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Parent Care
Geriatric Care Managers
The Solution For Long Distance Elder Caregivers
News Alert – Long Distance Caregivers Rejoice!
There is an underutilized resource in the healthcare profession that long distance caregivers need to know more about – geriatric care managers. A geriatric care manager (GCM) can perform many of the responsibilities that you are now doing (or not doing), and more importantly will perform them as a qualified healthcare professional. Their mission is to positively impact an older adult’s overall health and well being.
A GCM can significantly reduce the amount of time and stress that you now experience as a long distance caregiver. A GCM will not eliminate all of your responsibilities but perhaps can do even more by easing your burden, reducing your stress and providing you hope.
The quality of my mother’s life has benefited significantly from the services of a GCM. It just happens that in addition to being her daughter, I am also her GCM. The more important role will always be that of daughter, so sometimes the objectivity and effectiveness of my GCM role succumbs to my emotionality or what seems intrusive to me as a daughter. This is my GCM story.
History
My mother is 87 years old. She is what I called charmingly confused but oh so charming. My relationship with my mother has blossomed as she has aged, as to have the myriad of responsibilities that I have assumed for her.
My mother’s first downsizing was from the San Francisco family home that I knew since sixth grade to a one-level, first-floor condominium in the suburbs close to 20 years ago. Since then she has lived in a senior complex that provided both independent and initial level assisted living services, a higher level assisted living complex, skilled nursing facilities and in my home.
In the Home
For most of the time my mother lived in the condo I would have described her as a fully functioning senior in the community. Although she needed little support at this stage, for many of you your parent’s first level of care assistance might be an aid in the home for 4 hours a day, a couple of days a week. Managing these activities, as described below, is one of the primary activities of a GCM.
Fast forward this story to last year. I moved my mother into my home when she fractured her pelvis several months after having hip surgery. I coordinated the home health and rehab services provided under Medicare, monitored her recovery, key health metrics and response to medications, identified changes of condition and interacted with her doctor. I set-up private duty aid services that commenced with 24/7 care. Although working with private duty aid companies, I was still involved in selecting, terminating and managing aids, managing aid schedules and following up if an aid did not arrive when expected. I also ensured that the cooking, laundry and food/supply shopping was taken care of and that the house was kept clean.
At the Doctor
When my mother moved to the suburbs, I provided recommendations of new doctors. This exercise has repeated itself several times since. The doctor role then expanded into coordinating visits including set-up, reminder calls and transportation. Next, I began accompanying my mother to these appointments and soon thereafter I became her patient advocate. I made sure that all the doctor’s questions were answered completely, that all symptoms were reported correctly, and that I fully understood the diagnosis, its implications and the recommended treatment. I also processed drug prescriptions.
Evaluating Alternative Living Situation
After residing in her condo for several years, my mother started asking about alternative senior living situations. We discussed the pros and cons of the various ownership structures and I provided some recommendations. She chose to move into a senior community that provided both independent and some assisted living services on a rental basis. I visited the community on numerous occasions and at various times of the day to validate my sense of the community, its offerings, and the people that lived in it, worked in it and ran it as well.
In Assisted Living
While coordinating and assisting my mother with her move, I remember thinking it came none too soon. A move frequently becomes an eye opener to the reality that lies just below the surface of life. Just one look at her refrigerator and I knew she would certainly be getting a more nutritional diet.
Just as the move gave me insight into aspects of my mother’s life that she was not managing as well as before, it also allowed me the opportunity to help set-up her new life, particularly the physical environment – less cluttered, no rugs laid on top of the carpeting and appropriate lighting.
After a short period of independent living, I quickly triggered her first “move” into assisted living services - medications management. When my mother exhibited more pronounced signs of physical decline, the next “move” was for bathing and laundry services. At this point, I started processing her mail and managing her finances.
With more regular visits, I observed evidence of increasing dementia and mobility issues. Unfortunately, I was not able to convince my mother to not wear sunglasses while she was walking down the hallways and she fell and fractured her hip.
