Five Things You Must Know About Geriatric Health and Care Management
By Pamela D. Wilson, MS, BS/BA, NCG, CSA
Managing geriatric health and using care management is beneficial to the care of aging parents, spouses, and loved ones. Care managers who specialize in caring for older adults are a specialty in the field of geriatric health. Care management expertise is priceless when the family is not available or does not have the experience to manage and oversee care.
In my years as a geriatric care manager because of the number of clients I served and the matching situations, I was able to save clients worry, anxiety, and time because of the depth and breadth of my experiences. This experience remains valuable to the caregivers and aging adults that I assist today.
Here Are the Four Things You Must Know About Geriatric Health and Care Management to Get Better Care for Loved Ones
1) Geriatricians Are Medical Specialists for Older Adults
Newborns and children visit pediatricians who are medical specialists for babies and young children. In my opinion, for persons over age 60, a geriatrician is the best choice to manage geriatric health. If a geriatrician is not available, a physician with the specialty of internal medicine is the next best option. It takes work and working with specialists to receive better than average care in the caregiving and healthcare systems.
There is presently a shortage of geriatricians. Requesting to be placed on a waiting list is an option if a practice has a waiting list. Some geriatric health medical practices are so full that many are not accepting new patients. Other practices may accept Medicare but not Medicare supplement plans.
Changing physicians requires planning. Changes to health insurance after age 65 can only be initiated during the annual enrollment period at the end of the year. Signing up for Medicare A, B, and D is important to make sure that coverage exists for hospitalizations, regular medical care, and prescription drug coverage.
When you are eligible for Medicare, I recommend meeting with a Medicare specialist to review all of your options about Medicare and supplemental policies so that you are not surprised about a choice you made years into the future.
Managing Chronic Medical Conditions
The majority of individuals over age 65 have several chronic medical conditions. If medications are prescribed, seeing a physician every six months or a year is necessary to receive refills.
Over 50% of older adults in the United States are diagnosed with a chronic medical condition. The most common chronic conditions are heart disease, stroke, cancer, chronic lung disease, obesity, Alzheimer’s and dementia, diabetes, arthritis, epilepsy, dental cavities, and chronic kidney disease.
These diseases are not life-threatening but make daily life challenging if multiple conditions exist. For example, high blood pressure and heart disease result in mobility concerns if individuals are not proactive in being physically active. High blood pressure also leads to circulatory issues that can result in a diagnosis of dementia.
One Chronic Disease Causes Another and Another
The diagnosis of one disease, if not managed, can easily result in the diagnosis of subsequent and related diseases. The medical community has not been thorough in explaining the risks and long-term effects of chronic medical conditions to patients. For this reason, adults are less proactive in responding to medical diagnoses because explanations are not thorough and questions are not asked.
For example, heart disease may result in circulatory issues that can make walking difficult if legs and feet swell. Poor circulation results in neuropathy, which is a loss of feeling in the legs and feet, that can be painful. Individuals with neuropathy begin to limit walking because of pain. Limiting physical activity then results in other health concerns which in the long term make it difficult for aging adults to remain independent and living at home.
Heart and circulatory issues can also result in strokes and a diagnosis of dementia. Being proactive about health throughout life results in fewer health concerns when older. The dream of a positive retirement happens when positive actions are taken to support good health.
Chronic Medical Conditions Result in Care Needs
Ignoring chronic medical conditions results in significant health issues for older adults because each chronic medical condition can affect another chronic medical condition. Advancing chronic medical conditions become irreversible when the individual diagnosed has not been proactive to manage or reverse the condition.
Many individuals lack the self-control to eat a salad instead of eating junk food. Making good food choices is a learned habit. Because stress is prevalent in society, many individuals turn to comfort food which is not the healthiest for the body.
Chronic medical conditions are associated with higher costs of care and earlier physical disability. Quality of life decreases over time. Caregiving becomes a need earlier in life. Home care and living in care communities is expensive. Healthcare costs are skyrocketing. The likelihood of living in, and ending life in a nursing home or other care community, rather than living at home increases with the diagnosis of multiple medical conditions.
2) Advocacy to Support Better Than Average Care is Necessary
In addition to the idea of seeing medical specialists, advocating for better than average care is a necessity. Being proactive, even if you are healthy, helps avoid the diagnosis of chronic medical conditions and declines in overall health. Learning to advocate within the healthcare community is a learned skill.
For many aging adults and caregivers, the healthcare system is intimidating. The idea of disagreeing with a physician or going up the chain of command to receive customer service represents conflict. If one does not possess the correct social skills and know what questions to ask, the system can be less than helpful. Physicians and others will refuse care and treatment.
