Help in a Crisis Situation

Peter called in a panic. “My father's just been diagnosed with a brain tumor. My mother has dementia and can't take care of herself. And Dad can't help her anymore; he has cancer.” One of three sons who were all juggling demanding work schedules and family responsibilities, Peter knew decisions had to be made – decisions he didn't feel comfortable making. He also knew that neither of his two brothers had the knowledge to make informed choices. Fortunately, Peter was referred by his parents' physician to ElderCare Solutions Inc., a Chicagoland-based geriatric Care Management practice operated by nurses.

The geriatric Care Managers of ElderCare Solutions assist families in managing the needs of their elderly family members. Most Care Managers are nurses or social workers with education and expertise in geriatrics. They monitor an elder's condition and evaluate the caregivers who are providing care. Their ongoing assessment includes such things as the elder's need for adult day care, home delivered meals, and home health care. Care Managers will also assist families in choosing an appropriate long-term care setting if necessary.

“Many of our elderly have experienced significant losses,” says Signe Gleeson, RN, MS, cofounder of ElderCare Solutions. “They are fragile and vulnerable, and they have very specific needs. Their families want our help to understand and respond to those needs.”

Names have been changed for privacy.

Transitions for a Surviving Spouse

Mrs. J was an 83 year old woman who was alone after the death of her husband; he had been her primary care giver. Physically healthy, Mrs. J had significant problems with her memory and could not manage her household or her care without her husband's assistance. Her children, who lived out of state, were eager to move her from her home.

ElderCare Solutions was contacted by the family to help with the transition to move closer to Mrs. J's daughter. They were understandably concerned about their mother and wanted to make the move immediately. ElderCare Solutions counseled them to give their mother some time to grieve her husband's death before having another life changing event. While Mrs. J had dementia, she had not lost contact with her feelings and was grieving the loss of her husband of more than 40 years. ElderCare Solutions offered guidance on how to help Mrs. J cope with the loss of her husband and the impending loss of her home and community. The importance of acknowledging her losses was stressed. She needed to create a sense of closure to the life she shared with her husband in their home.

ElderCare Solutions found and supervised caregivers for Mrs. J in her home as an interim measure. Her large support network was contacted to ensure she had support during the initial weeks and months after her husband's death and a good-bye gathering was organized so that she could make her good-byes to the many friends she and her husband had during their lifetime in their neighborhood and community.

ElderCare Solutions helped the family find a care facility that would be able to meet her current and future needs. The family was consulted about the changes, both physical and emotional, that might occur with the move. ElderCare Solutions explained that transient periods of confusion might be expected and that Mrs. J might seem more impaired than she actually was, until she could become oriented to and comfortable in her new home.

Three months after her husband's death, Mrs. J was successfully moved a care facility near her daughter, who could watch over her.

Kathleen O'Laughlin, RN, MS, JD, is a cofounder of ElderCare Solutions Inc.

Names have been changed for privacy.

Providing Care for a Resistant Elder

Martha called ElderCare Solutions at the recommendation of her doctor. Her mother-in-law, Ann, had been deteriorating over many months. She was increasingly reclusive and her clothes barely fit her shrinking frame. She neglected her home and her hygiene. Despite her best efforts, Martha could not get her mother-in-law to accept assistance.

ElderCare Solutions staff gained entry into her home. Because Ann had developed so much resistance to Martha's help, we met alone with her. It took several visits of listening and observing to build some small measure of trust. Consultations were made with Ann's physician. A care plan that outlined the situation and proposed short and long term plans was sent to the physician and to Martha. A written report brought objectivity to an emotionally laden situation and helped Martha understand why she couldn't “do it alone.” ElderCare Solutions educated Martha about her mother-in-law's illness and helped her adopt new ways of interacting to avoid anger and resistance. With phone updates to Martha, in-home assistance was put in place and changes in medication were made. Despite these measures, Ann's condition continued to deteriorate. She was no longer safe alone in her home.

ElderCare Solutions initiated and guided the transition to long term care. Her physician was consulted to initiate a hospitalization for thorough evaluation and treatment. ElderCare participated in hospital staff meetings to ensure all relevant problems were addressed, and found a care facility to meet Ann's needs.

Martha was able to continue to meet her own work demands, knowing that her Ann was receiving the expert care she needed. ElderCare Solutions collaborated with the care facility to ease Ann's admission and transition. Ann settled successfully into her new environment. Relieved of the burden of trying to take care of herself, she became calm and comfortable, able to accept the attention and care provided to her. Martha was able to take on the role of dutiful daughter-in-law and they were able to return to a satisfying and relaxed relationship.

Names have been changed for privacy.

Protecting Vulnerable Older Adults

Mrs. O's niece called ElderCare Solutions from out of state. They had worked with another agency, but didn't have a “fit” with the Care Manager. She contacted ElderCare Solutions at the suggestion of the social worker in her geriatrician's office. She described her aunt, a widow, as fiercely independent and proud. Mrs. O denied having any problems despite significant short term memory deficits. ElderCare Solutions agreed to meet with Mrs. O. to make an assessment and establish a rapport.

When we met her, she was living at home alone, with a caregiver who visited for a few hours a day. We discovered that past caregivers had “borrowed” large sums of money from her. It also became clear that the current caregiver hired to attend to her was not coming at the assigned hours, although she was being billed for the time.

Because of her lack of insight and the lack of oversight, she was at risk medically and financially. She was cordial but leery. She had “no problems” we could help her with, but she did agree to a second visit.

Over the course of a few weeks, ElderCare Solutions developed a trusting relationship with her and her long distance family. Despite her initial resistance and insistence that she had no needs, we were able to get her to consider a live-in caregiver to oversee her care and the household. She participated in interviews of “the help” and ultimately chose a caregiver that stayed with her for 6 years.

We guided Mrs. O and her caregiver through the early rough days of adjustment in their relationship and saw it blossom in to one of mutual regard and devotion. We helped her and her family worked through her resistance and anger to give up driving. ElderCare Solutions secured and oversaw her medical care. As she declined and was less able to initiate activities and interests, we found Adult Day Care where she broadened her social contacts, both giving to and receiving from others.

Mrs. O had a wonderful zest for life and a will to live, which we fully encouraged. When her failing heart could no longer sustain her, we arranged for hospice care. She died at home, with her devoted caregiver at her side. Through our long term involvement with Mrs. O, overseeing and coordinating all aspects of her care, she was able to live her last years well and as she choose. As importantly; she was able to die well and as she choose, in her home.

Names have been changed for privacy.