The GCM or aging professional can recommend more than one intervention to solve a single problem. For example, an additional intervention to assist live-in lover and care giver Sally Hemingway to get respite from caregiving for her male companion Tom Jefferson could be as follows:
Problem: Problem- Caregiver Sally Hemingway is in need of respite
1. Arrange trial day at Elderday day Adult Day Program. This will provide Sally with some needed relief and a few hours to take care of her own personal needs. Although he has resisted the idea of being left at a center, Mr. Jefferson was willing to give it a try, when it was posed as a card group. On Tuesday and Thursday there is an active card group playing bridge. Mr. Jefferson is an avid bridge player. He had been apprehensive about being at this complex because it has a Nursing Home, along with Day programs, Assisting Living, apartments, memory center and a very busy activities calendar. One can come and go from the social program and participate in other activities within the complex.
a. Interventions GCM to a arrange trial day at Elderday Adult Day Program. This will provide Sally with some needed relief and a few hours to take care of her own personal needs. Although Mr. Jefferson has resisted the idea of being left at a center, he was willing to give it a try, when it was posed as a card group. On Tuesday and Thursday there is an active card group playing bridge. Mr. Roosevelt is an avid Rummy player. He had been apprehensive about being at this complex because it has a Nursing Home, along with Day programs, Assisting Living, apartments, memory center and a very busy activities calendar. One can come and go from the social program and participate in other activities within the complex.
b. GCM work with Sally to arrange Trial Day with program manager on a Tuesday or Thursday for cards.
c. GCM to stop by while he is in Day Program, meet Sally for coffee to help her with her anxiety about leaving him.
d. If trial works, GCM will arrange for half day once or twice a week (any 4 hours for $22) to give Sally an afternoon to take care of her own business
e. GCM follow up with Marsha Dowling MSE, Director o the Elderday Social Day Care program.
Because the family and Mr. Jefferson and Sally want Sally to stay as Mr. Jefferson’s care provider you have crafted multiple intervention for respites and multiple sub interventions or steps to achieve that intervention, in this case respite.
How do you combine assessments? Let’s again take a caregiver assessment and functional assessment. In your functional assessment you have found the older client has a self-care deficit. They have a family caregiver yet their clothes are dirty and they are not being bathed on a regular basis. When you do your caregiver assessment you find that the family caregiver, the aging spouse, is not only depressed but also burnt out. They have been caring for the husband for 7 months are exhausted and skipped critical care giving tasks. Adult children are aware of this and called you, the geriatric care manager or aging professional, to do a geriatric assessment. You can list both older client self-care deficit, caregiver burnout and need for informal support (the adult children) as problems in your care plan. You can also list need for formal support –(a caregiver support group, a private duty home care agency) as a problems in your care plan. You are calling attention multiple main problems – why they need a caregiver, the problems with the caregiver and extended family in a brief, through, and connected list in your care plan. This is just what you need in a care plan under problems. You have derived the problems from two separate assessments yet connected them in the care plan.
How do you connect aging client assessments? For example, if you find through your functional assessment that the client’s clothes are dirty and they are not bathing, start with self care deficit in your care plan then list that manifestation of the problem. If you find your caregiver assessment that the family caregiver is depressed and angry and is on the edge of placing the older person even if they are at the level of care- start with caregiver burnout and then list the manifestation of that burnout. You have then connected two different assessments.
Frequently, many older clients have similar deficits as they age. Most care plans will include one or more of these problems, and it is good to incorporate this list into your psychosocial and functional assessment tools. These can become a pick list you can add to the beginning of your care plan because many of them will appear in your care plan.