The number of Americans age 65 and over is expected to more than double over the next 40 years and those age 85 and over is projected to more than triple. What does this mean for case managers? With this growing number of elderly comes a corresponding need for caregivers, a role that is often much too complex for elders’ adult children and family members to assume alone. Many adult children will be faced with concerns about caring for their aging parents that include ensuring good health care, finding the right living situation, and handling legal questions. Case managers will be increasingly called upon to assist elder patients and their caregivers in navigating the system to meet elders’ complicated health needs.
One of the most important roles the case manager can play is to encourage adult caregivers to communicate with their elder parents early about health needs and future living situations. Children can ease the transition by honoring their parents’ wishes whenever possible, making changes in small steps so it is easier for their parents to adjust to the change, and educating themselves about legal, financial and medical issues. Sometimes adult children and family members may miss the early warning signs when it’s most important to initiate conversation. Case managers and other medical staff can educate caregivers on the key warning signs to watch for, which may indicate if an aging parent needs additional assistance, medical care, or a change in living arrangements. Some of these warning signs include:
• Weight loss without trying to lose weight could indicate a serious health problem, such as cancer, dementia, depression, heart failure or malnutrition. The desire to eat may be affected by a decreased ability to taste and smell caused by medication or the natural aging process. Physical impairment also may affect the ability to grasp cooking utensils or read food preparation directions on food labels.
• Improper use of medications, such as not taking medicines as prescribed or over-dosing, may be a symptom of forgetfulness or confusion.
• Becoming lax with personal hygiene, such as infrequent bathing, not brushing teeth or shaving, could result from dementia, depression or physical impairment.
• Erratic behavior could be an indication of depression that may result in significant mood change, withdrawal from friends and loss of interest in hobbies.
• Car accidents may be caused by slowed reflexes, poor vision, physical weakness or an overall inability to drive an automobile.
• Not Keeping follow-up appointments post hospitalization, and looking for warning signs.
• Patients with diagnosed Congestive Heart Failure, not weighing daily, checking extremities for swelling to avoid readmission to the hospital
• Missed medications could indicate the need to develop a relationship with a pharmacy, so that medications can be delivered to the home bound.
While it is not easy for adult children or their parents to admit that health problems may exist and a change in lifestyle and living arrangements are necessary, recognizing the issue and talking about it early can help make the transition easier. Case managers can be influential by educating elders and their caregivers about the best healthcare and housing services available based on an elder’s age, preference, health and financial situation. Choices include home care services to help older people with health or personal care needs, programs for meals and transportation, or adult day care at a community facility two to three days a week. Other housing options include adult congregate communities for able-bodied people over the age of 55, assisted living communities for those who need some assistance, or skilled or intermediate care facilities.
As elder adults live longer, many are not living healthier. With increases in co-morbid chronic diseases such as heart disease and diabetes, the health needs and demands of elder adults can be demanding and complicated. Case managers have the knowledge, experience, and resources to partner with caregivers to ensure that elders are receiving the healthcare and resources that they need to promote the best quality oflife and well being for all involved.
