Crawford Care Management


For the new care manager, the challenges can be overwhelming. Unlike traditional case management, care management is all encompassing. Case management typically focuses on the medical physical status and history of the individual and tracks the current medications, dietary status, and recent episodes with a concentration on being prepared to intervene as needed. Care management encompasses case management in that it deals with the medical components of the individuals' life, but the focus is different. Case management identifies the historical and current status while the care manager concentrates on improving the status in order to avoid future episodic changes of continued degradation as the result of chronic illness. 
The Broadspire Care Manager's role is that of the client advocate. Because the client is typically an elderly individual or one with disabilities which cause him or her to be dependent to some degree on others, the care manager should consistently demonstrate supportive, professional consideration. The care manager should be thought of by the client as a knowledgeable, kind, considerate professional whose role is to encourage independence and support the client's quality of life. The care manager should use all experience and training necessary to identify the client's needs while investigating and coordinating products, services, and activities which enhance the client's life and interests in a quality, cost-effective manner.
Without question, the care manager should focus on all components of the client's life including, but not limited to:

  • Medical physical
  • Psycho social
  • Environment

Tasks performed on behalf of the client should be directed towards improving the safety, comfort, wellness, independence, and quality of the client's life. Recommendations should target both professional and fee-for-service tasks as well as those tasks for which there is no out of pocket charge. Some examples of recommendations follow.

  • Evaluation by appropriate physician(s), psychiatrist(s), and dentist(s) to ensure the client is in good physical condition appropriate for the client's age.
  • Assessment of the living environment including cleanliness, temperature, working appliances, safety, and location.
  • Assessment of social activities enjoyed by the client including friends, routine activities, clubs, entertainment opportunities, and church / synagogue participation.
  • Evaluation of personal care including bathing schedule, hair, skin, nails, make-up needs, and interests.
  • Many elderly and disabled individuals enjoy looking at old photographs, telling and listening to stories, watching movies and videos, playing with a kitten or puppy, visiting an art gallery or museum, and listening to music from their era. Care managers should look for opportunities to stimulate an elder's memory of times when they felt more competent and capable.

The Broadspire Care Manager's overall role is that of an advocate. Working with family, friends, and professional advisors of the client will assist the care manager in coordinating the most appropriate products, services, and activities for the client. Maintaining a professional advocacy role for the client means becoming a trusted advisor who can communicate interests and needs on the client's behalf long after the client may be able to verbalize these interests and needs.

Following are the standards of practice for professional Geriatric Care Managers

  • While the "primary client" usually is the older person whose care needs have instigated the referral to a professional geriatric care manager, all others affected by his or her care needs should be considered part of the "client system."
  • To the greatest extent possible, the professional geriatric care manager should foster self-determination on the part of the older person.
  • The professional geriatric care manager should respect the older person, and when applicable, the family's right to privacy by protecting all information which is given in confidence and all information of a confidential nature. It should be made clear to the client the limits of confidentiality as appropriate.
  • The professional geriatric care manager should define her or his role clearly to other professionals.
  • The professional geriatric care manager should strive to provide quality care using a flexible care plan developed in conjunction with the older person and other persons involved in her or his care.
  • The professional geriatric care manager should act in a manner that ensures her or his own integrity as well as the integrity of the client system.
  • The professional geriatric care manager should not exploit professional relationships with clients and families for personal gain.

Caregiver Training
Many families have a resource that has worked for them over many years sometimes as a nanny for the children or housekeeper. Other families may have a friend or associate through their church or club who has offered to help them. As family members age and need assistance, these family resources are often a more comfortable and cost-effective source of assistance than help through an outside agency. While Broadspire does not suggest hiring private, unlicensed, uninsured caregivers, certain circumstances result in such arrangements. The woman who cared for the children is often a natural selection to care for an elderly person.

Most private caregivers, whether an outsider to the family or the daughter or granddaughter, have the elderly individual's best interest in mind when they accept the responsibility. Most will do everything they know how to do for the person. However, with aging come needs that many people are unfamiliar with. Some diagnoses, diabetes for example, requires special diets and even some special food preparation techniques. Some aging individuals have difficulty transferring from bed to chair or washing their hair. Some become easily agitated or demonstrate other difficult behaviors. With training, caregivers can build skills to assist these individuals without hurting the client or themselves.

Following are some components of Broadspire Caregiver Training programs that can be offered where appropriate.

