By Dianne Smith, RN, MA, CMC
This article will provide insights into assessing needs and using technology that can help our clients to remain independent longer. Technology can be integrated seamlessly into a care management practice by care managers who are willing to experiment with new innovations. This article provides a set of steps that can be taken that will enable care managers to incorporate technology into their practices. High risk clients or the “frequent fliers” in the hospital emergency department are most likely to benefit from the use of technology. These clients often have chronic illnesses such as COPD, CHF, diabetes, or dementia, and despite diligent medical care, are uncontrolled in their disease process. They are responsible for most of our night and weekend care management calls due to falls, infections, medication errors, and uncontrolled behaviors.
Utilizing technology can allow the care manager to manage these cases by minimizing the occurrence and duration of hospitalizations and by closing gaps in care. It can also assist us in helping our clients to remain in their own homes and avoid placement for a longer period of time. Any technology that is considered should address a care plan goal or at least bring the care manager closer to the stated objective. Depending on the chosen technology, a care manager may be able to help a client avoid a care transition, decrease falls, avoid medication errors, decrease the workload on the caregiver, provide additional oversight, or help manage assets by streamlining care and minimizing disruptive behaviors. The process of implementing a technology begins with a geriatric assessment and is followed by investigation, implementation, follow-up problem solving, and evaluation.
As with any assessment, the goal of the technology-oriented geriatric assessment is to identify the concern, including the physical, mental, and emotional issues that could be improved or stabilized. With technology, the care manager must be especially sensitive to establishing a good relationship with the client, as an atmosphere of trust is so important for the innovation to be accepted and implemented. The following questions are recommended as part of the technology-based assessment:
- What can be done to improve client safety, enrich their life, and meet their stated goals and objectives?
- How can technology be used to promote and ensure compliance?
- What will it take to get us to our goal?
As with any assessment, it is important to listen to what the caregivers, family, friends, and the client are saying. In this way, the resources and energy can be focused into solving problems and finding more beneficial outcomes. Gaps in care should be identified so that technology and other solutions can be identified to close those gaps.
Collateral problem-solving of several areas can be vastly beneficial to our clients. A fifty-percent improvement in several areas will result in a significant impact in a client’s life. For example, placing an alarm on the doors may not keep the client from exit-seeking, but it will alert the caregiver of their impending exit. While this intervention will not totally solve the problem, you helped the caregiver be aware of the client’s movements while you search for technology or other solutions to the exit-seeking behavior. Installing a PERS in the event your client has a problem and needs to seek help does not guarantee the client will remember or decide to use the system. But the benefit of training the client and re-testing the system weekly is that they may remember and feel the need to use the system if they need help. It also gives some peace of mind to the family that a system is in place and could be useful in a problem situation, If a problem is well stated, the solution will be closer at hand. For example, if there is a concern with wandering, the care manager might ask: when are they most likely to wander and what are the safety concerns for this particular client?
Once the client’s needs have been identified, the care manager can start to identify helpful technologies. The technology must fit the client’s budget, lifestyle, cognitive abilities, and physical strength. It is also important to make sure that it allows the client to be as independent as possible, to be safe in their own environment, and to improve the ability to monitor their health and well being. An important factor to consider is the risk versus benefit. There may be instances where you identify a wonderful technology, but it may prove difficult to overcome the client’s barrier to learning. It may help to have a discussion with the client about the need to perform tasks differently and the value that can be gained by the change or addition of technology. The care manager’s job is to assess which option will most benefit the client and to recommend a product. The following investigation steps are recommended:
- Keep a file of equipment and technologies available.
- Network with other professionals in your area or on the Internet who have faced the same client problem and ask how they resolved their concern.
- Uncover innovations that can then form the basis for effective strategies.
- Search the Internet for technology options.
- Ask what worked and what did not work for others and if there were factors that limited the success of the technology and how these limitations were overcome.
The main thing is not to be afraid to ask lots of questions. Many of us have a fear of technology, so it is best to investigate technologies with one client concern in mind.
The implementation phase can begin with the care manager sitting down with the care team family and/ or care providers) to identify risks and concerns. The team works together to determine how the technology can provide a solution and become integrated into your client’s home.
This step will allow you to evaluate the readiness of the client and their care system to understand and utilize the innovation. You will also need to demonstrate to the client how the technology works and its benefits and shortcomings. It is important to show the value of technology by demonstrating both how the client will benefit and how the care team’s stress will be reduced. If we can inspire confidence in those involved that the innovation will produce positive change, we have succeeded. It is important to make sure to do your homework and answer all of your own questions. Another important task is to ensure that the home has the appropriate electrical outlets, phone jacks, and space. Don’t forget to purchase any additional batteries, extension cords, or power strips and provide clear, boldly printed instructions for the care team, and make sure they know how to reach the product technical support team.
Follow-up Problem Solving
The care manager should schedule follow-up visits at regular intervals either in person or via telephone or e-mail. During these visits, listen carefully to make sure the technology is being used correctly. Address any concerns and provide additional instruction or training promptly. As with any client issue, it is the care manager’s job to be sensitive to the changes that are affecting our client’s home environment. Once the client or care team becomes disillusioned or negative toward the technology that you have recommended, it is difficult to restore confidence.
Never underestimate the benefit of a positive attitude and having the entire care team and your client involved in supporting the technology. Remind everyone that the more you use the technology the more familiar it will become. Set the tone so it will be a positive experience.
After a technology has been operational for some time, it is critical to determine whether the initial goal has been met in full or in part by the technology. If the goal has not been reached, your job is to evaluate whether additional training and support or supplemental technology are needed, or if the technology product should be removed altogether. The care manager should not be afraid to continue to search for solutions that meet the client’s needs and budget, but if the technology is clearly not working, it is okay to admit it and thank all those involved for their efforts.
Providing state-of-the-art care through technology in the client’s home ensures our clients every chance of staying active and independent for longer periods of time. Care Managers who access technology for their clients benefit by having healthier clients and an expanded knowledge of the use of technology in their practice.
Dianne Smith RN, MA, CMC, has been a Geriatric Care Manager for nine years in Central Florida. She has a Bachelor’s in Nursing, a Master’s in Counseling, Certification as a Care Manager from NACCM and over 35 years as an RN. Dianne has a background in critical care and has served as a Parish Nurse, Parish Nursing Consultant, Hospice Chaplain, and is currently a core team member for the Health Ministry at First Baptist Orlando.
Dianne spoke on Technology for Technophobes at the NAPGCM National Conference in 2008 and has integrated the use of technology into her practice. She is currently involved in the study of care transitions as they relate to the elderly population and the prevention of errors inherent in multiple care transitions. Dianne is President of FHL Care Management, LLC in Orlando and can be reached at [email protected]
Advocare Care Management is your preeminent care manager in Boca Raton. We work with you to get the resources, tools, support, connections, and advice for aging life care for seniors or loved ones. We assist families throughout South Florida including Palm Beach counties. We are available 24 hours a day and will give you the help you need. Contact Advocare Care Management today and let us help you.
Reprinted with permission from Aginglife.org. Advocare Care Management is the place to go when caring for an aging loved one.