The Value of a Geriatric Case Manager
Diane Dennis RN
50plus Magazine
Several years ago, Jessica Smith received a phone call that changed her life.
An elder law attorney she’d met when serving as her uncle’s medical power of attorney years before was now calling with an unrelated request.
The attorney had represented Jessica’s uncle and knew Jessica was a nurse. He asked if she might now consider serving as a geriatric case manager for another of his clients.
Unaware that this job existed, Jessica was excited to discover that she could use her medical and healthcare knowledge to serve seniors, typically in their homes, providing health advocacy, medication management, and help keeping them safe.
Geriatric case managers are often the first and only healthcare professionals to make house calls, often averting health crises and avoidable hospitalizations, as well as spotting untreated medical conditions.
Jessica felt she’d found her calling and set out to create a company. Referrals came primarily from adult children concerned about their parents’ welfare and well-being. Her business was soon thriving.
One client, Maria, was an 85-year-old post-op patient living alone. Maria’s surgical incision had become infected at the hospital and required ongoing wound care and antibiotic therapy after her discharge.
While checking Maria’s wound and changing her bandages, Jessica noticed something else of concern.
“Maria, you seem short of breath. Are you feeling OK?”
“Yes,” Maria replied. “I have asthma.”
Not convinced, Jessica checked Maria’s vitals: pulse, blood pressure and lung function. Finding her pulse irregular, she asked if Maria had a cardiac condition, which was not in her records.
“Oh, yes, I forgot,” said Maria. “I have atrial fibrillation.”
Not comfortable concluding her visit, Jessica called Maria’s cardiologist. The doctor was relieved for the call and requested to see Maria that day for cardioversion, a procedure to normalize her heart rhythm.
Maria’s condition could’ve been life-threatening if not treated. Jessica was relieved she hadn’t simply accepted Maria’s explanation without further action as the outcome could have been disastrous.
Later that week, Jessica visited her client, Mack, who was confused and irritable. He had an enlarged prostate and could not always empty his bladder. Suspecting a urinary tract infection (UTI), Jessica took him to his doctor for a urinalysis, which confirmed her suspicions. He was prescribed antibiotics, which prevented complications and hospitalization.
Seniors can become dehydrated quickly, often caused by treatable infections such as UTI. Left untreated, such infections can quickly become life-threatening.
Jessica reported Mack’s condition to his daughter, who lives in San Francisco and is grateful for updates and the care her father receives from Jessica and her team.
Cases can be. . . complicated
Relationships between clients and their adult children aren’t always easy. Family dynamics can be fraught with dysfunction, long-term misunderstandings, conflicts, and even abandonments. This is often complicated when a client’s mental illness or personality disorder has been confused with dementia. In such cases, behaviors can escalate and become even more chaotic.
“One of my biggest challenges is working with the primary care physicians of my clients who have a combination of brain disorders and dementia or Alzheimer’s,” Jessica says. “Families often have difficulty articulating their parents’ symptoms to a doctor for various reasons. The senior may have never been formally diagnosed and now presents behaviors that are exacerbated and confusing. Or, there is shame — families are often reluctant to discuss abuse or dysfunctions.”
Even when families do share, explanations for their parents’ behaviors are often inaccurate, exaggerated, or under-reported, making it difficult for a physician to know how to treat.
This is where a geriatric case manager comes in. S/he spends time with the elder, observes behaviors, and talks with family members. This provides more accurate descriptions of past and present behaviors, helping the doctor determine an effective treatment plan.
Jessica helps ensure living situations are safe by asking questions to determine whether the next best step is for an elderly person to move to community living. These conversations are often fraught with emotion as most people want to live out their lives at home, even when it doesn’t support their wellbeing or safety.
Families often fight about this; accusations can ensue, relations can become strained, and families distanced. When life transitions are needed, a third party can calm the waters during this process.
While geriatric case managers have existed for decades, many are not aware of this service and its benefits. Although being a nurse is not a requirement of the job description, it can provide an invaluable advantage, thanks to knowledge of pharmacology, mental health disorders, and the aging process.
Diane Dennis RN is dedicated to helping seniors live their best lives. She is a Geriatric Case Manager and owner of Age at Home Service.