When an elderly person needs medical care, the experience can be quite overwhelming, frustrating, and even scary. There are several complex pathways through the health care system, and navigating them isn’t always straightforward. Elderly people can often be frail, have multiple co-morbidities, and take a number of medications. In some cases, they may be unable to manage their own care. These factors only complicate the process. So when an elderly person isn’t able to help themselves, who steps in as a coordinator for them in the health care system?
One problem: no regular primary case physician
One of the main problems is that some seniors don’t see a primary care physician (PCP) on a regular basis. They only visit their specialists (such as a cardiologist or pulmonologist) when needed. While these specialists may be skilled and competent physicians, they usually address only a specific diagnosis and do not assign treatment for the patient as a whole. By maintaining a relationship with a PCP, the patient ensures that someone is putting all of the pieces together and looking at the “big picture.” And sometimes even this may not be enough, when patients who do see a PCP utilize other parts of the medical system — for example, a hospital or skilled nursing facility — and fail to keep their physicians in the loop. Sometimes the PCP will not even know about the admission, and often no one communicates with them about what is going on with their patient.
Another problem: lack of shared electronic medical records
This leads to the next concern which is the lack of shared electronic medical records. According to an article by the National Center for Biotechnology published October 2017, less than 1/3 of U.S. hospitals effectively send and receive electronic medical records for patients who receive care somewhere else. Without these records, hospital physicians are less likely to be able make solid informed decisions, and more likely to make mistakes. Moreover, the problem is exacerbated by the fact that elderly patients are often unreliable when it comes to reporting their medical conditions accurately. Many elder adults have cognitive impairments. Simple old age also factors in, with normal age-related memory decline and difficulty hearing and seeing. Some patients simple do not understand the medical jargon and end up retaining only minimal information about their medical conditions and plan of care.
What to do? Some hospitals offer navigator help programs
Some hospitals are penalized by Medicare for when they have to re-admit patients within 30 days of the original hospital discharge. In response, maybe have implemented programs that include monitoring the patient post-discharge. In such programs, nurse discharge navigators are assigned to check in with the patient in the community and provide services, such as follow-up appointment coordination, appointment reminder calls, and resource connections. Ensuring that services such as elder in-home care are set up can make a huge difference in the patient’s overall success. If implemented appropriately, these discharge navigation efforts are extremely beneficial in making sure that elders successfully achieve their post-discharge goals.
But this is a small step towards a solution for a gigantic and rapidly growing problem.
Most of the time, it falls on the patient themselves and their loved ones to advocate for themselves and coordinate the sharing of information, set up of necessary services, and compliance with discharge plans of care. This can be quite overwhelming and burdensome, especially for the spouse of an elderly person or the adult children who are also juggling a career and family obligations.
What to do if you’re the health coordinator
If you find yourself faced with the task of being your loved one’s care coordinator, AARP suggests the following steps:
- Observation — Listen intently and watch everything. Not only will you learn more of what you need to know to care for your loved one better yourself, but you will also be more likely to catch errors and miscommunications.
- Organization — Staying organized with all the needed documents (medication and allergy lists, advanced directives, physician contact info) will keep you better prepared when unexpected medical situations arise or questions are asked of you, and your loved one can’t speak for themselves.
- Communication — Keep key players such as the PCP and elder care providers informed about changes to your loved one’s medical condition and needs.
- Questioning — If something doesn’t sound right, speak up!
- Tenacity — Never give up on receiving the care or support that your loved one needs and deserves.
Another solution: hire an aging life care manager
To make things easier for yourself, consider hiring an aging life care manager to assist your loved one with care coordination. A professional aging life care manager (also known as a geriatric care manager) has been educated in various fields of human services — social work, psychology, nursing, gerontology — and trained to assess, plan, coordinate, monitor and provide services for the elderly and their families. Advocacy for elder adults is a primary function of the care manager. However, be are that they charge privately for their services, so their clientele are limited to those who can afford them. If the means are not there to support hiring this kind of professional, don’t be afraid to reach out to your other support systems, such as extended family, friends and neighbors, and even your church congregation. Often these groups include people who want to help but do not know how, so you may be surprised by the response when you ask for assistance.
The most important thing to keep in mind is that the squeaky wheel really does get the grease — so speak up and make your expectations known to your loved one’s health care providers and you are much more likely to see positive results!
About the Author: Pam Reynolds, CMC is the President and co-owner of Allegiance Aging Care Services. Pam has spent almost fifteen years working in senior care including long term care facilities and home health care. Her higher education is in Social Work, and she has been credentialed as both a certified Geriatric Care Manager and Licensed Assisted Living Administrator. Read more about Pam and her team of Aging Care Professionals here.