Geriatric care manager’s serve older adults before they find they are dying. GCM’s work with chronic care clients, some times for years, who eventually succumb to their illness.
People usually learn that they have a terminal illness from a doctor who gives them a diagnosis. In order to work with terminally ill patients and their families, the geriatric care manager must understand both the physical and emotional aspects of the dying arc. Due to recent advances in medical technology, the period between diagnosis and death can be long. This period is termed the “living-dying interval”.
Then the progression of most terminal illnesses will be similar to that of a chronic illness. There may be intensive medical treatments involving drug regimens, surgeries, and dietary modifications that improve the quality of life or extend the time left to live. However, the client never fully regains their former level of functioning. Progress fighting the disease is followed by relapse. The disease progresses and mental and physical symptoms slowly get worse over time. As an individual progresses to the final stages of terminal illness, problems such as infections gradually become more difficult to treat and the ability to speak, eat, dress, and toilet oneself deteriorates. With the help of an interdisciplinary team of health care professionals, the geraitric care manager monitors these changes and decides what they mean in terms of on going care. These changes will be reflected in an updated care plans.
After the diagnosis, coping and accepting ones own death or the impending death of a loved one can take some time. It begins with an intellectual realization followed by
an exploration of feelings. As the dying and their family members begin to accept what is happening they begin to make adjustments to accommodate the changes that come as the disease progresses.
This process of acceptance and adjustment to terminal illness has five phases:
· before the diagnosis,
· the acute phase
· the chronic phase
· the recovery phase
· the terminal phase
Interventions vary according to the phase.The GCM may already have served the client and they are now facing a terminal diagnosis. But a geriatric care manager may be brought in when the family is negotiating through any one of these phases, their work begins with making a determination of what phase the client is in during the initial assessment.