Elder-Care Case Management
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Elder-Care Case Management deals with all aspects of caring for an elderly person who has been entrusted to the rounds that a case manager makes in a schedule of matters that must be attended to for that elderly person. This includes not only being observant of the physical condition or health needs of the cared-for elder and monitoring the elderly person’s financial affairs, but also staying sensitive to the emotional needs of the cared-for.
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The work may also include interviewing, hiring, and supervising a home-health aide. Most of the cared-fors who receive case management also have home health aids. The home-health aides escort the cared-for to doctor appointments, shopping, movies, theater and most outside-of-the-house activities.
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In the circle of triangle of persons who have an interest in the affairs and condition of the person who is being cared for...most often, the cared-for is precisely that, an elderly person being cared. He or she is not also the client, who may instead be a family member (spouse, son, daughter...niece or nephew) or some kind of fiduciary such as a long-time family accountant, attorney, court-appointed estate manager, or so on. The circle of interested parties may also include the home-health aide.
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Given the different priorities of the parties involved, and while case management usually involves assisting the elder with routine banking matters, bill paying and handling related financial affairs... the professional geriatric-care manager—meaning the Elder-Care Case Manager—must never lose sight of the health, safety and well being of the cared-for elderly being the standards that must be met in such case work, and the chemistry or lack of it between the parties.
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Financial Management in
Case Work with Elders
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In my personal case-management work, I help my cared-for with bill paying and banking as needed. I visit on a weekly basis and write out the checks for the bills, analyze and review the actual bills and costs incurred on the bills with the cared-for and, sometimes, with the client son or daughter or accountant or so on. Most of my cared-for’s keep a nominal amount in the checking account. As money is needed for bill paying, I will help the cared-for move the money from an investment account or a savings account into their checking account.
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When a cared-for has to conduct banking, I fill out the forms and the cared-for is often escorted to the bank by a home-health aid. I review all banking activity after the cared-for and home-health aid return home. It is never a good idea to have the home health aid involved in the actual filling out of deposit or transfer slips for the cared-fors accounts. Indeed it is a very bad course of action when the home- health aide is involved in writing out her own paycheck and having the cared-for sign. That part, especially, in a plan of care should always involve a Private Geriatric Care Manager who carries malpractice insurance. The Care Manager should of course be accountable to the cared-for's children, lawyer, accountant or power of attorney.
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Case management of course entails overseeing the medical care needs of the cared-for. This involves scheduling and accompanying the elder to doctor appointments. At the appointments the case worker reports any changes in the cared-for's condition to the medical professional who may be a doctor or nurse practitioner. The case worker also informs the home-health aid of any changes in care needed for the cared-for, as instructed by the medical professional. If medicine is prescribed, the case worker picks up the prescriptions at the pharmacy and instructs the home-health aid on the administration of the medicine.
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As mentioned, in addition to assisting the cared-
for with financial affairs, case management also
involves the hiring and supervision of home health aids.
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Weekly visits should be conducted on all cases, and the visits should be intermittent, not scheduled, so that—quite frankly—the home-health aide is kept on her toes. During such visits, the case manager should check the cleanliness of the patient and the cleanliness of the home.
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It’s usually during such visits, on a weekly basis, that I drop off food money and check that the remaining money and receipts—that I am given by the home health aid—equal the amount of cash from the previous week. I also check on the food in the house, medicines, and non-food grocery items needed for housekeeping and such.
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Tales of mischief, in not "horror stories," can occur here... I’ve heard tell of a health aide weekly buying Tide detergent at $17 a jug, but when the case-manager checked the home, there was no Tide in the home at all. While the cared-for's laundry was in fact done once a week, we all know that even a household of many family members, a jug of tide can last almost a month. When questioned, the home health aid could not recall those expenses. However, after questioning, the charges never occurred on the receipts again for the life of the cared-for and the one jug of Tide lasted a very long time in that dwelling.
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All in all, a good case worker completes the tasks that a family member would provide if the son, daughter, niece or other were available.