When 81-year old Jack had a stroke, he was hospitalized for several days and then discharged to a rehab facility. His two sons scrambled to figure out next steps. Could their father return home as long as he had some help? What kind of help would he need? What were their options if he couldn’t live alone? They had no experience with the elder care system and it all seemed rather overwhelming.

You may have been in a similar situation if you’re a caregiver for an aging loved one. Often there are important decisions that have to be made about medical treatment, housing options, finances, and legal issues. If it’s the first time that family members have been in a caregiving role, they may not be aware of the resources available. Fortunately, a geriatric case manager can provide guidance, support, and practical recommendations to help families and their aging loved ones with all aspects and challenges of aging.

As a geriatric case manager with a nursing background, I’ll first do a complete assessment of the senior’s physical, medical and mental health status, functioning, safety needs, social circumstances, and environment. Then I’ll develop a care plan that addresses the senior’s needs.

For example, in Jack’s case, I helped his sons locate a reputable home health care agency to assist Jack with meals, bathing, laundry, shopping, and housekeeping when he returned home after rehab. The care plan also included simple home modifications, such as the installation of grab bars, to make Jack’s environment safer. In addition, I referred Jack and his sons to an elder law attorney as they wanted to review his advance directives. Once Jack’s services were in place, I monitored his care and kept his sons informed of how things were going.

A care plan is like a roadmap but it changes as circumstances change. When Jack’s health began to fail and living at home was no longer an option, I located a facility that could meet Jack’s needs and assisted the family with the transition.

Families often contact me when a senior is in the midst of a health crisis and they’re unsure about what to do. But even if your aging loved one is not in crisis, putting a care plan into place can save time and help you and your family members avoid stress later on.