Intensive Care Management for Survivors with Limited Family Involvement
As Survivors age, they rely more heavily on children and local family to organize and supervise care, and to help with day-to-day issues that arise. When there are no children, sometimes there is no one that the Survivor can depend on to help.
In Project for Holocaust Survivors financial assistance program alone, we have counted over 75 Survivors who have no children. In response to this very great need, Partners in Strength developed an intense case management program of weekly or bi-monthly visits by a social worker to help these Survivors safely maintain themselves in the community. The caseworker acts as an adopted niece and regularly visits to help with advocating with landlords, by monitoring home-care help, and by assisting with mail. She sets up doctor appointments and follows Survivors through hospitalizations and back to their homes. In times of medical crisis, the caseworker will research to see who the best treatment team is, and will use Bikur Cholim’s pull to get an appointment– occasionally even accompanying the client to a procedure when it is necessary to come with a “family member.” The caseworker brings groceries when it’s icy out and drops by before holidays with flowers to let these special seniors know that they aren’t forgotten. The case manager holds things together by finding out who may be in the client’s circle of care and can be called on at times – whether a kind neighbor, a distant relative in another state, or a caring doctor.
With Parkinson’s, early dementia, and low vision prevalent in this group of Survivors who are mostly in their 80’s and 90’s, continuity of care is not just a kindness. Having a helpful “relative” to rely on makes the crucial difference in an elderly survivor being able to stay at home, where he/she feels secure and most happy.
From our case files:
M, a program social worker, visited 92 year old Mrs. L, a homebound Hungarian Survivor with poor English, the day after she was discharged from the hospital. Mrs. L told M that she was given new medicine there, which she was to take along with her existing medication. M called a pharmacist to make sure that this was ok, and discovered that Mrs. L had been about to take double the dose of a strong medicine – both the name brand and the generic together, which could have seriously harmed her.
Ms. S is 84 yr old Holocaust Survivor from Czechoslovakia who never married. Y, her social worker, went to visit for the first time. Ms. S hadn’t picked up her phone when Y called to confirm the appointment time, and no one answered the door when she stopped by. Y asked neighbors if they had seen Ms. S and they hadn’t, so she went to Ms. S’s former place of work years ago and discovered that Ms. S had been hospitalized. She headed to the hospital and found that Ms. S was about to be discharged home against her will. She was requesting rehabilitation in a local nursing center to recover her strength, but was told that her insurance wouldn’t cover it. Y and other Bikur Cholim staff worked together to pull some strings with the local nursing center and arranged for them to admit Ms. S to recover under an exception to the insurance policy. Y continues to visit now that Ms. S is healthy again and back in the community.
Mrs. B, an 89 yr old Polish Survivor, has macular degeneration and Parkinson’s, and requires full time help. During a private meeting with her social worker E, Mrs. B confided that her normally kind aide was becoming rough and impatient when Mrs. B needed help in middle of the night. Of course, this was affecting the aide’s own sleep, and Mrs. B didn’t know how to address the issue. E sat down with the aide and Mrs. B and spoke about the normal progression of Parkinson’s and how it makes it difficult for Mrs. B to turn over and get up at night alone now. E talked about how hard this must be for the aide and also for Mrs. B who didn’t want to bother the aide’s sleep. Together, all three talked about some creative solutions for managing the source of the problem, including the use of a pulley system or hospital bed, or having time for the aide to nap in the day. This conversation let the aide know that her behaviors were being observed by someone on the outside, but in a gentle and supportive way. Mrs. B and her aide have resolved this issue for now, with a bit of outside help. E continues to monitor the situation with regular, private visits with Mrs. B.