I Am A Care Manager And This Is What I Do

«She is my eyes, ears, hands, and feet. I am disabled.» That is how Joan, a weak but feisty 89-year-old, described my work to a nurse at the assisted living facility (ALF).

Joan developed brain cancer after melanoma metastasized. Following rehab from brain surgery, she was admitted to hospice. She moved into the ALF while her home, a quaint 1940’s lakefront ranch, needed to be made safe for her return. Her husband had died years ago and her only child, with whom she had a strained relationship, lived out-of-state.

Cancer with its sequela of side effects, compounded Joan’s age-related poor eyesight and debilitating arthritis in her hands. Each new painful ailment pushed her further away from autonomy and dignity. My job was to close those gaps.

An empathic approach helped me build a trusting rapport with Joan as she lay in her hospital bed at the ALF trying to gain control over what would happen to her home. As I got to know her better, I became more aware and was able to assist with some of her unspoken emotional needs too.

She is my eyes, ears, hands, and feet. I am disabled. That is how Joan, a weak but feisty 89-year-old, described my work to a nurse at the assisted living facility

Joan was a wealthy, well-traveled, intelligent, proud woman who had struggled privately as she became overwhelmed with household work. Upon opening the front door to her home, I surveyed her struggle. Critter droppings dotted the carpets. There was a large crack between the wall and ceiling. Ants crawled on garbage bags. Food in the refrigerator was spoiled and most dry goods had expired long before she left for the hospital. Dirty clothes were discarded on the floor in untidy piles. Closet doors were either jammed shut or open with the contents spilled out. The smell in her bathroom, indescribable. I wrote all the obvious chores and concerns in my notebook during the walkthrough and later prioritized them at her small antique desk.

The next day I began tackling my arm’s length to-do list. My first hire was a housekeeping service to organize the clutter, do the laundry and give Joan’s home a deep cleaning. Carpet cleaners worked tirelessly to bring the dirty carpet back to its neutral color and remove the musty odor that had settled into its fibers. I reinstated garbage services and had the overfilled cans parked at the curb every Monday morning, rain or shine.

Looking outside through the lake facing windows in Joan's home, I saw that a picturesque waterside sanctuary had emerged after landscapers groomed the overgrown lawn and redefined the perennial flower beds. Inspired, I added plants and other decorative touches inside to achieve the same sense of serenity I felt outside. When winter arrived, I hired a company for snow removal and kept water trickling in the faucets.

In addition to managing the issues at her home, Joan began asking me for other help, such as:

• buy and deliver a box of chocolates to an acquaintance

• research a piece of her family history online

• compare senior cell phones and teach her how to use it

• Google answers to her on-the-fly questions about historical events and people

• locate where to buy a special face cream from France

• purchase soft clothing so she could dress herself

Joan fell at the facility and stayed at the hospital for a week before returning to the ALF. Her questions became more medical in nature and were beyond my skill set. The hospice nurse was not around as much as I had hoped, and the ALF was short-staffed. I talked to Joan about hiring a private nurse advocate. I knew someone from my network who would be a perfect match. Joan unenthusiastically agreed, but to my delight she and the nurse advocate met two days later and bonded instantly.

I talked to Joan about hiring a private nurse advocate. I knew someone from my network who would be a perfect match. Joan unenthusiastically agreed, but to my delight she and the nurse advocate met two days later and bonded instantly.The nurse advocate took over visits at the ALF while I focused on renovations at Joan’s house.

We collaborated on Joan’s care plan and her transition home, but sadly it did not happen. Major repairs were necessary to make it livable and time was not on our side. Joan’s health deteriorated quickly. While Joan paid me to help her with the necessary overhaul at her home, I volunteered my time many evenings to read articles aloud and tell her stories after she lost the ability to talk. Dying at the ALF was not what Joan wanted, but with our support she was able to accept the reality of the situation.

After her death, my tasks changed to clearing her room at the ALF and assisting the executor with preparing the house to be sold. While I could not transition Joan home, I know that I helped to make her final weeks of life at the ALF more dignified and less lonely. Throughout our time together, Joan and I got to know one anther. We shared smiles and laughter. I know she would be overjoyed that the decisions she made for work to be done at her home increased its value which resulted in a larger memorial donation to her favorite charity.

Joan is not her real name, of course. Identifying details were also changed in this narrative to maintain privacy.