The Layers of Geriatric Care Management
Any number of things draw case managers to their field. For Nina Mottern, RN, BN, CCM, her case management career gravitated toward geriatric care management when she realized she needed to find a nursing job that aligned with her family life.
“When you have young children, you gravitate to employment that will work around a family schedule,” Mottern said. “Oftentimes, that seemed to involve geriatrics in a geriatric setting. And so, I kind of came about it that way.” Eventually, though, Mottern discovered that the specialty was really for her after recognizing just how much help her patients really needed.
“There's just a lot of hoops and barrels people had to navigate that being older, were more difficult than they had imagined,” said Mottern. That realization turned into a decades-long career in geriatric care management.
Challenges for Geriatric Care Management
One major challenge that Mottern and other geriatric care managers face is care transitions. These discussions with caregivers, especially if there are multiple people involved in a client’s care, can be frightening to them.
For example, palliative care referrals can be a minefield of emotions for clients and caregivers. When someone hears palliative care, they think of hospice care, often incorrectly assuming that their loved one is at the end of life. Palliative care can support a client and their family for years, as it gives both parties the support they need.
That is why Mottern advocates for giving caregivers the information and education that they need to understand what is happening.
“I find that it's been really helpful to provide the education for resources that help their journey, just knowing when it's time to change care, knowing when it's time to introduce another support system,” Mottern said.
In addition to navigating emotionally charged conversations and educating clients and their families, geriatric care managers must be aware that a one-size-fits-all approach to providing resources may, in some cases, not be helpful. Or, conversely, the plan the care manager develops may not actually align with the caregiver’s or client’s goals.
To illustrate her point, Mottern tells a story about how she had developed a “grand plan” for a caregiver and supplied them with all the resources and information they would need. However, the caregiver only wanted to be able to go out to lunch with their friends once a month, so only required care for the client during that time, rendering the “grand plan” ineffective for the client and caregiver.
“I've learned early on that you can have all of the knowledge, but you really have to listen,” Mottern said. “That was an eye opener for me because I just had all this information and all these ideas, but that was all she wanted—to be able to go out to lunch once a month—at that point in time. That just meant the world to her.”
A Focus on the Caregiver
Mottern describes geriatric care management as an onion—the more you peel from it the more layers you will expose.
“I found that upon closer inspection, not only does the patient need support, but the caregiver needs support of their own, more support than just emotional,” said Mottern.
On top of identifying and coordinating resources for a client, geriatric care managers often coordinate resources for caregivers in need of both emotional and physical support. While some organizations, like Veterans Affairs (VA), have limited resources for caregivers, uncovering resources available to clients and their families can be a significant undertaking.
“The base way geriatric care managers can serve families and clients is to be diligent about their awareness of resources in the community, and even to have an awareness of resources out of state,” Mottern said. Understanding options outside of your local area may be critical for helping clients relocate closer to family and other caretakers who can support them.
If Geriatric Care Management is For You
Case managers work every day to ensure continuity of care for their clients, and those who’ve chosen to work in a specialty like geriatric care management provide resources, education, and understanding for both clients and caregivers. While geriatric care management has its own unique challenges, like developing customized responses for caregivers who may not share your same vision for the client’s needs or helping clients and their families through emotional life changes, there are joyous elements, like helping reunite loved ones, that make geriatric care management an ideal option for many case managers.