When I tell folks that I am a social worker working for an elder law attorney as the firm's Elder Care Coordinator as often as not I get the deer-caught-in-the-headlights look. There is nothing typical about a social worker working for an attorney nor is it typical for a law firm to incorporate care coordination into its practice. Just listing Elder Care Coordinator job responsibilities seems to fall a bit flat. I am attaching the ECC description that we share with clients of Elder Law of East Tennessee. However, what I really want to share with you is a description of what I do and how I am able to offer assistance from the moment someone first contacts Elder Law of East Tennessee.
It is my job to talk with callers about their situation and to determine if ELET is the right fit for their particular needs. The moment I start speaking with folks I am using my knowledge about the practice, my accumulated expertise in senior services, and my clinical skills. The caller may have thought they were calling to schedule a time for legal consultation, but soon realize they have a supportive and knowledgeable professional on the other end of the line. Folks are often so glad to have the opportunity to talk to someone who really understands what they are dealing with that the initial call may end up lasting a long time. That is okay. ELET is a firm that is all about meeting care needs. As an Elder Care Coordinator, I provide support and care as much for the family members as I do directly for the older adult.
When clients and their families come in for their initial consultation visit, the phone contact has gone a long way toward establishing a warm relationship. Informal assessment starts during the two hour consultation where I carefully listen and observe. Every family is different. Relationships are complex. Needs vary. I start forming a potential care plan and a method for successful implementation right then. Families leave the consultation relieved they no longer have to manage the complexities of care coordination alone and on top of all their other life responsibilities. Whether the worries relate to getting more in-home care, transitioning out of the home, understanding how Medicare or Medicaid works, working out transportation issues, developing strategies for safe medication administration, decreasing the risk of wandering, resolving problems between and among all sorts of health care or service providers, I can help.
Once ELET has been retained, I visit the older adult where they live, observe how they function in that environment, gather more information about their support system, learn about their care preferences, obtain relevant medical records, etc. I have many conversations and take as much time as needed to be sure I understand the family system carefully noting strengths as well as where there might be weaknesses. I see my ECC role as one that can bring in extra services or provide education to fill in where there are gaps or shore up where I fine stress and strain. I don't see my ECC role as "taking over" care responsibilities or displacing existing systems that are working well. However, I will help clients and families look realistically at their situations and try to avoid problems that can reasonably be anticipated.
People's lives are fluid. Things change. Sometimes my "value" to clients and their families is helping them decide when is the right time to make a change in where the client receives their care. It is a decision that is difficult both emotionally and logistically. It can take time and skill to find a solution that everyone can agree on. Even after a client is transitioned from home to another care setting it will take a while to work out details and to develop a level of comfort in the new environment. I offer as much support and assistance as needed.
Over the course of the relationship between ELET and clients, I am always available to address changes in care needs as they arise. I stay in touch with families by phone or email. I make routine monitoring visits to the older adult's place of residence. If the client no longer lives in their own home, I review charts and talk to facility staff to ensure the client has the highest quality of care possible. If the client still lives at home, my visits help gauge functioning and safety. I work closely with everyone involved with the client's care to update the care plan as often as needed. Families know I am available any time they have a concern or question. It is a real joy to know that families don't have to worry that they are "missing" something or that they have to totally rearrange their own lives around the care needs of their loved ones.
So, what does it mean to be an ECC? It means wearing a lot of different hats-all with caring and professionalism. It means becoming a part of a family system. It means partnering with clients to find as good a fit as possible for their care needs. It means being an advocate with health care system professionals. It means being a broker with other senior service providers. It means being creative and flexible. It means being sensitive and sensible. It means always thinking about the best interests of the client first. It means the family can breathe a sigh of relief and put on a smile of satisfaction because they know the care their loved one is getting is the best in all aspects of their care!
At Elder Law of East Tennessee you will always get advice you can trust and the care you deserve.
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