Technological advances in the delivery of healthcare combined with shorter hospital stays, limited discharge planning and expansion of home care technology have transferred the responsibility for the care of frail elders and persons with disabilities onto families. Family members are now asked to assume a health management role in the home and carry out medical tasks that traditionally were carried out by health care providers, with little or no preparation, training or support. This combined with the fact that older people are less likely now to have family close by than in the past means that people need a support system to be able to comply with their complex healthcare needs.
In response to the dramatic demographic shift to an aging population, Care Managers with training in health and social services have emerged to provide high touch care, as well as advocacy, training and emotional support to older adults, the disabled and their families to supplement this new level of responsibility. Care Managers often serve as the point person to identify, access and coordinate information, health care and home and community-based services.
Family caregivers tend to be a vulnerable and at risk population that the health and long-term care system neglects. This makes the family caregiver at greater risk for stress related illnesses and mental health problems, including increased risk of mortality.
Given the fact that so many of the disabled and older population in South Florida live at a distance from their primary family support system, they need to have surrogate relationships that support the important work that they do in caring for one another. Sustaining family caregivers and their ability to provide care at home or in the community is crucial to our health and long term care systems.
Professional Care Managers often act in this role. The care manager is usually a professionally trained/degreed nurse, social worker, psychologist, gerontologist or therapist with a history of working in the health and human service delivery fields. Most often the private care manager is hired by a family member (usually the adult child) to act in their stead when they cannot be present, or take the time from work and family to coordinate and manage all of the logistics of care in the community.
The Care Manager will work with the healthcare team and all of the providers of home delivered services to coordinate the appropriate provision, supervision, compliance and follow up of medical needs. In addition, the Care Manager will provide education and emotional support to help the family cope with the stresses of compounded losses and grief.
One of the primary functions that the professional Care Managers plays in support of the healthcare system is to assure compliance with the physicians Plan of in the home environment. This includes monitoring medication routines, reviewing and improving safety concerns, assuring compliance with high tech treatments and therapies and appropriate follow up back to the physician. Often the Care Manager will become aware of issues that arise only in the home care setting that the physician, health plan or hospital could not possibly know because they do not have access to the patient in the community. By providing this information back to the physician and requesting specialty consultations or treatment, the work of the medical community is enriched and made more customized for the individual patient.
Care Managers can be especially helpful to the medical community when the patient and/or caregiver have cognitive limitations. In these situations, especially in early dementia, the patient is able to compensate enough that the doctor may be unaware of functional decline or impaired decision making. Likewise the family caregiver may attribute cognitive or functional changes to the “normal aging” process because of lack of knowledge. When this occurs, the physician is not provided with an accurate picture of the deficits and needs of both patient and family caregiver.
Again, the Care Manager as an advocate can help to accurately report the needs of the patient and the family, so that the primary care physician can order specialty testing to determine the needs of the patient. Furthermore, the Care Manager can help to connect the patient and family to the appropriate resources in the community that will enable the family to maximize their strengths, coping ability and reduce the risk of caregiver burnout. The high touch approach of the Care Manager truly facilitates a holistic approach to patient care.
