Meet Emily Saltz , LICSW, CMSC (Founder and Director, Elder Resources, Elders.com). She is a bundle of energy, misses no small detail, and when you talk to her she seems to listen with her whole being. It’s not surprising that Elder Resources, which she founded in 1993, is one of the longest-running and highly-respected private geriatric care management services in the Northeast. Saltz, a social worker by profession, is steeped in this work and understands the mechanics of the health care system just as well as she grasps family dynamics and the distinct needs of elderly people. It’s easy to imagine how Saltz’s compassion and humor help families navigate the uncharted territory they face when assisting a family elder.
I wondered aloud, “How do people end up on your doorstep? Are there usual incidents or events that prompt people to pick up the phone and call you?” “Yes.” Saltz responded decisively. “People typically call us when they are in crisis. We wish they would call sooner. They often call when they have noticed an alarming physical or cognitive decline in their loved one, during an elder’s hospital stay or after a fall.”
Saltz explained that people discover Elder Resources and similar groups around the country by word of mouth or a referral by doctors or attorneys. Anyone can call or go to the website of the National Association of Professional Geriatric Care Managers (NAPCGM) at www.caremanager.org and find a nearby Geriatric Care Manager.
“Why don’t families reach out sooner?” I asked. “Is it a financial burden? Denial? Or that most of us want to handle the situation on our own?” “All of the above,” Saltz answered, “plus, as a profession, we’re not as known as we want to be. Geriatric Care Management is the best kept secret in the health care system. People simply don’t know about us….until a crisis. Then, when they search for support, they are likely to be pointed in our direction. And even then, geriatric care management is not reimbursable under insurance.”
The lack of public awareness and financial limitations constitute two stumbling blocks. But Saltz also talked about the ways in which family dynamics and relationships exert an impact on adult children and their elders. “Families don’t talk enough,” Saltz said. “Many parents and their children do not have the kinds of conversations that lead to long-term, thoughtful planning. Most of us avoid talking about caregiving and end-of-life issues until we’re in the middle of it. When family members finally do reach out for help, they often feel terrified or paralyzed.” The denial has lifted and the situation can seem daunting.
At Elder Resources, the preliminary assessment serves as the basis for decision-making. One question facing so many families is whether a person can continue to live at home or not. I asked Saltz if she and her team are always able to answer that question. “Yes,” she answered. “It’s clear immediately… though not always after the first visit; we make several home visits, providing a professional, objective evaluation that takes into account the elder’s cognitive, physical, and emotional domains. When completed, we make recommendations that involve choices and options. We arrive at a conclusion by doing a comprehensive assessment and listening closely to the expressed wishes of the elder as well as the strain on family, siblings’ relationships with each other and relationships with the parent. The competency and decision-making capacity of the elder is central. We come away with a solid impression. In all that, one important goal is to honor the elder.”
Another important part of the process, according to Saltz, is to get past “no”…an answer that can bring progress to a halt. If, for example, an elder wants to stay at home but does not want strangers in the house, and family members cannot provide daily assistance, then all participants are asked to help resolve the deadlock…to work together to get past ‘no’. Saltz added that the elder’s ability to accept help can make a difference as does his or her network of support in the community and from friends and family.
Not surprisingly, as we age, many of us want to stay in the familiar and comfortable environs of our own home. According to Saltz, mobility and access typically prevent people from being able to continue to live in their homes. She noted that relatively simple modifications can sometimes enable an elder to stay in his or her own home. For example, while a $5,000 stair lift seems exorbitant, it might ultimately provide the key to providing at-home care. Saltz added, “People can’t stay at home when they need more care than they can afford. At this time, the only place elders without assets are guaranteed to receive 24/7 care and supervision is in a nursing home. There are few publicly funded programs that provide 24/7 care at home for low or moderate income elders.
Saltz and other geriatric care managers assist people during a sometimes tumultuous stage of evaluation and transition. Families are in turmoil and sometimes in conflict. I wondered what kinds of family conflicts she most frequently encounters. “Anxiety is heightened,” Saltz said, “and if family members shared conflicted former relationships, they generally don’t get better with added strains. Kids might attribute (past) motives to parents that are no longer true. And as a rule, the more kids in the family, the greater the conflict…there are simply more opinions to take into account.”
“The adult child/parent dynamic is complicated,” Saltz explained. “The parent isn’t your child.” Saltz repeated the advice that families should talk more to avoid strain…that they share conversations about the future, and plan ahead. Saltz said that she has observed parents and children who come together in positive ways to support the parent’s new needs. “They reach a greater level of intimacy and love,” she said. “It can happen.”
Eileen Lyons, Director, Custom Elder Care Research & Development