Geriatric Case Management

Geriatric Case Management

Geriatric Case Management

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Long-term care services, in general, have been facing turbulent times and challenges in the last few

decades (Pratt, 2016). Let us examine some of these challenges.

Challenges and Weaknesses of Geriatric Case Management

The long-term care system has its flaws, and the need to overcome those flaws in such a dynamic

environment poses some challenges. Some of these challenges include the following:

 Financial solvency: Geriatric care in general is reimbursement-driven. Providers take it upon

themselves to meet needs for which there is reimbursement but have been reluctant to create

services for which they will not be reimbursed or for which reimbursement is extremely limited.

In some cases, services have to be provided for several months before reimbursements are

made, especially when the provider is new.

 Provider turnover: Many providers get frustrated with stringent regulations and slow and

limited reimbursements. Some may decide to look at other services and abandon geriatric care.

In some cases, approval becomes a serious problem, and providers may be required to have

thousands of dollars in the bank depending on the program.

 Provider burnout: Caring for geriatric patients is not an easy task. Some of the geriatric patients

may need total care. Having several patients of that nature could result in provider burnout.

 Provider job stress: Some providers may have limited staff simply because they would like to

save money. As a result, one staff member may be assigned to several patients, which may

eventually lead to staff burnout.

 Employee dissatisfaction: Employee dissatisfaction is a prerequisite for employee turnover.

Many employees, especially those lower level staff working with the clients directly, may

express dissatisfaction over work overload, low wages, and so on. The provider may have to

pacify employees, at the same time striving to maintain a reasonable number of clients to work

with to stay in business.

 Patient complaints: Geriatric patients and their families are sometimes hard to please. Many

patients and their families complain about issues when they are dissatisfied. Family members

become very concerned about their loved ones and would not want any abuse-related issues.

 Patient-related medical errors and lawsuits: Providers have been plagued with lawsuits

because of medical errors. Medical errors are serious problems in caregiving and must be taken

seriously by providers.

 Legal compliance: Providers are required to comply with federal and state regulations and

practices. Violations may lead to consequences including fines and probations, which may

hinder services.

 Change management: Change management is also another problem impacting geriatric care.

The health care industry is a dynamic industry. Sometimes abrupt changes may pose problems

for the provider. Besides, long-term care is a fragmented and uncontrolled system consisting of

numerous parts that should be integrated (Pratt, 2016). It is a mixture of health and social

services.

 Technology: The use of technology in health care today is a mixed blessing. Although technology

has contributed a lot to enhancing the quality of care, it does not come cheap.

 Information management security: Providers must secure patient information or risk a Health

Information Portability and Accountability Act (HIPAA) violation. Penalties for HIPAA violations

may pose problems for providers.

Nevertheless, long-term care services have some strengths that should be leveraged, and these include

the strengths of geriatric case and care management.

Strengths of Geriatric Case and Care Management

The following are some of the strengths of geriatric case management:

 Response to changing needs: Even though geriatric care has been evolving, it has still provided

for the changing needs of its clients. A new mode of delivery has evolved over time in the

industry.

 Make a professional assessment: Providers, including case managers, have been able to do

professional assessments effectively to determine the needs of the clients.

 Arrange care services: Case managers have worked with hospitals, community resources

organizations, and other entities to provide the needed services for their clients.

 Find community resources: Case managers have access to community resources. They are in the

position to direct their clients to these resources.

 Assist with placement: Case managers can assist with a residential placement when the time

comes.

 Be a source of information: Case managers are a great source of residential, assisted living,

adult day care, and other information, which is vital to their clients.

 Providers have increasing focus on customer services: The long-term care industry is very

competitive. The only way providers could remain in business is to focus more on good

customer services to keep their clients satisfied.

Some alleviation strategies for the challenges of geriatric care include the following:

 Have patience with clients because these patients are unstable

 Assign good physicians and caretakers to geriatric clients

 Get family members involved

 Get them involved in activities with other patients

 Help them to be independent by assisting when necessary with their activities of daily living

 Help them with their legal issues

 Help them with their medications and doctor visits

 Pay close attention to general hygiene, including dental care

 Assist with community resources

 Help them with mobility and other physical activities

 Take care of their assistive devices

Patient–Client Assessment Models

Geriatric case and care managers help their clients to meet their comprehensive health needs by

implementing several approaches to the client assessment, including the following (The Commonwealth

Fund, 2017):

 Intensive case management

 Strength-based case management

 Generalist case management

 Clinical case management

 Integrated model

 CareMore model

Based on the needs of the client, assessment utilizes one or more of the case management services

listed above. We shall examine the CareMore Model of assessing clients and developing a case

management plan to help clients seeking services in hospitals and long-term care facilities.

