Rona S. Bartelstone, LCSW, MSW, CMC Senior Vice President of Care Management

George, 95 and single, was facing the loss of his two closest relatives and friends. He didn't think he could survive these overwhelming transitions, but with the help of his Care Manager he continues to thrive despite his grief.

In less than three years, George lost his brother-in-law and sister. They were a very close family that traveled, socialized and finally settled as a trio in Florida. Apart from his sister and brother-in-law, George had few friends.

The brother-in-law was the first to die, and George became depressed because he and his sister, who had dementia and functional limitations, depended on him. The brother took care of his ailing wife, cooked, shopped and paid all the bills. He also had a great sense of humor, which helped everyone to cope with their stressful caregiving responsibilities. Although there was an aide to help with the physical care of his sister, George felt incapable of supervising her care.

George could hardly eat and could not stop crying. He was overwhelmed by his grief and anxiety.

Fortunately, an attorney, who was serving as their trustee, contacted SeniorBridge (formerly, Rona Bartelstone Care Management & Home Healthcare) for support. During the initial home-visit it was determined that George needed counseling and an antidepressant. And, it was recommended that his sister have 24 hour home care to assure her physical safety and wellbeing. This began immediately and quickly gave George some relief.

With weekly emotional support from Sandy Goldberg, the Care Manager, George began to eat and his depression was helped by the medication. Sandy also provided support and guidance to the aide in caring for his sister.

Unfortunately, the sister's dementia worsened and she was beginning to have some behavioral problems. She fell and fractured her hip and shoulder. After six months in a rehabilitation facility, she passed away.

To help George through this acute new phase of grief, the Care Manager provided additional support. She worked with the physician and a psychiatric nurse to adjust his antidepressant medication. An appetite enhancer was also added to ensure that George was getting enough nutrition.

With the support of his medical health care team, the Care Manager and the aide, George was able to cope with the loss of his sister without becoming ill. He knew he was being well cared for and had a sense of stability with the care and emotional support that was being provided. This time, instead of becoming immobilized, George was able to participate in making the funeral arrangements for his sister and helped to discard the belongings of his sister and brother-in-law.

George still has home health care from his trusted aide. He functions better and more independently now, including taking responsibility for his own medical appointments. He continues to find the support of the care management relationship a stabilizing influence in his life. In fact, he and Sandy have a great rapport which provides him with a feeling of having a surrogate family—something he desperately needs for his mental health.

George is a perfect example of the power of the care management relationship in times of loss and transition. This relationship has enabled him to remain as independent as possible, to reside in the community and to cope with his losses.