Welcome Wisdom

Care Coordination: A Care Manager’s Expertise

by Felicia Juntunen, MA, CMC, ECM Director of Care Management

The healthcare journey can be full of challenges for older adults (and their families) and further complicated by the management of chronic diseases or dementia – sometimes both. Patients often express frustration with providers who are unfamiliar with them, with the cost of care, and the lack of collaboration between healthcare systems. Family caregivers may be tired or confused about care options or have limited time or experience dealing with their loved one’s chronic care needs. Clients and their families may need education and guidance in decision-making. Care coordination that addresses these concerns is a core function of how Aging Life Care Professionals demonstrate their support for older adults who may find themselves in complex situations or struggling to receive care in a challenging medical system.

Advocacy is at the heart of a care manager’s expertise as they help clients pursue more effective healthcare. The Aging Life Care Association states, “Aging Life Care Professionals are strong and effective advocates for clients and their families, promoting the client’s wishes with health care and other providers, ensuring that client’s needs are being adequately addressed.” A care manager’s aptitude for care coordination draws on their knowledge of health and disability and their ability to offer crisis intervention.

Care management coordination between providers, including doctors, other services (home health, for example) and family members helps accomplish continuity of care leading to better outcomes for a patient and contributing to cost savings. Care managers regularly coordinate and attend physician appointments with their clients. They assist clients in determining their goals, communicating with healthcare professionals, and staying on course with a plan of care. They help clients who need assistance following through with diagnostic orders and acquiring and managing new medications. Clients who find themselves in a health care crisis that results in hospitalization can rely on a care manager to communicate to medical personnel their client’s health history, baseline status, and health care directives– all information that is critical to effective care. Care managers help navigate emergency room visits, hospitalization, and skilled nursing (rehabilitation), by providing continual advocacy for the client by ensuring each level of care is familiar with and supports the client’s objectives. With advocacy from a care manager, providers understand a patient’s history, status, and goals, leading to less duplication of services and avoiding unnecessary hospitalizations or inappropriate placement.

Aging Life Care Professionals help coordinate care to support clients and their families, focusing on an individual’s priorities, emphasizing communication, and promoting continuity of care. At Elder Care Management, our care managers lead with personal and compassionate service to our clients. A care manager is on call 24 hours a day, 7 days a week to respond to urgent matters. We work to ensure our clients receive the best possible advocacy and pride ourselves in communication supporting successful collaboration between providers. Improved quality of care and outcomes that align with client wishes and priorities are goals to which we are committed.