This triggering event also triggered a change in living situation. At this point my mother’s care needs were greater than what could be appropriately handled where she then lived. Upon discharge from the hospital, I moved her into what I considered then to be the best skilled nursing facility in the county. That environment met her needs until an ownership and management changes caused a significant decline in the quality of care provided and another move was triggered.
After my mother’s next hospitalization, I selected an assisted living community that could accommodate people with higher level care needs. In this environment as my mother’s health declined, managing her hospital recoveries and infections due to leukemia took a greater focus.
At The Hospital
Over the last ten years there have been countless hospitalizations. As her patient advocate, I have managed issues related to emergency room intake, history and treatment; hospital in-patient treatment, surgery and recovery; hospital discharge and selection of discharge facility, transportation, and home health and rehab services. Because my mother is now unable to use a call button or communicate her needs, I have personal aids assisting my mother even while she is in the hospital. All of the duties involved with management of aids in the home also apply here, plus modifying their activities to the hospital environment.
In a Skilled Nursing Facility
My mother is currently at end of life and now resides in what in my opinion is currently the best skilled nursing facility in the county. Although this is a medical model of care, my mother needs additional assistance because she is non-ambulatory and is unable to feed herself, use a call button, or communicate her needs. Just as the level of care that is provided in hospitals has declined, so too has the level of care provided in skilled nursing facilities declined. Similar to when my mother is in the hospital, I observe, report and monitor her medical and personal needs on a daily basis and at specified care management meetings. In addition, I perform all the duties related to managing her personal aids, plus modifying their activities to the skilled nursing environment.
Major Decisions
As my mother has aged, I have become increasingly involved in major decision–making for her. In most of these cases, a geriatric care manager would provide a referral to the appropriate professional.
- Long-Term Care Insurance - One of the first things that I did after completing my gerontology program was recommend that my mother purchase a long-term care insurance policy. This has turned out to be one of the best financial decisions I have made on her behalf.
- Advanced Health Care Directive – I assisted my mother in understanding the protections of an Advanced Health Care Directive, in completing the document, and in executing and notarizing the document.
- Legal Documents – I have ensured that appropriate legal documents were in place and current such as financial power(s) of attorney, trust(s) and will.
How Can A GCM Be of Help to You?
All of what I have just described can be performed by a GCM, referred out by a GCM or managed by a GCM. My mother’s history covers a wide range of situations but everyone’s story is unique.
So What Can a Geriatric Care Manager Do for Your Parent and You?
Whether you use a GCM on a long-term basis, for a short term incident, to obtain the perspective of an objective experienced professional, to validate your thought process regarding an upcoming decision, or to facilitate a family meeting, these all are valuable services. Some would even say invaluable because in consulting a health care professional you have the peace of mind of knowing that you did the best that you could for your parent.
Your Role
Yes, I am a geriatric care manager and in that role I have positively impacted my mother’s physical health and well-being. But the most significant impact that I have had on my mother’s life has been as her daughter. It is in that role that I have provided the emotional support and love that cannot and should not be delegated to a professional surrogate. It is a role that has required my time – the most precious resource that I have - to bring joy to the increasingly less time that remains for my mother.
With a GCM you can reduce the many burdens and stress of long-distance caregiving and delegate responsibilities to a healthcare professional best capable of performing those specific duties. It will then allow you more time for the role only you alone can perform. It is in that role that you will find the greatest joy.
May your life be filled with no regrets;
May you see the ordinary in the extraordinary; and
May someone be there to brighten your world as you age.
Esther Koch
About Esther Koch
Esther Koch is a gerontologist, geriatric care manager and eldercare advisor. Her firm, Encore Management, provides personal and corporate advisory services and seminars that assist Boomers with the range of issues associated with caring for an aging parent and their own aging. Her media interviews and articles have appeared on television, radio and in print. For more information about Encore Management visit www.encoremgmt.com.
The following background information is provided to further your knowledge of geriatric care managers and the services they perform.
Professional Background and Experience
Most GCMs are health and human services professionals with experience in aging and eldercare who have degrees in gerontology, nursing, social services or psychology. They may or may not have specific care management certification. If certified, the likely certifications are CMC - Care Manager Certificate or CCM – Certified Case Manger.
