Geriatric Care – The 4 Steps for an Assessment

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Geriatric Care:  The Four Steps for an Assessment




Guest:  Mary Peters – Care for Life Founder, Geriatric Care Manager Host:  Sally Hughes Smith – Author/Artist, The Circle


Sally Hughes Smith:  Welcome to Age to Age.  I’m Sally Smith.  Let’s talk.  We have Mary Peters with us, President of Care for Life, which is a geriatric care management company.  We’ve learned, through Mary, that there are several ways to go about taking care of your older loved one; perhaps hands-on, yourself, with them living in your home.  But, there are many times when someone has problems that are beyond what they’re able to solve easily.  At that point, someone like a geriatric care manager; of which I’ve learned there are 17,000 across the United States, can come in and help.  Now, Mary, in your literature, and in things I’ve learned through you, I understand that one of the absolute first steps in starting a process with a geriatric care manager is a basic assessment.  What does that consist of?


Mary Peters:  Well, the four steps of geriatric care management are what sets us apart from other caregivers, or agencies.  What is an assessment?  You can call an assessment an evaluation.  You could call it a check-up.  You could call it different things.  But, we call it an assessment. 


The first part of the assessment is that we look over all of the physical aspects of the potential client.  We want to know if they have any chronic problems, any symptoms that prevent their mobility, if they’re getting proper nutrition.  We want to know all that’s involved in their physical condition that we could address and, hopefully, make better. 


After we do the assessment, and we’ve gathered all the information that we can, from the doctor, the children, and from the client, we will develop a care plan.  This care plan will include all of the strengths and weaknesses.  Then, we’ll have a list of outcomes that the person will be able to achieve.  For example, someone may come home from the hospital after surgery and be weak.  We will partner up with the physical therapy clinic, so the physical therapist can come in and help that person become stronger.  Or, maybe, we would take the person to the physical therapy clinic for their visits.  That’s what we do as far as a care plan is concerned.  We want to look at everything and make a care plan for all the strengths and weaknesses.  And we like to do this with the adult children.  


Sally Hughes Smith:  There’s one thing in the assessment that I’m so impressed with, which is that you review the existing social and spiritual support.  We touched on this earlier, that is, the connectedness of this person to the world.  Is that difficult to assess?


Mary Peters:  Well, we want to look, mainly, at family support.  Is there family support?  Does the family live away?  Is the family so busy with work that they can’t come by?  Are there other reasons why the family isn’t available?  Was the person a churchgoer?  Do they have a community of church friends that we can encourage to come and visit them?  Having spiritual and social support is very important.


Sally Hughes Smith:  Do you find that many churches have this, a sort of elder ministry, the way they have classes on parenting, and marriage; support groups for all sorts of issues that people have?  Is this becoming increasingly prevalent within the church framework of outreach?


Mary Peters:  If you call a church and want to provide a program, or to tell them about someone, usually, a church has a senior person that handles all of that.  They put together programs.  They see who’s in the hospital.  They visit people.  Churches are very important.  They also have parish nurses.  The parish nurses do not get paid.  They’re part of the parish, and they go out and see the clients, in their homes, to see how they’re doing.


Sally Hughes Smith:  You say, also, that you’re quite comprehensive in this evaluation because, obviously, you’re trying to look at everything.  You’re looking for problems to solve.  And one of them is examining their current legal documents.  Do you just ask to see them?


Mary Peters:  Yes. We want to see if they have advance directives.  For example, our guardianship patients, we try to find out what they want as their end result, and what they’d like to have before they go into dementia.  We want to know if the adult client has a healthcare power of attorney, and who is the agent for that attorney, and if the agent and client agree. 


There’s also a healthcare power of finance; someone who will take care of the money.  Once a person becomes unable to make their own decisions, the powers of attorney kick in.  I can’t get a power of attorney for you, because you can make decisions on your own.  This goes into affect after someone becomes demented, or is injured. 


Sally Hughes Smith:  How is this assessment done?  I would guess that you’d have someone who is very knowledgeable in the legal field; an elder care lawyer; that there would be doctor’s visit to find out what’s going on physically; meetings with the family; and that you’d go to the client’s residence.  I would assume that all of these pieces of the puzzle are brought together in this assessment, and that you could let a family know, ahead of time, what they’re looking at from a financial standpoint.  Am I correct?


Mary Peters:  That’s right.  With the power of attorney, we do send them to an elder law attorney to prepare the healthcare powers of attorney.  We emphasize to the children that this is very important, and will save a lot of time, and agony.


Sally Hughes Smith:  Well, it’s wonderful to know that there’s someone out there, especially if you’re one of the ones that lives across the country.  I’ve seen how not having current legal documents in place can turn into an absolute nightmare.  People don’t realize what a difference it makes just to have a simple will.  Well, thank you so much.


Mary Peters:  You’re welcome.


Sally Hughes Smith:  Glad you could come, Mary.  It’s always a pleasure.  And thanks to our listeners for joining us.  We welcome your suggestions and comments, always.  This is Sally Smith, Age to Age, saying goodbye; wishing you courage and joy on your journey.  We are all connected.


If you have any questions about the services or programs offered at the Medical University of South Carolina, or if you’d like to schedule an appointment with one of our physicians, please call MUSC Health Connection at:  (843) 792-1414.





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