Aging Adults Deserve Care – This Does Not Happen Without Substantial Effort
In the 20+ years I advocated for my clients, I had frequent and ongoing discussions with healthcare providers about what was best for my clients. The challenge with the healthcare system, especially with geriatric health, is that providers are rushed.
Diagnosis and treatment are generalized across a large population. Unless you are the expert about your own health or have someone to advocate for you, receiving better than average care can feel like a battle.
If a loved one has a diagnosis of memory loss, the level of advocacy needed is greater. The healthcare system views older adults as disposable, “they’ve lived a long life,” and undeserving of care and treatment. If you don’t stand up for yourself or a loved one, you will be overlooked. Patients can also be viewed as difficult patients.
When aging parents and loved ones have multiple chronic medical conditions, seeing a specialist is the next level of care. A geriatrician or internal medicine physical treats general conditions.
For example, when heart concerns increase, seeing a cardiologist is a proactive action. Being proactive, if one asks questions and takes an interest in health, helps avoid the snowball effect of new and related conditions being diagnosed.
Healthcare is Biased Against Care for Older Adults
Until one becomes an older adult or takes care of aging parents the experience of being declined for medical treatment is an unknown. Many older adults cause this situation by refusing to listen to physician recommendations and being designated as a difficult patient.
Being designated as a difficult patient occurs when medications are not taken as recommended. Other situations where patients refuse to follow recommendations to improve diets, lose weight, and increase physical activity result in denial for treatment. Unknown to most patients, these refusals are documented in medical charts. This means that the likelihood of being refused treatment increases with refusals to accept medical recommendations.
Being a Difficult Patient Reduces Treatment Options – The Hip Fracture Example
An example of an older adult who falls and breaks a hip will help illustrate the idea of treatment options. An older adult who is 85 and has been very physically active, still walking a mile a day, falls and breaks a hip. Knowing this information about the physical activity level of the older adult, the orthopedic surgeon will more than likely initiate a full hip replacement because this individual has a high likelihood of returning to the prior level of physical activity.
Another older adult who is 85 is in poor physical condition. The person sits all day, moving only to go to the bathroom or walk inside the home. This person has a low recovery estimate because the current level of activity is less than what would be expected after surgery at a rehabilitation community. Rather than receiving a full hip replacement, this individual may receive a partial replacement or a hip pinning to repair the fracture. This treatment allows the individual to return to their prior level of low activity.
In some instances during my years as a care manager, some clients were refused treatment for a hip fracture if the fracture was minor. Clients who were wheelchair bound and who had other chronic diseases were viewed as a high risk for any type of surgery.
Older adults who have a diagnosis of dementia also require advocacy for surgery and treatment. The healthcare system believes that because memory loss is a diagnosis that the individual will refuse to participate in rehabilitation after surgery.
3) Care Managers Who Specialize in Geriatric Care Are Valuable
I frequently receive questions about the value of care management. In my opinion, due to personal experience in my own family and over twenty years of professional experience, care management is beneficial.
The benefit of care management, for older adults with multiple chronic medical conditions, is care oversight with the goal of maintaining health and avoiding health emergencies. Before I became involved, many of my older clients experienced health “ups and downs.” The same clients were in and out of the hospital repeatedly for the same condition.
Care managers are problem solvers and have the ability to relate one situation to hundreds of other like situations. It is this expertise that family caregivers who are limited in experience lack.
Low Health Literacy Rates Negatively Affect Geriatric Care
Because the United States has not supported health literacy by providing consistent health education to consumers, most older adults fail to follow physician recommendations. Because physicians make medical recommendations that many patients ignore, patients are viewed as difficult and some physicians give up trying to be helpful.
Patients have the right to refuse medical recommendations and treatment. Refusals without discussion make receiving better than average healthcare a challenge. Few people, in any situation, want to help anyone who continually refuses recommendations.
Some adults are suspect of the healthcare system. When information and reasons are not provided to support medical recommendations, it is difficult for the general population to follow through with recommendations and treatments.
Part of the issue that results in low health literacy rates is that older adults hesitate to question physicians. The other factor is that family members do not know what questions to ask. This lack of providing information and asking questions results in an unintentional “don’t ask – don’t tell” situation.
Healthcare professionals do not explain information or do not explain at a level that family members and older adults understand. Family members and older adults don’t know what questions should be asked. Unfamiliarity with geriatric health and the availability of care management is a common issue.
