Mary is taking care of her aging husband, Bob, at home. He has diabetes and is overweight. Bob has sensation loss and pain in his feet from the diabetes, making it difficult to walk, and has diabetic retinopathy and cannot see well. Last year he was hospitalized for weeks with a severe infection from stepping on a tack he didn’t see or feel. Mary is having difficulty helping him out of bed and with dressing and using the bathroom. She relies heavily on her son Mike who lives nearby to help, but he and his wife work full-time and have young children. The siblings all live out of town. A family friend tells Mary about Aging Answers, who helped her family cope with the care of a loved one. The cost of an initial assessment and care plan from the care manager was $600, and additional services to set up the care were billed on an hourly basis. Mary feels she has the situation under control and spending that kind of money for someone from the outside to come in and tell her how to deal with her situation seems ridiculous.
One day Mary lifts her husband after a fall (one of many these days) and injures her back severely. She is bedridden with pain and cannot care for her husband. Her son now has two parents to care for. Mike decides to bring in Aging Answers and pay the fees himself. Laurel and Nancy do a thorough assessment of the couple, their home, and their resources. Laurel suggests they see a geriatrician with her that she has consulted for other clients. He spends a great deal of time with them. He prescribes a new insulin regimen to better control Bob’s blood sugar, and advises exercise and a basic diet. The x-ray shows Mary has small fractures in two vertebrae that will heal in time without treatment, but are very painful in the meantime. Mary neglected her own well-being as is typical of caregiver spouses. She has osteoporosis, but she never went to the doctor for herself before to be diagnosed and treated. The doctor agrees with Laurel’s suggestion to have a Medicare covered home health care agency in for nursing, physical therapy, and home care aide for both and writes a prescription.
Therapists come in to teach Mary exercises and proper lifting and bending, and work with Bob to reduce his risk of falls. A registered nurse addresses her pain, improving their nutrition, and management of Bob’s diabetes. Laurel obtains medical equipment for easier use of the bathroom facilities (Medicare covers some of this). Nancy has the fire department install free smoke and carbon monoxide detectors (they had none), and connects them with a program that provides volunteers for yard work and minor home repairs. Laurel and Nancy arrange for private pay compatible live-in caregivers from a company that she has had positive experiences with for other clients. The caregivers will assist Bob, clean, and cook while Mary recovers. In a few weeks Laurel & Nancy will reevaluate to see whether this can be reduced or eliminated. Nancy conferences with the family to explain the care needs and obtains commitments from everyone to assist. Mike’s siblings agree to share the cost of care management. Mike no longer feels overwhelmed and resentful towards them for not helping. He didn’t know how or what to ask of them, so he did it all himself.
Laurel refers the family to an elder law attorney to prepare documents that will enable the family to assist Bob and Mary if they become incapable of making decisions. Nancy educates the family on applying for veteran’s benefits for Bob, who is a WWII veteran. The benefit could provide up to $1,800 a month towards his caregiving expenses if he qualifies. Laurel obtains the required paperwork from the doctor. Laurel and Nancy help Mike prepare a “Crisis Folder” so that he and his siblings have all of the information and paperwork they need to act quickly. Laurel facilitates a sensitive discussion between Mike and Bob and Mary on their end of life wishes so that the family knows what should be done or not done under various scenarios. Mary and Bob will have a better quality of life and health for their remaining years. They will be in their own home where they wish to stay, for as long as possible. The family is now prepared should Mary and/or Bob decline in health or abilities and need other arrangements. The cost of care management for Mary and Bob was a worthwhile investment with significant returns.
Adapted from "Planning for Eldercare" May 18, 2007
courtesy of National Care Planning Council
http://www.longtermcarelink.net/a13information_article.htm
