ARTICLES / General /
Partnering with a Care Manager /
By Rona S. Bartelstone, LCSW, BCD, CMC
Caregiving is never easy and it takes many
people to provide the appropriate support
services for all. Traditionally, we think
of the physician as the point person for primary
care. However, with all of our medical
advances, most diseases have become chronic
illnesses that require a range of health,
social, emotional, environmental and physical
services in addition to medical care.
Since the health and social service systems are
fragmented and difficult to navigate, private
care management has evolved to create a
partnership that guides families through the
This partnership between the care manager and the
family facilitates the coordination of appropriate
care at the appropriate time, in the right setting
and in accordance with the preferences and resources
of each situation. What a colleague of mine
calls the “Goldilocks” approach to individualizing
care for each situation. Rather than trying to
describe the partnership between the family and the
care manager, below is an actual situation that
resulted in assuring that the care recipients were
well provided for, the family was given peace of
mind, and the doctor had someone who could assure
that his plan of care was actually being implemented
in the home.
One Family’s Story
Mr. and Mrs. Chasser (not their real name) were
faced with multiple care decisions as they were
living in South Florida away from their family and
beginning to deal with long term care needs.
They were a worldly couple who had saved enough
financial resources to meet their needs in
retirement. They had done some traveling and
were now content to stay at home as they began to
experience some physical and cognitive changes.
Mr. C was 82 and relatively healthy, though he
was beginning to experience some memory loss.
For this reason he had asked his wife to take over
the daily money management. Mrs. C was 80 and
had a heart condition for many years. She
began to tire more easily. She also had some
osteoporosis that caused discomfort and limited her
ability to walk long distances.
Mrs. C was also becoming increasingly anxious.
She remembered her mother-in-law’s “senility” and
feared this was happening to her husband. She
had never had to be responsible for money
management, investments or legal issues and did not
know what she would do if her husband lost his
ability to handle these needs. On the other
hand, she was afraid to ask him to teach her because
he was very sensitive about his memory loss and she
did not want to upset him.
After a trip to visit their grandchildren, Mrs. C
experienced a stroke that caused her to become very
weak and she lost her language. Although she
was expected to regain some of her mobility and
speech, she would never be as active again.
While Mrs. C was in the hospital and rehabilitation
center, Mr. C realized that he could not manage at
home alone. He was unable to take care of the
shopping, meal preparation, laundry or housekeeping.
He also had difficulty dressing himself because his
wife had always laid out his clothes for him.
He became very frightened and began to knock on the
neighbors’ doors at all hours of the day and night.