Poor Care Results from Consumer Lack of Experience and Knowledge
The majority of family caregivers have no prior experience as caregivers. Learning occurs on a trial and error basis. Mistakes occur that result in poor care.
These are the situations where geriatric healthcare management is especially valuable even if only a one-hour consultation. Because of combined time and experience with multiple families and cases, care managers can save older adults and family members time, effort, and frustration. Information that is obvious to a care manager because of experience provides solutions for family caregiving situations.
4) When Planning for Costs of Care Include Geriatric Care Management
Because the existence and benefits of geriatric care management is somewhat unknown, individuals fail to plan for care management costs as part of a retirement and healthcare plan. Some, not all, long-term care insurance policies are now reimbursing for geriatric care management.
When thinking of planning for retirement, three areas should be considered. These three areas include geriatric care management or a caregiving expert, a financial planner, and an elder law attorney. These are the three legs of the chair that support better than average planning and better than average care.
Planning to have power of attorney documents completed in early life should also be part of the plan. Power of attorney discussions help families talk about caregiving needs and eliminate the question of “who will care for me?”
Geriatric Care Management Results in Better Plans and Better than Average Care
Care management is becoming more well-known as an option for individuals and families who want better care for loved ones and who may lack the expertise or time to devote to working with the healthcare system. The reason this area has taken so long to become well-known is that geriatric care management is a privately paid service.
General health insurance plans do not reimburse or pay for care management services. Care management and overseeing geriatric health is a personal option that can make a positive impact on health and quality of life.
The Value of Care Management and Caregiving Experts
Rates for care management range from $75-150 an hour depending on the expertise of the care manager and the services provided. Care managers specialize in various areas that include geriatric care, developmental disabilities, children, and specific medical conditions.
Caregiving experts or navigators who serve as professional fiduciaries (court-appointed guardian, medical or financial power of attorney, personal representative or trustee) and care managers have rates similar to attorneys, which are in the $200-$500 range per hour. Individuals working in these areas, like financial planners and attorneys, have certifications and belong to professional associations that require ongoing education.
A care manager serving as a court-appointed guardian, medical or financial attorney or in another role of legal responsibility requires additional training and certifications. Acting in a legal role is a specialty that some care managers do not want to pursue.
The Importance of Care Planning
Care managers and caregiving experts complete care plans for clients based on goals agreed upon with the individual and the family. These care plans include helpful information that families must know about care management and geriatric health. Families have the option of implementing the plans or using the care manager or caregiving expert to implement the plans.
Over the years I have supervised, coordinated, and managed care for 24-hour care situations in the home. This is the most comprehensive type of situation because I managed both financial and medical aspects of care. Projects range from replacing roofs, repairing chimneys, rodent removal, supervising pet surgeries, daily care oversight, and hiring and supervising in-home caregivers.
I managed the care for clients living in care communities with multiple and complicated medical diagnoses. In some situations, this also included hiring private caregivers for additional support. The thought that one moves into a care community and all needs are met is faulty.
Care communities provide a base level of support. The rest of the care is up to the family — if family exists — or to the care professional managing the situation. This base level of support is often the reason that private caregivers are retained.
In other situations, families are looking for outside opinions and recommendations. In these situations, the care professional takes steps to complete an assessment and to make recommendations. The family then has the option to implement the recommendations or to retain the care professional.
5) Caregiving Experts Provide Peace of Mind for Older Adults and Family Members
Overall, in situations where care management is used, the quality of overall care and well-being improves. Multiple health conditions are better managed, and clients gain a sense of confidence that their needs will be met. Family members gain peace of mind that the care situation is being managed and that if an emergency occurs, this situation will also be managed.
When geriatric care management is included in a family caregiving plan everyone involved benefits. Older adults receive better care. Family members, instead of being the caregiver, can continue to be the wife, husband, son, or daughter.
Family relationships are improved rather than strained by the demands of caregiving. A win-win situation occurs when families are aware of the four things you must know about geriatric health and care management.
Pamela D. Wilson, MS, BS/BA, CG, CSA is a national caregiving expert, advocate, and speaker who solves caregiving problems. Since 1999, she has been a direct service provider as a court-appointed guardian, power of attorney, and care manager. In response to the need for accessible, accurate, reliable, and trustworthy information Pamela offers online caregiving support and programming to solve caregiving problems, advance healthcare literacy, and promote self-advocacy. She collaborates with professionals in the areas of estate planning, elder law, and probate, financial planning, and healthcare to raise awareness of and sensitivity to family caregiving and healthcare issues.
© 2019 Pamela D. Wilson, All Rights Reserved.