Are you a non- profit agency considering adding geriatric care management? You have many questions to answer before you make this business and culture changing decision.
Does a for profit geriatric care management business fit into your non – profit organization? In order to make this decision it is best to do a market feasibility study before you decide to add GCM to your present service mix.Have you weighed the chances of a for profit succeeding in your presentnon-profit culture? Have you studied the competition in your area? Have you evaluated the number of customers and potential demand for these care management services? All these steps should be taken in evaluating the opportunity to add a for-profit geriatric care management arm to your existing non-profit agency. Hiring an outside consulting firm to do this market feasibility study is a good business move and may save your non-profit many dollars and regretted decision
Adding Friends to the Circle of Care
Friends of the careprovider need to be brought into the family caregiver’s circle of care. The main caregiver often desperately needs respite from unremitting stress of caregiving. Encouraging the caregiver to use their friendship network to go out with friends to lunch and dinner, go to a movie, go away for a girl’s weekend, may take the GCM arranging respite with either paid or family caregivers.
Encouraging caregivers to use a social network like facebook can help reconnect with old friends and classmates to have a way of feeling emotionally connected This again can be a good GCM task. Caregiver support groups offer brand new friendships with others with the same issue of a needed breathing space. These new comrades in caring can bloom outside of the support group as well and buttress both caregivers.
Encouraging the family caregiver to let friends know how to reach them and frankly understand their caregiving situation, can help the caregiver build a circle of support. As caregiver’s often do not reach out for support, this takes real skills in coaching by the GCM.
Family Caregiving Alliance supports a circle of care concept and can be another resource to encourage caregiver to reach out and ask for help.
Emotional resources can link a circle of care for the direct family caregiver. These emotional supports could and should include adult siblings . Siblings are the longest and deepest relationship in any person’s life. Reconnecting midlife or aging brother’s and sisters, through the circle of care, is a critical GCM task but to achieve this, the care manager may have to depend his clinical skills in helping siblings with forgiveness or reconnecting siblings who live long distance.
Midlife siblings have often spent the last 30 years tending to their own families .So the point of reconnection with middle aged brothers and sisters often happens when they are still working or retiring yet thrown into a crisis in parent care. This is where the GCM either needs to have clinical skills to can help with healing this sibling reconnection and at the same time find the resources for the family. If the family is dysfunctional, the resources might include a mediator who specializes in aging families or a Marriage and Family Therapist who specializes in Aging (hard to find)
Once the terminal diagnosis is known with an elderly client , the care manager is often the one who will initiate and guide advance care planning discussions. As difficult as these discussions may be, the burden on the family is significantly lessened if decisions about advance care planning are made before the client’s condition worsens.
Hopefully this has already been done but many people put it off for fear of death. A recent study found that less than 50% of severely or terminally ill patients had an advance directive in their medical record.
Communication between clients and their loved ones greatly improves the quality of care received as advanced illness progresses. Conversations about quality vs. quantity of life enables care managers to better coordinate services for continuity of care and plan for or stay away from various medical treatments.
The dying person’s decisions about these issues relieve the family from stress and the burden of having to make these decisions. Family members who can participated in end of life discussions about their dying loved ones health care preferences, have the less burden of making treatment decisions . Family members will see out their attending physician as the preferred source of information and reassurance, but the role a geriatric care manager can reducing family burden, by educating the family and avoiding futile life-sustaining therapies if not indicated , and providing effective comfort care.
Advance directives are legal documents that allow clients to make decisions about their health care and finances in advance of when they are not mentally or physically able to do so. These documents which must be signed, dated and witnessed naming another person to make decisions for you.
Your job as a care manager is the make sure the dying client has these documents:
• A durable power of attorney for health care or a health care agent assigned in that document as part of the advanced directive form to make decisions if that person cannot.
• A living will – (This form of advanced directive that only takes effect if you are diagnosed with a terminal illness.)
• A do not resuscitate order DNR (efforts to restart the heart after it has stopped).
• If the client does not have these legal documents pre-hospital admission and wishes to create them, the Geriatric Care Manager will suggest that the documents be put in place with the oversight and consultation of an elder law attorney elder law attorney or the client’s family attorney.