‘Til Death Do Us Part- Care
Management for Aging Couples
Helene Bergman, LMSW, MA
Geriatric Care Manager
Elder Care Alternatives, NYC
Presented at New England Chapter NAPGCM
Geriatric Care Management: The Complexities of Caring
April 4, 2005
Workshop Objectives:
1) Identify issues unique to Care Management (and caregiving) for an elderly couple when both individuals are
physically and/or cognitively impaired.
2) Identify and understand the family dynamics that exist
when both parents (or loved ones) require substantial care.
3) Create a Care Plan to address the functional needs of
each individual and the emotional needs of the ‘couple’.
Primary Issue
Self Determination
Autonomy vs. Protection
Hypothesis:
A Care Management Protocol for an infirmed
elderly couple significantly differs from that
designed for a single elder.
*How
*Significance of Issue
Meet Three Elderly Couples
Mr. & Mrs. G
Mr. & Mrs. D
Mr. & Mrs. P
Mr. & Mrs. P
Married over 50 years.
History of dysfunctional marriage w/alcoholism
She (S) 75 w/borderline personality disorder, OCD
and dementia (AD w/Korsakoff syndrome) and
paraphasia; violent and aggressive; under IBW;
hypersexual; beautiful
He (J) 80 w/post stroke (HTN, s/prostate Ca)–
memory loss, disoriented to time, mild paranoia,
depression w/psychosis; passive aggressivenarcissistic, controlling and manipulative; tightfisted
*Neglect of Medical Issues- no medication
compliance
*Home environment- chaos and clutter
*Family System- Closed boundaries w/distrust;
sons w/sibling issues; emotional closeness;
functional distance
*Social withdrawal-no friends, no neighbors, no
activity
*Safety factor-crises w/violence, police,
hospitalizations
*No advance directives; no LTC plan
*Assets- about a million.
What are the similarities among these elderly
couples?
1.
2.
3.
4.
5.
6.
7.
8.
A couple with a long term marriage and a commitment to be together.
Two elderly clients with direct care needs and diminished cognitive
capacity (dementia or depression) to make decisions on their own
behalf.
One elder with more medical needs and the spouse with more
advanced dementia.
A couple known to either a hospital, nursing home or community
agency.
Recent history of chronic crises.
Co-dependency of the elders to maintain status quo and sabotage a
Care Plan.
Adult children who are aware of the crisis but feel impotent to make
change. Strong Denial and Resistance!
Adult children who are suffering the emotional loss of two parents at
once.
The Differential Assessment
 The Marital Relationship









Barriers to Care (Environmental/Human)
Risk Factors (Safety, Security, Medical)
Legal Issues
Financial Issues
Home Care
Home Environment
Family Dynamics
Social Support
Change Factor
Care Plan Options
Maintain the couple at home with adequate
supports
 Relocate the couple to a supportive
environment with adequate supports
Separate the couple and relocate each to an
appropriate environment with adequate
supports
What happened to?
• Mr. & Mrs. G
• Mr. & Mrs. D
• Mr. & Mrs. P