5. Getting a Premium Package of Services in a Short Time

Lesson

Sometimes the family is devoted but just cannot take the time to attend to any of the caregiving duties, even the small ones. They want someone competent to take this over. They truly understand the professional nature of the service, and appreciate it.

Background

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This story is about Martin Freeman, an 87-year old man who lives in Brooklyn.  I was contacted by his daughter-in-law, Cathy, who called after he had been admitted to the hospital, having just had a stroke.  Prior to the stroke he had been independent and was living in an assisted living residence in Brooklyn.  His family consists of Cathy, her husband Steven, who has a son and Martin’s sister, Helen, who lives in the mid-west.  Because Steven is a very busy lawyer and Helen is an equally busy professional, Cathy was given the job of solving the homecare problem for Steven’s father.

Cathy questioned me about my experience and made it clear from the start that they’re looking for someone to be involved in a big way, who is going to be responsible for every aspect of things that come up.  That has included many different things.

The first step was that she checked my references.  Within a few days, she told me, “OK, he’s going to be discharged soon.   We have nothing set up.  We have no idea what we’re doing.  We need you to come to the hospital and give us your professional opinion about what we should do about every single aspect.”

That consisted of meeting Mr. Freeman, but also talking to all the different staff people at the hospital who were providing different services.  That meant the primary doctor, the neurologist, speech therapist, occupational therapist, physical therapist, social workers, the nurse’s assistant and the head nurse.  Cathy is very thorough.  It’s not to say that it is essential that every family use me to talk to every single professional involved in the hospital care;  the family often is content to do that themselves.  This family did some of it on their own, but clearly wanted me to hear what all the professionals were saying, and offer some on-the-spot feedback, not only to the family, but to these professionals.  I was to serve as their advocate.  All that went very well.

At this point, I was not yet retained, but I knew this was sort of an audition, and if they weren’t pleased, they would have stopped everything right there.

Steve’s Role

Cathy told me, “OK. Steve I’m impressed, but I have to talk to Steven and Helen and tell them this is what we did so far.”  And then she calls back and says that Steven and Helen want to talk with you. Once we did the conference call, they were reasonable, very receptive to my ideas, to my assessment, to what I had seen at the hospital.  So we talked about the practical things that we needed to do for the discharge home which was going to be three days’ later.  So, in three days time, I had to put together a team of homecare workers that were going to be held under very close scrutiny; the standards were going to be very high, and that if they didn’t perform, it was going to be my fault.

So I said to the family, there’s a wide range of providers of homecare and, obviously, there’s a wide range of costs for homecare.  I’m going to give you the range; I’m going to give you each one and you’re going to tell me which way you want to go.  And I determined pretty early on that they were going to go with the high range, the high end, and I was pushing that because I thought their father would require that.  I knew it was going to be a very difficult situation because there are a lot of things [going on] and there’s a lot skills that the workers have to have in view of the family’s needs.   They agreed and they appreciated the level of detail and clarity in helping them choose which of these ways they were going to go as far as where the homecare workers were going to come from.

I then contacted a company specializing in high-end homecare providers; told them these are the parameters; this is when he’s going to be discharged; this is what has to happen for this to work.  “You guys will get your fee if you come through with these very good workers in this very short period of time.  And I have to meet them in person.”

In fact, we didn’t have time for me to meet everybody before, but we worked it out so that they found all the people, but there wasn’t time for me to meet them because he was already being readied to go home.  I spoke to them all on the phone, and I determined which one I wanted to be the primary person, based on my initial assessment, and it turned out to be correct.

And then we met at the hospital, but I met the aide before we went up to determine if this was going to be the person and I still felt confident about them.  The family knew that this was the best that we could do in view of the short timing they had provided me with to pull this all off.

Outcome

So the outcome of this story is not only does he have good care, from these homecare workers within an assisted living environment.  The other major part is the medical care.  There is a doctor for every part of the body; the most recent ones were a psychiatrist, a neurologist, a cardiologist, a pace-maker doctor, and a primary doctor.  I accompanied him to these doctors, got their instructions, and worked with homecare workers to make sure they implemented the doctors’ instructions correctly, while also conveying the instructions to the family, because they want to know all about his treatment plan.

This case is an example of what might be called the Premium Service of Elder Care NY.   It’s Premium because of the price and the totality of it.  In most cases, the family deals with their relative’s doctors.  In the “premium” service, I take care of the doctors, the homecare, making sure that they have all the supplies that they need, making sure the medications are being disbursed properly. We have recently added some perks like a musician comes once per week and plays for a half hour, which Mr. Freeman loves. Also we have found an outstanding physical therapist who has made an impact that the previous ones were not able to do.

I offer this level of service when it seems appropriate, but I don’t push it.  People seem to know and want to do it themselves, so I really don’t say you should do it with me.  I tend to look at their level of stress and say “It looks to me like it would be really helpful to you for me to take over some of these things.”  So part of the offering is based on the observation of need.  It’s nice when the family comes right out and says “We need it; we know we need it; this is what we want you to do.”


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