Care Coordination

Article submitted by Pamela Dombrowski-Wilson, geriatric care manager and owner of In Home and Family Services, Inc.
For more information, she can be reached at 303-526-2318, or visit her website: www.inhomeandfamily.com.

About 5% of older adults at one time or another will find themselves in a nursing home for a short stay after hospitalization or for rehabilitation. Today, most nursing homes have their own medical staff. This means that it is unlikely your personal physician will visit or be aware of your care while you are in a nursing home. This is the same for anyone who is hospitalized.

You as a family member, or the person in the institution, do have a voice in the care provided. However, many persons are too timid or hesitant to ask questions - or do not know what questions to ask. After all, everyone believes nursing home staff know best. This is not always the case.

It is practical for nursing homes to have their own physicians. The disadvantage is that your personal physician (who likely knows most about your past or current condition) is not involved in your care. If you have a good relationship with your personal physician, you can request that the nursing home physician consult and coordinate care with your physician via telephone. You can also continue visits with your regular physician. This is important, since your personal physician will actually continue your care when you are released from the nursing home facility.

This type of care coordination is frequently provided by independent care managers who serve as family representatives. Care managers also serve to coordinate paperwork, test results and care information between the nursing home (or hospital) and the regular physician. They accompany and transport individuals to outside appointments. They also serve as a representative for the family to ensure that the person receives the necessary and best care possible. Most nursing homes will cooperate on this level if the family or other responsible individual insists. It is more work for the nursing home staff, but usually results in better care for the person in the nursing home.

When it comes to nursing home or hospital care, be proactive -- not timid or hesitant in asking questions. In many cases we simply don't know what we don't know. Utilizing an independent care manager for support during these stressful times can provide emotional support and ensure that you or your family member receives the best attention possible. It also ensures a smooth transition home - where older adults wish to remain.