General Assessment Process Using the CareMore Model

(The Commonwealth Fund, 2017)

The CareMore model is an integrated model that describes, in detail, the assessment process for high-

risk, chronically ill, geriatric, and relatively healthy patients. The model starts with enrollment, followed

by a medical examination by a physician or nurse practitioner. Based on the patient’s condition or

needs, different assessments and care plans are recommended, as shown in the model.

Projecting from the CareMore model, we see that any geriatric patient case management involves

assessment, management of care, oversight of caregivers, and family support (see figure below). Even

though the model is applicable to both geriatric and hospital settings, there are differences in the

assessments and plans developed for patients in these two settings, because plans are patient-centered

and patient-specific.

When we examine the model carefully, we will note that for geriatric clients, in-depth assessment is

made to provide holistic care for the patient. In this regard, assessments may include the spiritual,

mental, social, psychological, physiological, cultural, and social needs of the patient. The type of case

management plan developed is highly dependent on the needs of the patient (Murphy, 2017). Geriatric

patients are usually frail with chronic disease conditions. Therefore, programs developed for them must

also address these chronic disease conditions. Some programs developed for geriatric clients are listed

below.

Examples of Programs for Geriatric Clients

 Exercise and Strength Training Program

 Home Care

 Mental Health Program

 Social Services

 Podiatry

 Hospice

 Palliative Care

 Wellness Programs

 Transportation

For patients in the hospital setting, more attention is given to curative aspects of the presenting

ailments of the patient. Additional teaching is given to the patient after discharge with regard to health

promotion and maintenance.

Legal, Social, and Ethical Considerations

It must be noted that the long-term care system is reimbursement-driven. Medicare and Medicaid

services have reduced their cost over the years and have shifted cost to the provider or client.

Therefore, legal, social, and ethical considerations should be given with payment for services in mind,

because services are terminated if the insurance dollars are spent.

Legal issues generally under consideration in caregiving in the United Kingdom may include the

following (Murphy, 2017):

 The Human Rights Act of 1998

 Mental Capacity Act of 2005

 Equality Act of 2010

 Health and Social Care Act of 2012

 UN Convention on the Rights of Persons with Disabilities 2008

Some of these are applicable to the U.S. under a different nomenclature, but with a lot more similarities.

For example, in the U.S., the federal government has also provided some assistance to family caregivers,

mainly through the Older Americans Act’s National Family Caregiver Support Program (NFCSP). Such

provisions are available under the:

 Family and Medical Leave Act (FMLA) of 1993

 Medicaid Home and Community-Based Services (HCBS) waiver programs that include respite

care for family caregivers (National Caregiving Alliance, n.d.)

 The Social Security act of 1965 (Medicare and Medicaid)

 Mental Health Parity Act of 1996

Other legal and ethical issues specifically relating to geriatric care management discussed in previous

lessons include the following:

 Autonomy

 Maleficence

 Beneficence

 Informed consent

 Medical Power of Attorney

 End-of-life issues

 Advance directives

Conclusion

Providers dealing with geriatric clients face many challenges. These challenges must be overcome with

time if providers are to stay in business. With the Baby Boomer population aging, there is a growing

need for geriatric care in the health care industry. The geriatric population are fragile and are sometimes

plagued with chronic diseases. Special attention must be given to them in terms of the nature of care

and regulations including legal, social, and other ethical considerations. Experts have come up with

different models aimed at providing the best care for our geriatric population. The CareMore model in

the lesson is one such model. Study the model and try to respond to the questions for the unit.

References

Murphy, D. (2017). Counseling psychology: A textbook for study and practice. Nottingham, UK: John

Wiley & Sons.

National Caregiving Alliance (n.d.). Federal and State Family Caregiving Legislation: A Summary of Bills

from 2004-2006. Retrieved on July 16, 2018 from

https://www.caregiver.org/sites/caregiver.org/files/pdfs/Fed_and_State_CG_Leg_final_summ.0

2.21.07.pdf

Pratt, J. R. (2016). Long-term care: Managing across the continuum (4th ed.). Burlington, MA: Jones &

Bartlett Learning.

The Commonwealth Fund. (2017, March 28). CareMore: Improving outcomes and controlling health care

spending for high-needs patients. Retrieved from

http://www.commonwealthfund.org/publications/case-studies/2017/mar/CareMore