Iona’s nurse care manager Carol Kaplun’s day begins in typical Washingtonian way with emails and voicemails. That is where the similarity ends.
“There is often one email that was written in the middle of the night from an out-of-town caregiver who is distressed. It might be about someone who has fallen and is in the emergency room, or will be released from the hospital or rehab before they expected,” says Carol.
As a nurse care manager with Iona Care Management, Carol is equipped to help people who are facing seemingly insurmountable challenges as they interface with a complex and often fragmented medical system.
Carol gathers as much information as she can from the message and settles in to return the calls. One call is placed to a long-distance caregiver who is worried about the health of her father, who lives in the district. Her mother is in the dementia care unit of a local assisted living facility. Her father goes to visit every day, but lately on the phone he has sounded increasingly foggy about the details of his day. Can Carol go visit?
Carol nods when she hears her say “I can’t believe that I already need Iona. I used to volunteer there when I was in high school.” Carol takes down all the pertinent information and places a call to the father who will be at home after he goes to visit his wife at lunch time.
Carol finishes her calls and emails and grabs a folder of information that she has gathered for her next clients, a husband and wife who called because they were feeling overwhelmed by the volume of information about long-term care and the choices that they will have to make as they grow older.
When they called to set up the appointment, they made it very clear that they love their home and want to remain in it for as long as they can even though the wife has arthritis and their children live very far away. They want help from an objective and knowledgeable professional who can help them navigate some of the issues that they might face with a chronic illness and options they have for growing older in their own home.
“Sometimes we help people identify the problem. With this couple, they had identified the problem pretty well. What they needed help with was identifying the resources and an understanding of ways they could accomplish their goals within their financial resources,” she says.
The couple left an hour later with their decisions and some strategies they could employ to make those decisions in a timely manner. “That’s the very best scenario. They are taking the time to develop a coordinated plan before a crisis.”
Carol grabs her bag to drive to an area rehabilitation unit to meet with a discharge planner. A daughter had to return home to another city after attending to her mother and so called Carol to be at the discharge meeting and report back. The return of her mother to her home is pretty straightforward, and Carol calls to walk the daughter through the home health care and medical equipment needed for this transition.
Iona’s loan closet can supply a walker which Carol will deliver once the mother is at home, but arrangements need to be made for a delivery of other equipment to the house. The call should take only a few minutes, but the daughter feels aching guilt about needing to be away during this transition.
Carol listens attentively and validates her concerns, offering advice on how to seek support in her hometown and to identify strategies that will allow her to care from a distance. Carol assures her that she has seen people recover from this type of injury and that she is only a phone call away if more followup is needed at a later time.
After her visit to the rehab unit, Carol heads to the meeting with the gentleman who is home from visiting his wife at the assisted living community. The “fogginess” that the daughter hears on the phone from her father seems to Carol to be evidence of mounting caregiver stress related to his wife’s decline in the assisted living community. In addition, the father reports, “This house is getting beyond me. I can’t care for her and do the maintenance that I need to do.” Would it help if Carol arranged a time for him to come to the office and get on the phone with his family and talk through the next steps and all the resources that are available with Carol present? The relief on the father’s face is immediate.
They arrange a time to meet. Carol refers him to the local aging-in-place village for volunteer help around the house.
Sometimes the hardest thing to do is to ask for assistance, especially when there is a sense that you don’t want to burden your children. Sometimes there are differing opinions about what the next step should be.”
– Carol Kaplun, Iona nurse care manager
Iona care managers can help families negotiate difficult decisions about long term care or other needs.
Carol’s final visit of the day is with a woman who was referred by her building manager to Iona a couple of months ago. When Carol visited her for the first time she had to call 911 because it was obvious that the woman’s blood sugar was dangerously low. “She was increasingly unresponsive as my first visit progressed,” Carol remembers. “No wonder her neighbors were concerned.”
Since the woman lived alone and there was no immediate family, Carol served as an advocate for her in the hospital emergency room and later assisted the discharge planner at the hospital with an assessment of what she would need to return home safely. Carol arranged for resources like an emergency response button, home delivered meals and transportation to and from doctor’s appointments. The woman is doing well on her own and is about to celebrate a 92nd birthday. It is a good way to end the day.
Finally, Carol heads back to the office with the copious notes she took today that will need to be typed in a report to caregivers. She knows that tomorrow when she logs onto her email, there will be another family to help, another way to give back to a generation that she respects and admires, and another way to be an important resource in the network of care for seniors in the community.
May 6 – May 12, 2017 is National Nurses Week. Here at Iona, we are thankful for the nurses and nurse care managers who help older adults in our community remain healthy and safe, and provide expertise, oversight, care coordination, and support for family caregivers. Thank a nurse in the comments below!