When Miriam came to Israel, she practically ran the Jerusalem-based assisted living facility she moved into.
“She organized lectures for the English-speaking residents; she ran a movie night; she was even doing some writing for the facility. My mother was a businesswoman by profession and a go-getter by personality,” tells her daughter Orli.
From the beginning, Miriam needed help from Orli and her sister, both living in Israel. “Our mother doesn’t speak any Hebrew, so she always needed help navigating the medical system – hafnayot, hitchaivuyot – we had to take care of it all.”
As time went by, Miriam, who suffers from lung disease and needs oxygen regularly, became more and more dependent on her daughters for daily help.
Then, two and a half years ago, Miriam’s health took a severe downturn and she ended up in the ICU for weeks. “We thought she wasn’t coming out. She had a DNR and we were ready for the end.” Orli and her sister took turns sitting with their mother and clearing out her apartment. They tried to prepare emotionally for what seemed inevitable.
But then Miriam pulled through. She was released from the hospital with nowhere to go. “She couldn’t move back into her apartment and live independently. She did not want to go to the nursing ward in her old facility. She had visited people there and refused to live there; she found it ugly and depressing. She also didn’t want to come home with either of her daughters. So we needed to find her a new place. Fast.”
Orli and her sister found their mother an aesthetically beautiful nursing ward, with private room and balcony, in a different residence. It was almost a three hour drive away from Orli, but she and her sister assumed that in light of their mother’s deteriorating health, she wouldn’t be there for very long, and it was imperative for Miriam to be in a place where she felt comfortable.
Then, Miriam defied the odds. Again. She got stronger and stronger, until one day she got out of bed with her walker, decided she didn’t want to be in the nursing ward anymore, and signed a lease for an independent apartment in the facility!
“She didn’t discuss it with any of us,” Orli says. “But I went to gather all the furniture we had distributed from her old apartment, and bring it up to her. It was exhausting. I’m sandwich generation, and I run two businesses. But just like every other time, I went to great lengths to make sure my mother never felt like she was a burden and never understood the depth of the time, effort and angst we had to put in to make sure she had everything she needed.”
Orli drove six hours round trip to Miriam’s new home, twice a week. She managed medical appointments and medication. She coordinated which papers went to which office and when. She ran this schedule for two and a half years, never letting on to her mother the physical, emotional and financial toll it was taking on her.
“In retrospect,” says Orli, “it was a mistake to hide the truth. My mother thought she was independent, but she wasn’t. She didn’t understand how my kids, my business, my health and my marriage were suffering – not because she was being narcissistic or dismissive, but because I hid it!”
And then Miriam was hospitalized for a second time. Again, the family prepared for the end, and again, Miriam rallied. When it became clear that Miriam would be going home, Orli and her sister spent a month trying to set up the support Miriam would need at home, attempting to navigate bureaucracy to get a foreign caregiver – and failed.
In desperation, Orli’s sister posted a call for advice on her neighborhood email group – and someone suggested B’Lev Shalem, a Senior Care Management company.
“We called, explained the situation, and Rachel came to the hospital immediately,” Orli tells. “It was fantastic. They came and put their arms around me and said, ‘Don’t worry. We’ve got you.’ And they did. They guided us 100%.”
One of the biggest reliefs to Orli was the ability to let go of the role of caregiver. “We were then in crisis mode only as daughters rather than caregivers. It was a world of difference.”
What is a Care Manager?
A Senior Care Manager, usually a nurse or social worker who specializes in geriatrics, is a sort of “professional relative”- a specially trained professional who helps seniors and their families identify aging-related needs and piece together ways to meet them. Most importantly, a Care Manager is an advocate, ensuring that seniors get the support they need and deserve. Senior Care Management has been around in the U.S. for more than three decades – in Israel, however, the profession is in its infancy, so there are no professional standards or certifications to help you assess the Care Manager’s qualifications, experience or ability.
Here are some tips on what to look for in a Care Manager:
1. Knows how to work the healthcare system
The healthcare system should be working to help you. Unfortunately, it often feels like you need to chase, pester, cry and batter down the barricades before you get the help your parent needs – and sometimes it’s not clear where the barricades are.
Look for a Care Manager who has significant experience at navigating the healthcare system serving your parent – at communicating, advocating and following-up.
“When Rachel came to the hospital, she literally took me by the hand and walked me down the hall and helped me delay my mother’s discharge to give us time to get something in place. She knew what to say; she’s fluent – not only in Hebrew but also in the culture, the terms and the expectations of healthcare system.”
