We’ve all seen it – seniors (and/or their families) in denial about the post-acute support they will need to be successful at home. Readmissions goals are only part of the story – it is frustrating as professionals to see the same senior AGAIN. So how do we as professionals help seniors balance optimism with reality? How do we help them take the steps that will enable them to be successful at home? What can be done during the discharge process to overcome denial and affect the outcome?
Lifesprk pulled together more than 45 health, senior and financial services professionals recently to discuss this topic and identified the top 5 tips that move seniors from denial to action.
- Discover the root of the ‘denial’: It’s critical to first understand what is causing the ‘denial’ . . . and determining whether it is really denial. In fact, in most cases, the senior and/or family is not trying to be obstinate, difficult, or naïve.The underlying cause is often one of several main drivers for human behavior. The first is ‘fear’ – fear of the loss of independence, control, or changes. In other cases, people may just be naturally optimistic or stoic, and may not fully understand the depth of support they will need at home. Others may not understand or even know all the options for in-home or community-based support. And families may worry about taking away their loved ones’ hope or being seen as a ‘failure’ because they couldn’t care for their loved ones without outside help. That’s why the first step with any client and family should be to ask questions to fully explore their current situation as well as how and why they may be reluctant to accept help.
- Engage clients by focusing on THEIR goals and desires: It may sound simple but questions related to what’s important to the senior and his or her family as well as about their specific life goals, not just health care needs, are crucial to successfully engaging the client and family in the post-acute care plan. These questions go beyond just exploring their care needs to get to the crux of what really matters to the senior and family. Ask them: what do they see themselves doing once they recuperate? What activities and interests are important to them? What are they willing to sacrifice and what aren’t they willing to sacrifice?These answers will provide the base for ‘why’ the post-acute plan is important as well as insights for building a successful ’whole person’ plan. Beth Nemec, Lifesprk Director of Navigation, shared her experience with one senior: “I asked him what was most important to him and he pointed to the cat. ‘Okay, then let’s build a plan around that . . . keeping you with your cat.’” Most professionals agreed that focusing solely on care needs was not as effective as engaging the person in his individual goals.
These questions, which Lifesprk calls a ‘discovery,’ are essential to helping us as professionals to see the experience through our clients’ and families’ eyes. It may involve ‘stepping out of our own box’ as one senior care professional put it. According to Atul Gawande, we often want safety for those we love and autonomy for ourselves. So look at the situation through your clients’ eyes and ask whether the options we are providing support the clients’ autonomy or just their safety.
- Ensure clients understand all their options to make an informed choice: People want to understand all their options including the option of doing nothing. While our professional recommendation may be for a specific option, people have the right to understand what other less or more restrictive options exist and what may happen with each of those. Beth often paints a picture of each option – ‘here’s the level of support you can expect with each and here’s what would happen in certain scenarios.’At the same time, while sharing the spectrum of options available, be careful not to abdicate your professional responsibility. All of us have an obligation to help our clients identify the best options with the best outcomes using evidence-based care to empower them to make an informed choice. We must play the role of the “quarterback” who helps them understand their individual medical situations, learns their unique needs and wishes, and helps them identify the resources that will match most effectively with their goals. Medicare regulations and professional standards enumerate our obligations as coordinators of care to reduce fragmentation and to serve as guides for our clients to help them find the best fit options for them.
One professional shared: “I’m in health care and I had expected the health care system – someone – to tell me ‘Now is the time for palliative care’ and no one did.” Another shared her own experience being on the other side of a hospital discharge for a loved one: “I am a care manager and I had no idea how much was left to the family to figure out on their own.”
- Use stories to illustrate how clients can be successful at home: We learn through stories because never cease to engage us. More importantly, stories help show – rather than tell – why particular options are effective and what they can mean to our clients. If you face challenges getting people to accept certain aspects of their post-acute care plan, take some time to review your messages and develop a success story related to that recommendation, including why it worked and how it helped people achieve their individual goals.Stories can also be useful for immersing clients into scenarios they may face: ‘Okay, how would you handle this situation?’ Several senior care professionals stressed they often ask clients to demonstrate specific activities of daily living and other skills they will need at home to function independently. Many use the phrase, ‘Let’s hope for the best, but plan for the worst,’ to engage the client and family in planning for different scenarios they may encounter.
- Provide step by step recommendations over time: People in the midst of a health crisis are often overwhelmed and just want life to be normal again. To overcome reluctance, try focusing on just the first goal to help them achieve an initial success that is important to them – perhaps toileting independently. While this small goal may be tied to a larger goal such as volunteering at the library again, it provides concrete steps the client can take now. More importantly, it gets her moving forward with some action versus no action. Then once that goal is accomplished, focus on the next goal. If you are not able to follow the client throughout this post-acute period, connect them with long-term support and guidance that can help them focus step-by-step on incremental goals.
Engaging our clients and their families in their post-acute care plans is our single most important objective. The best care plan in the world is no good if no one follows it.
We want to hear from you too. What have you found successful in moving senior care clients from denial to action?