Case Management for Older Adults

by Emily S. Fudge

This article is published with the permission of the Hydrocephalus Association. It first appeared in the Hydrocephalus Association Newsletter, Spring 1999.

As more and more older adults are being diagnosed and shunted for adult onset hydrocephalus, many concerns arise about their quality of life, their lifestyle and their care. While there are still many unanswered questions about adult onset normal pressure hydrocephalus in general - what are the best diagnostic tools? who is the best candidate for treatment? what are the complications and risks of shunting? what does success mean to the physician, the patient, their family? - older individuals with hydrocephalus may, in some cases, need assistance from caregivers.

Caregivers are usually family members or extended family members who willingly take on the extra responsibilities and challenges involved with chronic illness, disability or aging in general. Often inexperienced, busy with their own lives, families and careers, caregivers too often operate in a vacuum with little or no emotional support, not enough information and little guidance as to the effectiveness of the care they are providing. An alternative to this situation is case management.

What is Case Management?

Case management is a collaborative process that provides support for the medical, physical, emotional and social needs of older adults. In cases where nursing homes and other institutional settings are inappropriate, case management serves as an effective mean of fostering an older adult's autonomy by establishing safe living arrangements in the privacy and comfort of their own home. It is based on a comprehensive evaluation of an individual's needs. It is best directed by a geriatric social worker or a professional experienced in the delivery of services to the elderly and their families.

Case management can reduce hospitilizations through ongoing monitoring of a person's mobility, medications and changing health status. By continually evaluating the health and general well-being of the older adult while honoring their sense of dignity, independence and individuality, case management can assist older adults in remaining connected to their families, friends, neighbors, pets and community. The goal should be to maximize the client's health, self-esteem, quality of life and right to self-determination.

How Does it Work?

The first step in case management is a meeting between the manager, the client and the client's family, preferably in the client's home. The case manager collects information relevant to health, diet, exercise, daily living skills and psychological needs. Past and current care is reviewed and the client's environment is assessed for safety and ease of living.

Once the case manager has reviewed the case, he/she will develop recommendations for the individual client. He/she will identify needed services and treatment (if necessary) and provide information on funding options, which might include Medicare, the client's insurance or perhaps neighborhood and community services. The case manager will provide a plan that may include a suggested number of hours with a companion / caregiver / nurse;assistance needed for basic daily living skills; need for medical equipment or adaptations to the living environment; need for appointments with medical specialists and perhaps therapists; and facilitation of social services.

When the client, the client's family, and the case manager have agreed on a management plan, the case manager will coordinate the care plan. This would include employing and providing orientation and training for the caregivers; communicating regularly with all parties involved - client, family, physicians; and attending to cost-management strategies and continued evaluation of the service plan. The case manager will also record all activities, visits and services, and submit reports as required to family members and healthcare professionals.

The National Association of Professional Geriatric Care Managers (GCM) has a Consumer Directory available for sale. The price is $15. Listing more than 900 professional geriatric managers around the country, the directory serves as a helpful guide to consumers wishing to locate a geriatric care manager. For more information about this Association, or to order a copy of the directory, contact GCM at (520) 881-8008.

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Case Management for Older Adults

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