Provision of service:  We provide on-going service only after your needs have been assessed, you or the person designated to act for you, understand and agree to a plan, the results that can be expected from it and the cost of service.

Self-determination:  Our plan of service for you will be based on your defined goals and which enhance the decisions you have made concerning your life.

Loyalty: Our first loyalty is to YOU. We will always provide service based on your best interest, even if this conflicts with our interests or the interests of others.

Termination of Service: We will end service only after a reasonable notice and a recommended plan for you to continue receiving service as needed.

Substitute Judgement: We will not substitute our judgement for yours unless we are acting in the role of guardian , appointed by a Court of law, or with your approval or the approval of someone designated for you.

Referrals/Disclosures:  We will refer only to services and organizations we believe most appropriate  and of good quality.  We will fully explain any business relationship we have with any service we propose, and give you information on alternatives so an informed deciion can be made.

Cooperation:  We will strive to assure cooperation among all the professionals involved in providing service for you.

Qualifications:  We are fully qualified in our profession to provde the services we undertake.  We continue to improve our skills and knowledge by participating in professional development programs and maintaining certification and licensing.

Discrimination: We will not promote or sanction any form of discrimination.

Professional geriatric care managers work for the client and the client family.  They take their direction from the client, are partners with the client, and are inetrested only in the well-being and comfort of the client.

I noticed and began to consider why I reacted to clients’  saying something like,  ” My what a wonderful job you do and what interesting information you shared, and how supported and encouraged I felt when you spent all that time with me/us.  And now, we have made an entirely different decision about our parent and so thank you and good bye.”   Ouch.  That a much different decision about a plan was made is not the painful part. (It is important that families feel empowered to make decisions about which they are confident.)  It is painful when the announcement is made so casually and matter of factly.

I think the answer to why is that families don’t fully appreciate that what can make a difference between an adequate service and an excellent service is heart and emotional investment on the part of the provider.

During the past 15 years I have had many opportunities to meet with bright and enthusiastic young professionals as well as folks who are excited about a second career who have heard of eldercare management or seen me at work and who decide that it looks fun, interesting, or is a career of the future because of our aging population.  “I want to do what you do”, they say.  “How can I get started?”

The fact of the matter is, the best eldercare advising and care management are borne from years of living and experience, years of education in a medically related field,  familiarity with a community, and a passion for and understanding of family systems, relationships, and the normal aging process. A passion that recognizes that each client is unique and special, requiring and deserving customized and personalized attention  and that his family is an integral part of the process is a essential element.  Sensitivity to feelings and emotions, the sometimes painful struggles of family  that had their origins decades ago, and a longing to provide a way to improve things is a requisite of this profession.

Continuing education, not because it is required to maintain a license, but because of an insatiable desire to know more, to understand more, so a better job can be done to really help client families is an important part of the excellent provider’s life.

Continued and intentional personal growth in order to stay centered and clear about ethical standards and professional priorities is another key to excellence.

And then, there is emotional energy and investment.  Ah.  There is a dangerous arena, right?  Well defined boundaries become essential to the care manager’s emotional and mental health and her ability to serve her clients optimally.  And of course, this is the area that is most closely related to the “zing” of hurt feelings I mentioned in the first paragraph.  So.  This is the occupational hazard of the best of care managers.  And it is one we gladly continue to manage so we can be available to do our soul’s work for elders and their families.

The  TV sitcom’s Golden Girls had a good idea when they got together to share a home and pooled resources to maintain a lifestyle that all enjoyed. 

How many homes in our community have one person living alone and “rattling around” causing their families angst?   What if there were another person who shared similar values and history, who needed a place, and between them (as housemates) they could afford to enjoy a new friendship and with now affordable purchased services to help conserve life energy and vitality? 

 HomeShare is a way to maintain housing stock, maximize independence and a dignified life style, and allow for a normative aging process integrated in the larger community.