  • Safe lifting techniques: This skill will aid the caregiver in transferring a patient without injury to the patient or to the caregiver.
  • Diagnosis appropriate meals: Whether the physician recommends the Heart Association diet or the ADA diet, the caregiver will learn about portion control, food selection, and preparation to support the individual's specific needs.
  • Disease training: Parkinson's, Alzheimer's, CVA, arthritis, and depression are examples of illnesses that require specialized care. The caregiver will recognize signs of change, learn techniques used to manage the care, and learn about the progression of those that are chronic.
  • Difficult personalities and behaviors: There are techniques for managing these individuals and their resulting behaviors that will help the caregiver and the individual to more successfully interact with each other and with others.
  • Exercise: Poor or no exercise can have devastating affects on the elderly. Lifting nothing heavier than a teacup, over time, will result in being unable to lift anything heavier. Not walking will cause leg muscles to atrophy, making the person unable to ambulate. Under a doctor's direction, the caregiver can be taught to work with an individual to improve their exercise program.
  • Establishing a routine: With the direction of a care manager the caregiver can prepare and manage the household and the individual with the least stress possible. Personal care, treatment plans, and social opportunities will be included to meet the needs and interests of the individual.
  • Skin care: Aging skin is very fragile. Caregivers will learn to provide skin care to protect the client from tears and breakdown. This is especially important for bed bound individuals, but can benefit all older individuals.

Watching Out for the Caregiver
Among the most important resources in America are the informal caregivers who provide assistance to those suffering from physical or mental limitations. Caregiving may include a wide range of support from assistance with activities of daily living like eating, bathing, and dressing, to instrumental activities of daily living such as shopping, cooking, and paying bills.
There are more than 7 million caregivers who provide assistance to those who experience some limitations in their day-to-day lives. While those receiving care do not require institutionalization, they do need some assistance to help them function and stay connected within the community. Caregivers face the delicate task of intervening gracefully in these peoples' lives to provide that needed support. While their intervention allows many to remain independent, caregivers often take on too much responsibility.

The caregiving role is frequently fulfilled by family members, usually a spouse, or by relatives or friends. Unfortunately, informal caregiving does not seem to be a shared activity. One person usually provides the majority of care. The caregiver role is physically, mentally, and emotionally demanding. It occurs at a time of increased anxiety and often results in the bulk of pressure on one person. Those who choose to play this important role are encouraged to make caring for themselves a high priority.

What Can You Do?
Among the caregivers' greatest needs are information and assistance. Take whatever steps are necessary to meet these needs as fully as possible:

  • Attend medical appointments with those whom you care for, but encourage the doctor and patient to communicate with each other. Take time to learn the differences between changes in bodily function that are caused by aging and disease-related problems.
  • Ask Questions. Ask as many questions as you need to understand the often complicated information surrounding treatment and care. As educator and communicator to your loved ones, you must first understand the information yourself.
  • Encourage independence. Don't volunteer to do what others can do for themselves. Do make decisions with your loved ones, not for them.
  • Honestly assess what you are capable of doing; then share the load. While most responsibility may naturally fall on you, the primary caregiver, look for help and delegate tasks. Don't do everything yourself - even if others don't perform fully up to your expectations. Build a network of helpers. Look into home health aides, housekeeping services, financial or insurance advisors, church volunteers, senior centers, transportation services, companion programs, adult day care and night time care, or delivered meals.
  • Watch for signs of your own stress or developing depression and act accordingly. Keep an eye out for a decline or increase in appetite, gastrointestinal distress, anxiety, anger, crying, irritability, fatigue, or neglect of personal hygiene. Practice relaxation techniques and, if signs persist for more than two weeks, talk to your doctor.
  • Take a break from caregiving. A temporary respite from your caregiving responsibilities is something you deserve. It is a necessity, not a luxury. You may find someone to come into the home and deliver essential care or seek out other resources where your loved one can receive appropriate care for a while.
  • Don't go it alone. Seek out training that you need, support groups to express your feelings in the caregiving role, and formal in-home services to support your efforts.
  • Stay organized. Try to establish a routine schedule. If you would find it helpful, keep a journal or a log to document personal and emergency information, changes in the caregiving situation, reactions to new medications, and other information.
  • Make time for yourself. Schedule and keep social activities; make time for exercise and other activities aimed at your own healthcare goals; and...
  • If you don't find the proper level of relief in the above list, give us a call and we'll help you identify additional opportunities.