impact your elderly loved one’s social well-being and identify both the positive activities to be pursued, as well as the obstacles or negative issues that impede successful social engagement.

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Here are a few examples of positive activities to be pursued:

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• Social outings

• Educational opportunities

• Cultural activities

• Religious/Spiritual activities

• Spending time with people

• Adaptation of past interests / hobbies / pastimes

• Exploring new interests

 

Here are a few examples of potential obstacles to social engagement:

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• Mental health conditions:  Depression, Anxiety, Paranoia

• Cognition changes

• Physical conditions

• Personality challenges

• Transportation

• Financial resources

• Communication issues

• Visual / Hearing limitations

 

Mental Health

 

Researchers estimate that one in five senior adults is living with a mental disorder; for seniors residing in a nursing facilities, that number jumps to one in three. The most common mental health conditions among the elderly are depression, anxiety, dementia, substance abuse, paranoia, and the negative emotional impact experienced due to living with chronic illness and pain. Unfortunately, older adults tend to under-utilize mental health services due to a myriad of reasons, including lack of funding and/or accessible services, poor coordination between mental health, health and aging services, the stigma surrounding mental illness and treatment, and denial.

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Aging Care Managers strive to understand each client’s mental health diagnoses, the ancillary issues impacting each individual’s mental health, and the resources available to provide support. For example, if your elderly loved one is coping with a mental health issue, they may benefit from:

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• Therapists

• Group Therapy

• Peer Counseling / Support

• Day Treatment Programs

• Senior Day Care Programs

• Psychiatric Hospitals (Geriatric Units)

• ECT (electroconvulsive therapy)

• TMS (transcranial magnetic stimulation)

• Psychiatry/Psychiatrists

• Detox / Rehab (Geriatric Units)

 

Initiating Needed Services

 

Getting needed services in place quickly requires organization, follow through, and perseverance. Having a professional Aging Care Manager on your side can save time and provide you with a respite. Our Aging Care Managers can handle tasks such as:

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• Calling the resources in the final selection process

• Checking on availability

• Applying / providing information about a client for the intake process

• Coordinating the delivery/schedule of a service or product

• Confirming dates with a client/family/provider

• Being there to introduce/facilitate initiation of service(s)

• Following up with others involved to update them

 

Handling All the Details

 

Aging Care Managers excel in these three areas:

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1. Creating trusting therapeutic relationships so that their clients accept needed services

2. Knowing “just the right” resources, and

3. Handling all the big and small details so families can regain peace of mind.

 

To understand how all of these skills can be applied: imagine a senior who has no local family and is about to be discharged from the hospital. The senior’s daughter, who lives 2,000 miles away, is called and told that a slew of things must happen over the next 36 hours. Since the senior can’t return home without care, home health services need to be ordered. In addition, durable medical equipment is needed, medications are awaiting pick-up, follow-up appointments need to be scheduled, and the list goes on and on. Should the daughter buy a last-minute airline ticket, take off work, and leave her spouse to manage the kids? Or should she engage an Aging Care Manager? The Aging Care Manager can meet with the senior and the hospital discharge planner to assess and handle all the details, including:

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• Arranging for a caregiver to start the next day

• Coordinating with the caregiver to meet the senior in the hospital prior to discharge so that they’re comfortable with the plan

• Ensuring that the medications will be picked up at a local pharmacy

• Faxing new medication lists to the senior’s primary physician so that they are aware of changes

• Organizing a new schedule of medications in pill boxes and establishing a medication reminder system

• Confirming home health company scheduling

• Alerting the primary physician about discharge and scheduling follow-up

• Coordinating transportation through a caregiver or other program to ensure the client will get to follow-up appointments

• Scheduling deliveries for medical equipment

• Being available 24/7 to answer questions and facilitate a smooth transition

 

An Aging Care Manager can help your family take action, implement the needed services, and assist with care coordination along the journey. To learn more, please call Aging Care Planning Solutions TODAY to schedule a free 30-minute phone consultation.  Click HERE to set up your appointment.