Services Provided
The key services provided are (1) geriatric assessment and care planning, and (2) service referrals, coordination and monitoring. The core foundation to the work that GCMs do is the geriatric assessment and care plan. GCMs work with older adults and their families to create a plan of care that meets the needs of the older adult. The core activities that a GCM performs, which are the core benefits perceived by the long-distance caregiver, are in the referrals, coordination and monitoring of services derived from the foundation of the assessment and care plan.
GCM services generally relate to care in the home and are for long-term services. It is this long-term care management that should be of particular interest to long-distance caregivers.
Depending upon a GCMs background and experience, GCMs might also offer a varied range of services including assistance with: evaluation of alternative living facilities (assisted living, skilled nursing); qualification for governmental assistance programs; and court appointed conservatorship services.
Geriatric Assessment
The first step that a GCM should perform, and you should want them to perform, is a comprehensive geriatric assessment. This is a multidisciplinary evaluation of an older person’s overall functioning abilities in the social, economic and physical environment that they live in.
The geriatric assessment starts with a personal history plus a medical history covering both physical and mental health. The core of the assessment relates to an individual’s ability to function on a day-to-day basis. Actual observation is a very important component of the assessment process.
A thorough geriatric assessment should cover the following:
Personal History
• Medical History
° Physical Health
− Medically Diagnosed Conditions
− Prescription Drugs
− Substance Abuse
− Nutrition
° Mental Health
− Cognitive
− Behavioral
− Emotional
• Functional: A variety of assessment tools would be used to address the range of an individual’s abilities to function on a day-to-day basis in the following areas:
° Activities of Daily Living
− Bathing
− Dressing
− Transferring
− Feeding
− Toileting
− Continence
° Mobility
− Gait and balance
− Fall risk
− Fall history
− Adaptive equipment
° Sensory
− Hearing
− Vision
° Instrumental Activities of Daily Living
− Telephone Use
− Shopping
− Meal Preparation
− Housekeeping
− Laundry
− Driving Ability
− Medication Management
− Handling of Financial Matters
° Cognitive Status
° Psychological Status
− Depression
− Anxiety
• Social Supports
• Home Safety
• Economic Resources
° Financial
° Insurance
• Legal Affairs Status
Care Plan
The care plan will document each of the problems that come to light through the assessment process and recommend specific interventions. The solutions developed should be tailored to the older adult, their social support system and their financial situation. Since generally GCM services are contracted on behalf of the older adult by a family member, buy-in from all parties involved will be necessary to ensure success of the plan.
A care plan generally includes the following sections:
• Presenting Problem
• History
• Functional Assessment
• Psychosocial Assessment
• Medications
• Care Plan Summary Recommendation
• Detailed Care Plan on a problem by problem basis with associated interventions
Referrals, Coordination and Monitoring
These are the key ongoing activities of a GCM. Frequently it is the GCM who will implement many of the recommendations in the care plan, particularly those involving the identification of appropriate service providers and the coordination of their activities.
The GCM monitors all designated activities on a 24/7 providing continuity of care and ensuring that the services desired have in fact been appropriately supplied. Monitoring will be performed as required- daily, weekly or monthly. A written report is usually provided monthly.
Business Models
There are two primarily business models of geriatric care management:
- The integrated model where the main business is providing care workers and geriatric care management is either provided as core to the management of these care workers or is offered as an additional service.
- The stand-alone model where geriatric care management is the only service offered.
How To Find A GCM
The best place to find a GCM is through the official website of the National Association of Professional Geriatric Care Managers, www.caremanager.org. The search is by zip code or city and state and a defined radius from that location.
Cost
GCM usually charge for their services on an hourly basis. Fees currently range from $75 - $150 per hour.
Primary Sources: Handbook of Professional Geriatric Care Management, Second edition, by Cathy Jo Cress 2007; National Association of Professional Geriatric Care Managers www.caremanager.org.
Published March 2007
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