What is Care Consultation?
Before I began working primarily with older adults, I worked in a residential treatment center for the chronically mentally ill. I started as a counselor and worked my way up to Program Coordinator, and for a time, Executive Director.
Our approach, at the treatment center, combined the distinct but complementary contributions of 30 staff members. The staff was highly educated, and I could count on each of them highlighting their particular ideas and contributions. My challenge with this talented but diverse staff was not like herding cats — that would have been easier — it was more like conducting an orchestra where all the members thought that they should be featured soloists.
It made sense that staff members would promote the considerable skills and knowledge that they’d taken years to acquire, however, no single staff member’s skill or approach was allowed to dominate the treatment. There’s a proverb which states that when all you have is a hammer, the whole world looks like a nail, and occasionally I needed to remind staff members that the residents weren’t nails and that staff members weren’t hammers. Rather than letting a narrow approach dominate, I favored promoting the benefits from the wide repertoire of the staff.
Making use of my repertoire of experience, rather than restricting myself to a narrow approach has, in the long run, served me and my clientele. When I took over the position of Director of Care Management at Elderhealth Northwest in Seattle, I had an extensive background in working with elders in various settings — in nursing homes, mental health clinics, and in home health. I had, however, never been a care manager so I set out to learn what this new role would encompass. If I had taken my title of care manager, literally, as if care management was my only tool with which to assist elders and their families, I would have followed common practice: I would have put care in place and assumed the role of ongoing care manager. However, it became clear that many of those referred to me were more interested in consultation than in my taking over the management of the care. Assuming an advisory rather than management role allowed me to use the considerable repertoire of skills and knowledge that I had acquired in various settings.
It’s said that crises are opportunities for change and, soon after I joined Elderhealth, I was given lots of those opportunities. Elderhealth had obtained a contract with the Crisis Clinic of Seattle, and I would be the provider of those contract services. My responsibilities to the Crisis Clinic would set me on a course to develop what I’ve come to call the brief therapeutic approach to care consultation.
Requests from the Crisis Clinic for my services almost always included the following: (1) An elder was at the center of the crisis, but it would be the caregiver who would receive the direct service. (2) The crisis typically consisted of an overwrought family member who had been providing care to his or her parent or parents and was feeling overwhelmed. (3) Often the elder or elders refused to hire part-time help to spell the caregiver. The caregiver and elders had frequently come to these circumstances through a frog-in-the-pot scenario — they began helping with a few tasks, and eventually became regular caregivers. (4) The crisis, as I would come to view it, was a systemic problem, a situation that included, at the least, the elder’s immediate family members. (5) Finally, Crisis Clinic referrals usually involved families with limited funds (my services, with an approximate 10-hour limit, were paid by the clinic), and I had to help these clients with a solution and move on. I would not be managing the care.
Given the above circumstances, with Crisis Clinic referrals, using one tool, care management, was not possible.
Here’s how I approached these cases:
After gathering information by phone, I would meet with the referred caregiver. I then typically proceeded by asking that all involved members (usually but not always, the adult children) come to a meeting (or meetings). Commonly, the elder(s) did not take part in the meeting(s), because they were either cognitively impaired or, in what would be unacceptable for the caregiver, they were outright unwilling to entertain any changes. If they could afford it, resolution included hiring ongoing professional assistance for the elder. If they could not afford it, resolution required getting help from other (usually) family members.
My services to Crisis Clinic clients comprised of advising elders and their families on care options.1 I did not make decisions for the family, and I was not involved after the initial agreement.
A care manager might look at the above description and conclude that I was doing care management. But, according to the definition, that a care manager oversees care, that is not the case. A family therapist might look at the above situation and believe that I was doing family therapy. But family therapy is working with conflicts within the family in order to benefit the lives of all involved, because that is usually the best way to resolve the presenting problem. Unlike with family therapy, care mediation sessions involve adults who most often don’t live together; hence, familial conflicts are relevant in only how they directly affect the client, that is the elder. Care consultation includes elements of both care management and family therapy, but is a distinct approach.
In my work with the Crisis Clinic I found that, rather than making decisions for the families about care, I would consult and advise, and let the family members make their own arrangements. One of the arrangements the family might make would be to hire me to oversee the care longterm, that is, take a role as care manager; sometimes I’d advise that and sometimes I would not, but instead refer the client to outside services. As I expanded my vision from care management to care consultation, I learned to view the client in terms of their needs rather than in the narrow terms of what care management alone has to offer.
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1 As the many categories and sub-categories on AgingWellNet.com illustrate, there are an enormous number of care options and they must be combined appropriately for each client. Matching care to the client is done by both care consultants and care managers. However, as a consultant, while I assess the care needs of the client, I do not hire the particular service providers; rather, I guide the clients’ families (or other involved members) in making careful choices.
For more on Care Consultation:
What’s the Difference Between Family Therapy & Care Mediation
Training the Care Consultant & Care Mediator
