6- A care giver and also one who can help obtain Caregiving Services for the older adult who is not able to continue to take complete care of themselves. The case manager may need to go beyond the normal expectation of care giving to the older clients/patients as some may need assistance that will be more than full time.  The case manager may need to help find resources to care for the older individual 24/7. Often the family of the care recipient provide the needed care. The estimate is that 85% of the caregiving done for older adults is done by their family, despite the prevailing myths that Americans do not take care of their loved ones. Of those who provide this service, about 85% of them are women.

       Many older adults are in need of assistance from others, most notably the eldest daughter. Termed the "Sandwich generation," this care-giver may be in her own retirement years  with parents in their 60s through their 90's. Even though family ties are considered important to our society, the strain of "going it alone" in these situations can emotionally harm both the care-giver and the

parent.  Reaching out for help is important, and helps strengthen

family ties. These adults take on the responsibility of caring for aging

relatives, and find themselves 'sandwiched' between the older

generation and have younger relatives to care for at the same time.

Many of these caregivers also report some conflict between their

work and caregiving responsibilities.

     Hayes (1984) identified four major stresses faced by caregivers.

They include:

 1) Feelings of isolation, and being forced by other family members to accept the  caregiving responsibility;

2) Changing of family roles and disruption of family routines;

3) Lack of ability to make a distinction between caring for and curing the elderly person; and

4) Feelings of helplessness at not being able to help improve the elderly person's health.

7- A community planner who helps the local government to understand the issues of older adults. In Bushy’s (1997) article on case management in rural settings, community size makes an important difference on how case management can be done with relationship to the local government. In a rural setting, unlike most urban settings, the case manager will be known in their non-professional roles such as with regards to their family, church, buying habits, recreational pursuits and the like. She suggests that it is even more important for the rural case manager to be heavily involved in the community than for the urbanite.

      This is true, she comments, due to “rural decision makers, in some cases, have been more anti-welfare, mistrustful and less amendable to having federally supported services programs.” She says that they “…can hinder effective case management.” She suggests that rural governments often think that the family matters should be left alone and remain private. Working in volunteer capacities within the rural community may help break down some of those barriers. 

      In more urban settings, it is not unusual today to find voluntary groups being created by the local government. This writer is a member of the Davis County Aging Board which exists to help meet the needs of the older adults by coordinating efforts between various levels of government (from the federal, state, county, and city levels).  Boards such as these are often forgotten by the case managers as a resource to advocate for the elderly and as a sympathetic ear for local changes in rules. If a situation comes to our attention that a rule is stopping and effective elderly program, we may have the ability to get that rule changed, thus removing a roadblock to efficient case management.

8- A consultant to help other professionals and the client work together with better understanding,  whether living in their own home or in a care facility. One area that is often overlooked is that of the spiritual lives of the client/patient, yet this is an area where case managers need to be cautious. Canda and associates (2004) showed through a qualitative study of social workers that there are ethical pitfalls in working in this required area. People do have spiritual foundations, whether that is through organized religion or not. In fact, the word worship simply means to give worth to something. What ever a person values, they give worth to and it becomes something important to them.

      In the United States, religious pluralism is the norm as many people live out the American dream not recognizing that the Protestant Work Ethic is directly Calvanistic doctrine. The people who may “knock on wood” usually do not recognize that it springs from animism. Many of the holidays came from Holy Days of various religious beliefs.

       So spirituality is a part that the case manger must be aware and in tune with when dealing with the client/patient (especially so with the older generations). Yet the case manager must not create a dualistic relationship; one that would have the client/patient treat the case manager as a member of the clergy.  Canda and associates (2004) show that this is one area that human services workers need more guidance in. There is very little education or ethical specifics to help professionals deal in this realm. The article suggests the use of the author’s previous work (Canda and Furman, 1999) which is a framework they suggest to guide helpers in the spiritual area of the client/patient’s life.

       As a retirement planner for 21 years, this author has often dealt with older individuals and their other professionals, although rarely with their medical professionals. There are a host of areas that are better accomplished with a coordination of professionals. Some of them are: medical, legal. Tax, and their savings and investments. To try to help older individuals deal with professionals, this author wrote a small chapter in his book (now online) on how to employ professionals, not just obey them. The information can be found at: http://www.collegestudy.org/makingthemostofretirement/id13.html

     Older and younger adults process information somewhat differently and
 
problem solving differences are also abundant when time demands are short.
 
Linda Lui, (2003), completed a literature review of decision making

processes based on age and identified problem solving patterns. She

suggests that younger adult's tend to "...rely on a variety of cognitive

short cuts or heuristics."

      Less clear in the literature, due to less being less studied, is the
 
older person's pattern in decision making. Current studies, however, do 

suggest that older adults do fairly well in remembering familiar tasks but

may have difficulty in problem solving for new information due to declines

in working memory.