Cathy Cress

Expert in Aging Life and Geriatric Care Management

What is the GCM’s Role is the Recovery Phase of Death and Dying ?

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The recovery phase of death and dying 

This occurs when people finally are able to cope with the mental, social, physical, religious, and financial effects of their disease, a heavy load  In the disease process and acceptance process, this is the period of time after a medical procedure such as chemotherapy, radiation or surgery. The client’s response to treatment is being monitored. Recovery does not always mean remission, but instead, it is the ability to accept and deal with the struggles of their illness

A Story About the recovery phase

William died at the home of his son after he had accepted that he was to die of liver failure. He was hospitalized and had not signed a Do Not Resuscitate because he actually did want everything done to save him. He had new twin grandsons a grandaughter he adored and loved life. He was having dialysis to treat his symptoms. A care manager knew that the doctors suspected cancer but believed the procedure to find out would kill him. But they felt their hands were tied by the DNR and the hypocritic oath. The care manager, finally, after talking to a nun on the staff of the Catholic hospital who said she would help,  and talked to the lead physician and asked that he order palliative care. He did and all 4 physicians talked to Bill gently and about removing the dialysis and signing a DNR. He did and after a family meeting lead by palliative care and hospice, William came home with 24-hour care.

The Recovery Phase Begins

After his coming to terms with his death, he and his family, sons, and grandchildren were able to say the goodbyes and offer the unconditional love that they had been fearful to express before his acceptance. A feeling of light joy permeated his room. For almost a month he lived in the family room overlooking the garden, where his hospital bed was set up. Great-grandchildren brought pictures, marveled at “grandpa grandpa “ high up in a hospital bed. His son put a  headphone with a mike on and William could hear and speak, as he had not in years. His 24-hour caregivers were gifted loving care providers from a GCM agency  Livhome. 

Home Care and Care Management in End of Life

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The 24-hour shifts included a nurse of 18 years from Central America and a man finishing his Ph.D. from the Congo. They cared for him with great warmth, so his family could just be his family, relaxing in their love and surrounding him, as if in a circle, that swirled with 4 generations, going every which way while he watched, really loved, and melted into his last stage. They ate meals, chitchatted, and welcomed new family coming in to see William, as he remained in the center in his hospital bed, the fulcrum of the gathering.

End of Life Geriatric Care Management Well Done

The geriatric care manager, GCM Mary Brennan, from Livhome, a seasoned powerful and so kind LCSW,  was an orchestra leader in Bill’s death. She adjusted here and there, with care providers, family needs, Bill’s needs, and followed the guidance of hospice, who were slowly increasing the pain meds, and supporting his health and medical care needs in death. The geriatric care management agency worked as a partner supplying 24 care and support for the family.

Bill was able to have again, a magical care provider from Livhome, who had been with him for almost two years and was there at the end as were all his sons – a life fully lived and a good, good death.

You are only as strong as your weakest link- those are the care providers.

These people were the raft that floated bill up while the family, offered love and hospice provided medical and end of life support. Together they buoyed Bill into his last stage of dying, knowing that his family was the fabric of every step he took toward forward towards death.

 

Deliver a Good End of Life- Add Death and Dying to Your Care Management Agency

 

Serve Your Client Until Death Do You Part

 

Join me Thursday, March 11, and learn why End of Life Services Are a perfect new service for care managers

 

In this 1 ½ -hour webinar you will learn how to

 

 

1.Transition the patient/family through the five stages of death

2.Help clients be active participants in their care

3.Give the family/caregiver tools to manage their care

4.Provide family center care to caregiver and family

5.Choose the right support services through all stages of death

6.Introduce Hospice and Palliative care and work with their team

7.Use ALCA End of Life Benefits During COVID. 

8.Use  COVID -19  Family Coaching for GCM

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If you really want to add End of Life to your care management business sign up for this webinar now

How Does a Geriatric Manager Rate Her Husband’s Discharge?

Discharge Before The Affordable Care Act

Families leaving the hospital used to scramble to get mom or dad home from the hospital safely – often quickly. and chaotically. In some parts of the country, families were given notice that the following day – or perhaps in two or three days – the older adult would be ready to leave the hospital.

Word of the discharge sets the family in motion – seeking resources, exploring options, and lining up care- that shockingly may be themselves. For many families, this is the beginning of confusion and horror from the cost of care, the difficulty finding advice, the myriad health, functional, and safety needs to address, and finally the challenges of finding peace of mind after the discharge.

As a result, many older American were readmitted to the hospital between 30 and 90 days- doubling the discharge, the family confusion and often ending the older person in a nursing home

When the Affordable Care Act was passed, Medicare lashed at that huge problem. They began fining hospitals and all that began to slowly change. Hospitals paid more attention to hospital discharge.

 You can see that at Stanford University Hospital where my husband just had open-heart surgery for a defective valve.

His discharge is today after being here 7 days including today. He has had incredible care as I have documented in my last blog. We knew about discharge from day one. It may have helped that I am a geriatric care manager and knew this would be a critical transition so I asked about it. At Stanford, they have a unique discharge process and I was prepared for it.

Instead of one discharge planner, we will have three. The first is what I have been advocating since I wrote the chapter on  Care Managers and Hospital Discharge in Care Managers Working With the Aging Family. She is

our hospital care manager, Christine Harris BS BSN who has followed all our transition and been to see us every day, will be here to go over the discharge with Pete and me.

The second was a Cardiac RN coordinator who was with us yesterday and spent an hour going over-discharge and care in the first few months post-discharge with a binder that she reviewed at the meeting and we will have to take home.

Stanford Cardiac Discharge made physicians’appointments for the next month with the primary physician in a week and Pete’s cardiac surgeon in a month followed by a cardiologist who will be Pete’s follow from now one. Home Health through Medicare was set up by the appointment and we will have an RN, PT, and OT coming to our home post-discharge.

 All are at Stanford by Pete’s choice because we want to stay within one medical system although we live an hour away in Santa Cruz. We also have a primary physician 5 minutes away that he will see next week and use for any emergencies. Both systems communicate well already. A list of these appointments is in the binder

The third discharge planner is a Stanford pharmacist who will meet with us to go over the medication that will go home with my husband I already have a complete list that was prescribed.

Here are some steps that a care manager should follow in discharge that Stanford already implements

  • Help the family determine whether the family caregiver is willing and able to deliver care-
  • Pete has me my daughter Jill and her partner Tom McKay, who is a Ph.D. RN. We are all willing
  • OR suggest organizing other family members to deliver care-
  • Our family have a great team now
  • OR suggest hiring private duty care providers-
  • we do not need care Pete is walking, on limited meds stable after heart surgery
  • Advocate for the family to be included in the discharge meeting-
  • We were very included
  • Involve family in Home Care
  • We were very included
  • Request that the discharge planner share the hospital discharge list-
  •  We have an entire booklet plus will have met with 3 discharge planners
  • Assess the family caregiver’s willingness and ability to deliver care –
  •  We are willing
  • Reassess the client with comprehensive functional, psychosocial, depression, mental status- that was done by Cardiac Nursing Dept, Pt, OT, Respiratory and I will have reports
  • Measure the risk of readmission-
  • Pete has a slight risk. He never had any pain, moved out of ICU in a record 20 hours, and out of step down ICU but his heart rate in high so slight risk
  • Help the family determine whether the family caregiver is willing and able to deliver care
  • we are willing and able
  • OR suggest organizing other family members to deliver care-
  • no need but have friends delivering meals every two days
  • OR suggest hiring private duty care providers-
  • not needed

  • More after discharge

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