Advocacy in Geriatric Care Management
For: Caregiver Staff
Executive Summary
Charlotte*, a Care Indeed client in her 70s, lives east of the San Francisco Bay with her husband, who still works full time. Before being afflicted with congestive heart failure, peripheral neuropathy and some paralysis, Charlotte had held a distinguished role as a law firm manager; worked as a quality-assurance specialist; and put in 22 years of volunteer service. Known for her keen intellectual acuity and perceptiveness, Charlotte possesses a strong emphasis on competence and dependability.
Early internal evaluations, however, positioned Charlotte as a complex client characterized as "fussy," "difficult," or "The Queen." At the same time, mismatched caregiving assignments led to serious problems such as Charlotte nearly falling more than once.
To address these challenges, I went back to the beginning with a revised client-assessment process that better helps clients feel heard, respected and, ultimately, better cared for. As a result, I realized Charlotte's mis-assessed mobility challenges were at the heart of the caregiving problem, rather than any of her personal attributes.
Including steps for routine monitoring and follow-up, our revised care plan produced excellent results.
*All client and caregiver names have been changed to protect privacy.
4
Systemic Deficiencies Identified and Resolved
3
Near-Falls Eliminated
2
Ideally Matched Caregivers Assigned to Charlotte
1
Integrated Care Model Reengineered
How I Approached This
My approach isn't theoretical. Before I recommend anything, I immerse myself in the day-to-day reality of the environment.
My approach isn't theoretical. Before I recommend anything, I immerse myself in the day-to-day reality of the environment. Favoring observation and conversation over preliminary records, my direct immersion in Charlotte's setting gave me a detailed understanding of her capabilities, background, and unfulfilled requirements, even as my approach highlighted inconsistencies in the existing care procedures.
My Immersion Reflection
Mobility Misclassification
The protocol in place said caregivers needed to lift Charlotte when she wanted to move from, say, her bed to a chair in her breakfast nook. This so-called "full lift" approach had already led to three near-falls, including an episode where a caregiver who wasn't a strong physical match compromised her stability. At the same time, I observed how Charlotte's substantial upper-body strength meant she could use a walker to transfer herself from one place to another, as long as a caregiver was standing by in case of need.
Caregiver Readiness
Two caregivers had been found dozing during shifts, which stemmed from unaddressed fatigue and scheduling challenges. This highlighted the importance of screening not just for availability but for alertness, professionalism, and the capacity to remain fully present, especially with clients who depend on attentive support.
Understanding the Person Behind the Label
My interaction with Charlotte also revealed that she wasn't as "difficult" as she'd been labeled. She simply needed caregivers with the best skills for her situation. When behaviors seem troublesome, I realized, it may mean the care plan needs restructuring for a better match between clients and caregivers.
Ideal Caregiver Alignments
This was clearly the situation with Charlotte: everyone involved was satisfied once Maria and Cindy, two attentive and initiative-driven professionals who foresaw needs, began working with Charlotte according to the revised protocol for her individual care needs.
Transforming Challenges into Improvements
Based on my immersion, I developed these strategic modules to address the specific gaps and opportunities observed.
Protocol Revision and Monitoring
The amended care protocol clarified "Standby Assist ONLY" when Charlotte used her walker to go from one place to another. The near-falls stopped.
Onsite Validation
We began requiring care managers to observe client transfers within seven days of a new or revised care plan, promoting appropriate levels of care and foundational trust.
Improved Caregiver Evaluation
We began placing caregivers with clients based far more on our evaluation of their physical proficiency, initiative, and ability to relate to and connect with clients, rather than on availability for a given time slot.
Standards for Professional Conduct
We revised our caregiver core competencies to include respectful household behaviors, such as conveying appreciation and sustaining concentration.
Introductory Trial Protocol
We established a one-day preliminary trial for new caregivers to reduce mismatches and unease.
New Caregiver Benchmarks
With a nod to Charlotte's new caregivers, we began using the "Maria & Cindy Standard" as we recruited new caregivers, targeting candidates with innate curiosity and proactivity.
Results & Impact
We revised the care protocol within two weeks, and then began to notice a variety of benefits for Charlotte, her caregivers, and all of Care Indeed.
We improved safety and eliminated fall hazards
Onsite validations became standard for complex cases, helping to increase accuracy and rapport
We refined our evaluation protocols, leading both to better client-caregiver matches and diminished staff turnover
Our staff mindset shifted to view client challenges as improvement opportunities for us, not personal shortcomings
Charlotte's case has emerged as a pivotal educational reference at Ask Vanessa on how to elevate care from transactional to transformative