At 99, Arthur was amazing. He lived alone in his own condominium and enjoyed socializing and playing bridge four days a week at the local senior center. He thought he could handle his medications and meals well.
A childless widower, Arthur had already outlived most of his friends, but he kept in touch with a niece and nephew who lived in the Midwest. The staff at the senior center first alerted the family that Arthur had some problems. A few falls resulted in some brief hospitalizations. He was also showing signs of occasional confusion. His 94 year old lady friend who had checked up on him was no longer able to because her own health was failing.
Already in their 70's, the niece and nephew were not able to look after Arthur, although they were very concerned. A director at the senior center suggested an evaluation by a geriatric care manager to determine if he should go into a nursing home or continue to live at home with supervision. After a meeting arranged by the senior center director with Arthur and his family, I was hired as the geriatric care manager.
My first task was an assessment of Arthur's environmental, physical, psychosocial and financial situation. He took 12 medications, had an empty refrigerator and very poor short term memory. Although he could afford to hire 24 hour help, Arthur valued his privacy.
An individualized care plan was established, allowing us to consider his wishes as long as his safety was not jeopardized. With counseling, Arthur agreed to have a home attendant during the day and a life line pendant for when he was alone.
With careful screening, I hired a home attendant that suited his personality. She did the marketing, laundry, light housekeeping, cooking and monitoring of Arthur's medication. Accompanying him to the senior center four times a week was an important part of the care plan, as Arthur looked forward to his card games. She also made sure he was well-groomed by taking him to the barber and manicurist, as was his usual custom. During crisis situations, the home attendant and I worked together quickly and efficiently to assure quick access to medical care, especially to reduce emergency room visits.
The family was encouraged to work with an eldercare lawyer and an accountant. The niece and nephew assumed power of attorney and consolidated his assets. They returned home to the Midwest assured that they would receive weekly updates from me as the caregiver.
As Arthur was still able to sign his name, it was agreed that the weekly mail review and bill paying would be handled by Arthur and me, with bank statements going directly to the relatives.
He trusted me as his care manager and had a close relationship with his attendant. For the last two years of his life, Arthur maintained his integrity, had some independence, and a good quality of life.