Many elders have complex health and personal care needs that require ongoing care with different providers in multiple settings. If a hospital stay is necessary, the number of healthcare providers involved goes up exponentially.
Despite how common this situation is, clients and their families report that one of their biggest issues is disjointed and uncoordinated care. This situation becomes particularly dire when the elderly person moves from acute care services, such as the hospital, to their home. You may expect that the basic principle should be to organize care around the individual rather than organizing care within the provider siloes, but this rarely seems to happen.
On discharge from hospital:
- The family doctor often does not know about different medications prescribed by the hospital or the various specialists that might be involved
- The hospital sets a discharge date even though the family may not be able to confirm that personal care needs will be met at home within that time-frame
- A nurse practitioner working with one of the numerous specialists organizes follow-up appointments but no family member is available to take their parent, so the appointments are cancelled
- Another patient coordinator is recommending the parent needs Long Term Care but the waiting list is, on average, four years unless you are in crisis – so what do you do in the meantime?
- The list of navigators, coordinators, and care coordinators grows – but no one seems to be in charge
Trying to coordinate the coordinators creates untold stress for elderly patients and their families, who spend extraordinary amounts of time trying to sort out the confusing matrix of health services, providers, and options for care.
A recent article written by Paula Span in the New York Times, “The Tangle of Coordinated Health Care” pinpoints this issue that families are struggling with. “More specifically, who coordinates the proliferating number of health care helpers variously known as case managers, care managers, care coordinators, patient navigators or facilitators, health coaches or even – here’s a new one – ‘pathfinders’?”
Many of the points made in the NYT article hold true for Canada’s health system as well. And yet we must realize that with the elderly, coordinating the caregiving coordinators is only the tip of the iceberg.
Lack of Coordination Triggers the Domino Effect
A sudden health event such as a fall, a stroke, or a broken hip elicits major caregiving issues for families but can also trigger a domino effect with a cascading set of difficult factors to manage. The consequences can be far-reaching, from financial, to living circumstances, to quality of life considerations.
Many companies who claim to “coordinate” care typically do so from a personal care or caregiving perspective, but that is only part of the equation. Today’s reality is that most people will depend on private caregiving at least in the short term. This can be very expensive. And do you have the time and expertise to search out the best providers and sort out the financial implications?
Once the dominoes start to fall, elders and their families are faced with many difficult decisions and caregiving is only one aspect. Waiting until a crisis strikes only causes more stress for your elderly loved one and for you.
About Silver Sherpa
Silver Sherpa offers a unique combination of healthcare expertise, estate planning knowledge, and project management skills to help the elderly and families. Get in touch with us to discuss your needs – it can be as brief as 15 minutes or as long as you need.