B’Lev Shalem’s Care Managers were able to get Miriam seen almost immediately by an English-speaking geriatric doctor. “They know the system and they know how to advocate. They’re able to track down the right doctor and make them talk to you,” shares Orli.
If your parent has complex medical issues, it’s certainly a plus if the Care Manager had direct experience dealing with those specific issues. Practically, however, the experience working the system and knowing how to get to the right medical professionals is more valuable and effective in getting appropriate, timely care.
2. Can navigate government bureaucracy
Orli and her sister tried for a month to get permits for a foreign caregiver for Miriam – to no avail. Then B’Lev Shalem’s Care Managers stepped in.
“Rachel ran around like crazy getting us a foreign worker. She did everything. I was exhausted, sick, upset. I don’t even know what she did but she solved it. My mother now has a foreign caregiver living with her.”
Look for a Geriatric Care Manager that has a track record of successfully navigating government bureaucracy to get the client’s needs met. Additionally, he or she should be knowledgeable about all senior benefits available through the different governmental and non-governmental organizations and how to get them.
3. Fluent in languages spoken by you, your parent and your parent’s country of residence
Your parent’s Care Manager will have three critical points of contact where communication is key.
First: you. You need to be able to communicate naturally and fully with the Care Manager. It’s important for giving him or her a complete picture of your parent and family’s needs. Additionally, a major reason for bringing in a Care Manager is to take an emotional burden off you. In order for that to happen, you need to be fully heard and understood.
Second: your parent. For a Care Manager to best help your parent, they need to develop a close, trusting relationship. It’s very difficult to do so unless you can establish fluid communication.
Third: all the systems in your parent’s country of residence. In order for your Care Manager to get your parent the best care, he or she must be able to communicate effectively with all parties: doctors, medical secretaries, hospital staff, Bituach Leumi clerks, foreign caregiver agencies… everyone!
If your parent lives in Israel and you all speak Hebrew fluently, that’s easier. But if you or your parent are most comfortable in English, Russian, French, or Arabic, a Geriatric Care Manager fluent in those languages may not be just “a nice thing” – it may be mission critical.
4. Not affiliated with a particular facility
A Geriatric Care Manager should be your agent, your representative. He or she should be looking out for the good of your family and only your family.
Care Managers who are affiliated with any particular system, be it a nursing facility or a hospital or anywhere else, may be helpful in some ways – but keep a sharp eye out. Especially when it comes to a conflict between your interests and the interests of the facility they’re engaged by, the end result may not be in the best interest of your parent.
If you can find a Care Manager who is independent of any system or facility, you’ll be assured that their loyalty is to your parent.
5. Can facilitate healthy communication between you and your parent
Because Orli had painstakingly hid the drain caregiving had placed on her time and finances, her mother was reluctant to invest in help from a Care Manager. “She thought she didn’t need help because she didn’t realize how much help I was giving.”
Kaila, Miriam’s B’Lev Shalem Care Manager, empowered Orli to be honest with her mother about how hard the situation has been and the toll it was taking on her. Although it wasn’t easy, Orli is so happy about the outcome. “She had to understand how difficult this was for me in order to accept the help. I had to admit that I couldn’t do it. It allowed us to become mother and daughter again, not caregiver and the one who needs care. We were able to re-assume our family roles. She realized that she was indeed dependent. It was a milestone for us.”
6. Respectful of your parent – and you
Unfortunately, it is all too easy to see a dependent individual as someone whose say doesn’t count, and who needs decisions made for them. We object to this perspective in principle – and we’ve also seen that practically, you get better cooperation, better treatment and better results when you truly respect the individual you work with, regardless of their level of dependence.
“Kaila treats my mother as a whole individual. She doesn’t patronize her. She is the client. And Kalia doesn’t just take care of my mom – she takes care of me, of the family as a unit.”
7. Caring, compassionate and committed
You would hope that anyone who goes into the profession of Geriatric Care Management has these three qualities in abundance. But you can’t take that for granted. You need to make sure it’s there.
“Because we were in crisis, we didn’t do a standard intro and care plan. Rachel and Kaila just got to work immediately. They didn’t ask for one penny up front. When we were in crisis mode, I asked about payment and they deferred it – we hadn’t even paid them and they worked for us for a month! They trusted us and prioritized my mother’s care over the fees. Only when things calmed down did we sort out payment and work out a Care Plan.”
A Care Manager should be invested in the health, happiness and relationships of your family – and you should feel that emanating from them.
“Rachel and Kaila care,” says Orli. ”They care about me and they care about my mom as if they’re our family.”