The chronic phase is the time between the diagnosis and the result from the treatments. During phase, the dying person tries to cope with the demands of daily life while also going through necessary medical treatment, “often having to struggle with the unpleasant side effects of their treatment”.Chronic illness may also involve repeated episodes of deterioration in which the patient confronts and adjusts to these losses. Examples of these losses include cognitive function, sexuality, toileting, the ability to ambulate, eat and dress. The focus of life for both the family and the patient needs to be redefined, shifting from hope for a cure to coping with the illness
Geriatric care manager tasks:
- Assist family determine type of long-term care which may be safest and healthiest for the loved one: institutional: hospital chronic care or nursing home care, in home nursing care or family care and make arrangements
- Co-ordinate help from community organizations through the continuum of care
- Assist client and family connect with support groups in death and dying
- Assist learning management of disease skills such from health care staff, videos, manuals or brochures.
- Monitor anticipatory grief needs
- Learn about disease in order to help the patient make good decisions about his/her care and to help family members monitor their expectations
- Monitor caregiver burden: encourage family caregiver’s take time for selves, take breaks, get rest get to medical appointments, for grief needs
- Assess client’s non medical needs: transportation, physician’s appointments, household tasks, personal care if hospice involved- medical if not involved
- Assess family caregiver for overload, burnout, educational supports, home care supplement or family replacement care