HomeShare isn’t for all elders.  Continuing care retirement communities and large assisted living communities aren’t for everyone.  Small assisted living residences don’t meet all needs, either.  Yet all are excellent options and our northern Colorado cities boast some of the best. 

HomeShare can work with a variety of scenarios:   two older individuals, one old-old and one young-old, newly retired, one older with some health impairments and one youngish careprovider who needs a place to live .  Matching needs, personalities, and preferences so the arrangement works is the job for a professional skilled in several areas.  A professional care manager is uniquely suited to this task.

And what an exciting development this could be for our community!

Physicians can not be experts in all areas of medicine.

Physicians are human and thus, are imperfect.

One can have more than one physician.  The role of the PCP (primary care physician) is that of central information and support.  All information, diagnoses, medication orders should be in your PCP’s file for you.

Keep a small notebook with all your important health history and information documented.  Include: 

allergies,

medications (including prescriptions, over-the-counter (OTC), supplements, herbs, pain relievers, etc.

previous hospitalizations and surgeries,

copies of your insurance cards,

copies of advance directives, including Living Will, DPOA for healthcare, CPR Directive.

Before you have an appointment with your MD, think about questions you wish to ask.  Think about the symptoms that have been disturbing you (or disturbing those who care about you!), the issues you wish to have the doctor know and be prepared to discuss with you.  Write those on a bulleted list, and

Take with you to the appointment and give to the receptionist/nurse to share with the MD, or

Fax to the office no more than 24 hrs before your appt.  Call ahead to anounce the fax’s arrival and ask that it be put on your chart for the doctor’s attention.

Take a copy of this memo with you for your reference.

Keep a copy of the memo and any added notes in your small notebook.

If you must wait for your appointment, it may be because this MD gives his patients time.  He will give you time also.  Use this opportunity to re-formulate your questions or concerns, to get “centered” and ready for this important meeting.

During your appointment:

Ask what your blood pressure, weight, or any data collected are. Write them down.

If you can not hear or understand the doctor, ask him to slow down, speak more clearlyor loudly or repeat.

If you do not fully understand what he is telling you, or why certain treatments are recommended, ask for further explanation.

Do not agree to medications or treatments of any kind until or unless you underdstand fully what they are meant to accomplish, what the “downside”might be, or if there are any alternatives.

Be honest. Resist the temptation to misrepresent how much you smoke, drink, or forget your medicines.  The physician is not a judge, but a health care coach who cares.  He or she can not help effectively if accurate information isn’t available.  In fact, given inaccurate information on which to base treatment, that treatment may actually be counterproductive…and through no fault of your physician!

Consider having another individual be with you during the appointment to take notes, help in the discussion, and otherwise support the communciation between you and the physician.

If you receive treatment from any other physician, clinic, source, even if it is a direct referral from your PCP, ask specifically that a copy of the report or a summary of findings be sent to your primary care physician.

Follow all instructions and take all medications you and your MD have discussed and to which you have agreed.  If you have problems of one kind or another, or if desired results are not obtained, CALL your physician and report.

If you forget or feel confused about what you have heard after you return home, call the physician’s office and explain the situation.  A  nurse will likely talk with you so you are more comfortable.

Understanding that elderly bodies do not have the resilience of young ones is an important lesson.  Another growth opportunity comes with the realization that humans have been created to live a finite number of days.  Becoming comfortable with honoring the last days of one’s life as completely as one does the first can be a huge help at these times.  What we can learn  from our elders (by asking!) about their goals and desires is a major factor in peaceful constructive decision-making.  This knowledge forms the structure for our being able to support elder and family to make the most of these “late days.”

Palliative care is also known as “comfort care.”  It is different than “curative.”  It is NOT withholding care or treatment of symptoms that create discomfort.  Palliative care is all about making late life easier and more comfortable, allowing the energy and freedom to finish the business of living and loving.  It can be peaceful, providing moments of joy and gratitude.  The stressors that come from frustration and hopelessness are lessened.  Life can be lived fully again in preparation for ending well.  It is something for all of us to seriously consider for ourselves and our loved ones.