Remember that elderly patients have accomplished a lot. They’ve worked their entire lives, raised families, and made contributions to society. Case managers should show them the respect they deserve, says Robert McQuillan, MHA, NHA, associate vice president of LIFE Geisinger/skilled nursing facility operations in Pennsylvania.
They’re frustrated that they can’t hear well, understand all of your instructions, or move as quickly as they used to, and losing patience with them will only make the situation worse, McQuillan adds.
Recognize that the elderly find their situation hard to accept, suggests Alexis S. Early, LMSW-IPR, ACM-SW, transitional care social worker at the Dallas-based health system. “They are accustomed to taking care of their family and being independent. Now, they are sick and they have to depend on others. Maybe they can’t afford their medicine or can’t pay their utility bill and purchase the medicine at the same time. It’s hard to ask for help, especially when it means letting a stranger inside their world,” she adds.
Case managers should treat elderly patients as they would their family, suggests John Gutzwiller, BS, RN, managing consultant for Berkeley Research Group. Spend more time with them and give them a chance to get to know you and communicate with you. Pull up a chair and talk to them.
Case managers should sit down and talk to patients on their level. “If you stand over the bed and talk down to them, it’s disrespectful,” he says.
As people age, they lose peripheral vision, says Michelle Moccia, RN, MSN, ANP-BC, Senior ER Center program director at St. Mary Mercy Hospital in Livonia, MI.
She recommends that when clinicians come into senior patients’ rooms, they make sure they are in the patients’ line of sight. Go over to their beds and make sure they can see you while you speak. Then, talk in a normal tone of voice instead of yelling.
Moccia points out that older patients are not able to absorb information as quickly as younger people and they may be slow in processing it. “When I talk to seniors, I pace myself and give them another few seconds. I know that if I ask older patients to turn on their side, they might not be able to do it immediately,” she says.
Don’t let elderly patients languish in bed watching television and napping all day, Gutzwiller suggests. “Make sure the physical therapy evaluation is completed as soon as possible and that nursing is ambulating the patient regularly. Make sure they spend part of the day sitting in a chair and ambulating to the bathroom as their condition allows,” he says.
Talk to patients who live alone and get the name of a trusted neighbor or church member, and ask them to be involved when the patients are discharged, Early recommends.
Suggest an arrangement with a neighbor to signal when there is a problem, Moccia suggests. For instance, turn on the porch light or open a curtain at a certain time of day so that if it doesn’t happen, the neighbor will know there may be a problem.