5 Reasons to Hire a Medical Care Manager

When we first embarked on our world-traveling lifestyle, we told our family we would be there if they ever needed us. For the first time in more than three years of nomadic life, we were called back to the Bay Area by the parents on a middle-of-the-night-their time call while we were on a train in Italy.

Assessing the Situation

We checked in each day after the first frantic call. Admittedly, we wanted to see if the crisis would pass before canceling all of our near-term plans. We were in Bologna, Italy at the time, and getting back to California quickly was a long and expensive proposition. A few days later, Dad was in post-acute care and hated it, but he seemed to be on the mend. It became clear that we were needed, so we began making travel plans to get back to the Bay Area. We also had to cancel a cruise on the Danube, our time in Vienna, and flights from Vienna to the Maldives.

Our journey from Italy to California took us a few days and included an overnight in Istanbul. The 4:30 am call to prayer was not to be missed. But I can’t say enough about the Maserati security car at the Bologna airport or the service and food on Turkish Airlines. Everything was great, including the new airport in Istanbul.

Back in the Bay Area

We had no idea how long we were going to need to stay, so we decided to rent an apartment near the parents for a full month. The idea of sitting in NorCal traffic every day wasn’t a nice thought.

Our apartment had such great views from the 10th floor that we took some timelapse videos. One at sunrise and one at night time with the planes landing at SFO.

What We Needed To Do

Our first task upon our return was to assess the situation and figure out the current status. By the time we got back to the Bay Area, Dad was out of post-acute care and back at his assisted living community. Still, we needed to understand in detail what had happened and determine how to prevent it in the future.

On the plus side, our long stay in the Bay Area allowed us to see lots of friends, which is always nice. Our stays are typically only a week, so this visit was really different for us. We got a chance to see San Jose State cream UNLV and we stumbled into Fleet Week in San Francisco.

Another day we made our way to the Legion of Honor in San Francisco and we saw the most amazing exhibit of paintings. What made it special was that the rooms also had clothing designs by Guo Pei a Chinese designer. While we didn’t pay to go to her exhibit, the museum had placed many of her designs in the regular galleries. Amazing art, not clothes.

Care Management

Most of the time my father-in-law is able to manage his and my mother-in-law’s care. However, this time he was incapacitated and couldn’t manage anyone’s care. We are learning that this responsibility is usually left to the family. Care management is also not part of the assisted living playbook.

For this latest issue, we thought that their GP would coordinate his care while he was hospitalized, but that didn’t happen. Coordination was left to us, half a world away, and to Dad’s super-capable personal assistant, but she isn’t a medical professional. These factors led to a less-than-optimal situation.

We also learned there he’d been in a steady decline that wasn’t due to regular aging, it was due to a lack of salt. Because we don’t see them regularly, we didn’t notice this on our visits. Frequently, the elderly don’t have good appetites, which can lead to a lack of essential nutrients. That was the fundamental medical cause for the hospitalization.

Lack of Coordination

For this latest issue, getting from the emergency room to a regular room and then to post-acute care was not well coordinated by the hospital staff. His medication orders were not properly transferred from one care team to the next. At one point Dad had to tell the nurse he wasn’t supposed to take the salt pill offered. When we questioned the doctor about the medication coordination issue, he replied, “it’s supposed to work.” But it didn’t. Worse, the staff lost his clothes in all the transfers.

It seemed coordinating, telling one doctor what the others said, and making sure that information is provided to hospital staff, must be handled by the family. At least that seems to be the expectation of the medical community.

During Covid, we had many of the same problems but no one could perform these services. One hospitalization resulted in lost glasses, clothes, and hearing aids worth about $1500. Imagine ensuring that your loved one is getting the right medication. A person with dementia isn’t going to be able to give their medical history to a nurse in the emergency room.

Here is an excerpt from an email from one of the care management organizations:

“One of the frightening consequences of your parent’s aging occurs when your distance or schedule makes it truly difficult to attend to their medical or medicinal needs. How can you be sure mom will know all the questions to ask the doctor? What if dad forgets recent symptoms he’s experienced? And, among the most common causes of hospitalization for older adults: what if medications are mishandled, not renewed, or taken in the wrong dose or frequency? We have systems in place to prevent this from happening.”

The Solution: A Medical Care Manager

We chose to hire a Medical Care Manager. I had never heard of this service. However, it turned out there are several large agencies with representatives who did exactly what we need. Here is our list of the services we thought we needed on a regular basis:

1. Someone who could visit the parents frequently and assess their general wellness.
2. Keep records of their medications, their regular doctors, and a comprehensive ongoing medical history.
3. Go to the hospital when needed and help with care coordination.
4. Attend doctors’ appointments and help coordinate care between providers.
5. Provide us with a professional report each month.

Clearly, there is a need for this service if there are two large businesses doing it just in a small region of the Bay Area. There are plenty of elderly whose family isn’t local or isn’t available to perform these services. And don’t expect the expensive Assisted Living facility to perform these services. If you don’t live near your parents or other loved ones, consider hiring a medical care manager. Fair warning, they are very expensive but they can be essential to the care of your loved ones.

To find a medical care manager, you can do a web search for “medical care manager” or “geriatric care manager” or “eldercare” with your location. A website called Aging Care might be helpful too.

Putting this service in place gives all parties additional peace of mind. It is good to know that future issues will be addressed in the best manner possible.