The new frontier: Geriatric case management
Get ready to serve our aging population
America’s aging population and increasingly complex health care system have given rise to a relatively new field — geriatric case management.
As the population ages, the need for geriatric case management will become more acute and the opportunities for skilled geriatric case managers will be greater, says Kenneth J. Doka, PhD, professor of gerontology at the graduate school of the College of New Rochelle (NY) and consultant to the Hospice Foundation of America.
"We want to give quality care to the elders and give it in the most efficient and desired way, primarily in an at-home setting. The role for the geriatric case manager in facilitating this can be very useful," he says.
Case managers are a critical link in the health care system because they can coordinate all the services that seniors need and help them live a quality life, Doka adds.
Opportunities to increase
"Case managers can sell their role as a solution to the problems that aging Americans face. They can give people with chronic illnesses their best advice to help them marshal their resources, maximize their health, and make effective choices," he adds.
Bruce Brittain realized there was a need for his geriatric care management company, Wisdom River Partners, because of his experiences coordinating his elderly parents’ and in-laws’ care from a distance.
"Our company emerged primarily because of the unprecedented aging of the U.S. population, the fragmentation and complexity of the health care and social care systems available, and the scattered nature of our culture," Brittain reports.
In the past, elderly relatives were cared for by younger family members or neighbors, he points out.
Now, many seniors move to retirement communities, leaving their children hundreds of miles away, or families are transferred across the country, leaving their parents behind.
"Adult children often feel they are not doing enough for their parents. They have to cope with multiple doctors, dozens of pills, failed driving tests, short-term memory lapses or more serious declines, unusual purchases — and then there’s the whole home health care or assisted-living alternatives. It’s very frustrating, stressful, and often beyond the knowledge base of most families," he adds.
The company contracts with families to provide geriatric care management for seniors living in the greater Tampa Bay, FL, area.
"Geriatric care management is only about 20 years old, and it has been mostly a cottage industry. We are running our company with an eye toward growth and the ever-increasing need for our services," Brittain says.
As the population ages, the baby boom generation is spending more time trying to cope with their parents’ health care needs.
Geriatric case managers can be a big help to families, but they should tread softly, Doka suggests.
The baby boom generation doesn’t want to be told what to do or what to do for their parents. Instead they want to have all the options laid out for them, he says.
"The fact that a case managers has a title or degree won’t necessarily convince baby boomers to take their advice. They should be ready to defend their recommendations," Doka adds.
The opportunities for geriatric case management will only increase, points out Geraldine Go, PhD, APRN, clinical association professor of nursing at the College of New Rochelle.
"Right now, it’s not unusual for people to live to be 80 or older, and that is going to increase in the next decade or so," Go says, adding that within the next 20 years, more than 20% of the population will be 65 or older.
In the future, case managers will be dealing with clients who are older and more ethnically diverse.
The aging population is more educated and better off economically than they have been in the past, Go says. The downside is that the younger generation is not likely to be available to take care of older parents or relatives because of their careers, she adds.
"The idea of an older person being cared for at home by a full-time homemaker is a rarity. We now need to look at alternative living arrangements for older people," she says.
Go foresees an increase in the need for adult day care services, assisted living facilities, and independent living facilities for older people.
"They tend to be expensive and insurance doesn’t pay for it, so families are going to have to pay out of pocket," she adds.
Case managers need to strengthen their teaching role and work with clients to help them prevent illnesses, in addition to working with them when they are sick, she says.
End-of-life issues
"It’s important for the insurance industry to focus on health promotion rather than waiting for people to get sick and then paying for it," Go notes.
The aging of the population means that people are more likely to have chronic illnesses.
"If people don’t have a health care background, how can they know how to prevent illnesses? It’s rare for a doctor to have a half hour to go over everything a patient should do, what he should be eating, or other steps to take to stay healthy. It’s up to the case mangers to emphasize the education piece," Go says.
Case managers should urge their older clients to take care of estate planning, insurance benefits, advanced directives, and other paperwork they probably have been putting off.
It’s always better to make end-of-life decisions, such as advance directives and advanced care plans at a time when you’re not emotionally overloaded, Doka adds.
Americas aging population and increasingly complex health care system have given rise to a relatively new field geriatric case management.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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