As each day passes, we age. Our joints wear down, eyesight fades, we fatigue more quickly, we find a few more grays, and maybe the number of medications and supplements we take grows a bit longer. We may witness similar progressions in our loved ones. With any luck, these changes evolve gradually, and we learn to live with the little hurts. The bottom line is aging is a fact of life but living through it with acceptance takes different levels of patience and grace.

For most of my case management career, my clients' age ranged from 65 years and up. They were older than me and I could not always appreciate the challenges they faced because they were not relatable to my life experiences. Oh, how things have changed! Now, amid our own challenges, I truly wish I understood sooner so I could have been a more effective and empathetic case manager. Over the years I developed a process for working with my aging clients. Rather than launch into a massive initial assessment, I focused on things that were of immediate importance. It seemed to work well until faced with having to apply it to myself.

Not unlike what we all do, I ask clients about the most important thing in their life. It could be taking care of a partner or a beloved pet, remaining in one's home, going to a grandchild's graduation, wedding, or other milestone event. I ask what gives the person's life meaning. For me, it is helping my husband maintain independence and safety at home. I did not appreciate the gravity of such queries until faced with events that elevated their importance on a personal level. We lived through one crisis (e.g., a stroke) but when I faced unexpected, major surgery, we realized how close to the edge we were. As stated during a particularly stress-filled day, "We are one banana peel away from a catastrophe." We quickly understood that maintaining safety and independence was a shared primary goal, but striving to accomplish that goal was a moving target.

Getting an assessment underway helped me to paint a picture of each client's disease process, knowledge needs, and challenges in day-to-day life. I enjoyed those conversations and prompting each client to talk about the things they already noticed as becoming more difficult (or impossible) to manage. I especially liked hearing about the ingenious ways in which each of them rose to the challenge by adapting life to their limitation. Pointing out successful adjustment(s) helps people realize they were already part of their solution rather than the victim of their circumstance. This was one of my favorite techniques aimed at gaining a foothold of mutual respect and trust.

In our home, this acknowledgment has been an ongoing struggle. Both being headstrong individuals, we tend to overlook the adjustments we've already made. Posing the same questions to ourselves proved a frustrating exercise in truth seeking. We both recognized the inherent difficulty of honest introspection. It forces us to face our mortality in the context of a collective desire to remain independent. This was no longer just someone else's problem; it was our reality.

When considering the cumulative impact of health challenges, the little adjustments made along the way are easy to ignore but they should not be overlooked. Each one, no matter how seemingly basic, is a triumph in one's quest to be functional and autonomous. If I neglected to identify these things with a client, I missed an opportunity to build their self-confidence. Failure to acknowledge our personal hard-fought victories did a disservice to our spirits and feelings of accomplishment so naming the little wins became a routine part of our conversations.

Another essential part of my approach was to address crisis planning early on in an engagement. For example, procuring a continuous glucose monitor (CGM) instead of relying on finger-stick readings often arose. A client's insurance posed a stumbling block but eventually the barrier was overcome with persistence and seemingly unrelated documentation. For one person, I submitted visual acuity test results as part of an appeal for an upgraded meter featuring audio readings. The logic being that when someone could not accurately read their meter, they could not safely or properly care for themselves. I soon applied a similar argument to procure a CGM for my spouse. Initially denied, the appeal noted that he only had use of one hand and included a picture of the permanently bruised fingertips. In this case, a picture was worth a thousand words. While it took a couple weeks, his plan finally acquiesced and approved the meter.

Another potential emergency was that of choking hazard. Teaching a client to self-Heimlich was a standard intervention for those living alone; teaching a partner was another hurdle entirely. Some were clearly incapable of safely performing the maneuver, whether due to size differential, their own infirmity, or another reason. Getting accustomed to a wearable medical alert device was essential. Though some were initially resistant, most accepted my recommendation as we continued building a trusting relationship. Highlighting the little victories I mentioned previously informed the desire for autonomy; ultimately, each accepted that wearing one was for the best.

These measures may seem routine to some of us, but I did not fully appreciate the profound impact of asking a loved one or caregiver to be prepared to apply the Heimlich until I had to do so on my own spouse. After realizing he was choking, calling 911, and simultaneously applying the Heimlich, I was instantly at a DEFCON 5, red alert status. I had no confidence in my own effectiveness because of a recent surgery; however, the inevitable adrenalin rush worked miracles. It has taken weeks to process and decompress from the events of that morning. In the aftermath, I realized that what I had asked people to do carried an immense pressure of being someone else's lifeline. I no longer consider this as just another intervention in a case management plan and it is not only about correct technique. It took a personal, lived experience to comprehend the implications asking someone to be ready and able to apply the Heimlich Maneuver to a loved one. It took a different level of preparation to include a discussion about the potential for a post-traumatic stress reaction which might occur after having to actually use it.

Presently, my husband and I are evaluating continuing care retirement communities (CCRCs) as part of our journey to remain safely independent. I walked through a similar process with clients but now the decisions are our own and our list of questions are on point with addressing our needs. I've learned that there is neither a threshold nor ceiling indicator of when and what additional support may be needed. We struggle to project many factors to the best of our abilities, but we just do not know with certainty what we might need in the future. I have a much better understanding of the myriad factors influencing such an evaluation process and feel better prepared to support the next client walking through this phase of life.

There are so many examples of these themes, but at the end of each day, we have all aged and will continue to do so until such time as we transition. We have borne witness to the progression of time in our clients. While cosmetics and procedures may make the external changes less noticeable, there is not one person among us who escapes the inevitable. Going to battle with or ignoring the aging process is a grave error because it is only when we face facts without the aid of rose-colored glasses, that we can sincerely and gracefully embrace whatever may befall each of us. We may live with little or big hurts, but ultimately, aging is a fact of life. Living authentically, with acceptance, takes new levels of patience with oneself. I just wish I had learned these lessons earlier in life so I could have better supported some of my clients.