Geriatric Care Managers

by Jan Simpson

Once upon a time, families and extended families more often than not lived within a few blocks of one another, close enough to keep an eye on the needs of the young and old alike. Today, siblings tend to stretch out across the country if not the world, juggling children and jobs, elders, siblings, and spouses. When an elder parent or older loved one needs help, some families decide to hire a geriatric care manager to sort through options for short- and long-term care (home care or respite care) or housing needs (assisted living, nursing homes, retirement communities).

To learn more about geriatric care managers, I spent a morning with Meredith Patterson who has been an elder care consultant for 22 years. Meredith is a full member of the National Association of Professional Geriatric Care Managers (NAP-GCM), one of a handful of their Fellows nationally, and previously the National Chair of the Standards and Ethics Board.  We met the morning following the death of a client; she had been awake since 4 a.m.

I  posed three questions:

1. Why and when would someone hire a care manager? Geography and Medical Status

Families often seek professional advice on how to best manage home care or the transition to a care facility for more complex medical concerns. Care managers often know and have relationships with all of the housing choices in a geographic area .They also are connected with a community of social workers, nurses, psychologists, elder law attorneys, and other elder care professionals who many be of assistance. Beyond advice, some families, separated by distance from their loved ones, may use a care manager to supervise their loved one, but this option is expensive. Geriatric care managers may charge $ 50-175 per hour or more.

2. How would one assess the skill of a geriatric care manager? Credentials and Experience

To my surprise, geriatric care managers are not certified and have diverse experience, education, and backgrounds. Many are licensed in state as nurses or social workers. Before hiring a care manager, ask about their education and certification. Meredith is a licensed social worker, an MSW, LICSW and CMC. Look for full (not associate) membership in the National Association of Professional Geriatric Care Managers, and at least one of four certifications that require testing and continuing education (CMC, CCM, C-ASWCM, or C-SWCM).

Finding a care manager whose personality suits your family is important, but more important is his or her experience and knowledge of the specific issues your family is dealing with. Determine how long the care manager has been providing services and explore areas of expertise. Meredith has experience in neurology, which may explain why nearly 80 percent of her families have a loved one living with dementia.

3. What services do care managers provide? Advice and Coordination of Care

Some care managers are sole practitioners, others work for a practice with two or more care managers. The care manager should be available 24 hours a day, seven days a week. Many care managers work with home care agencies whom the family must hire independently.

Prompted by my question, “Do you have any financial arrangement with nursing facilities or a particular provider e.g., home care providers?”  Meredith indicated that most families are not aware that they need to ask about financial incentives: many geriatric care managers do receive a placement fee that may be a fixed-dollar amount or the equivalent to the first month’s payment by the family. Meredith refuses to accept fees and years ago, disturbed by the practices she witnessed, she became the National Chair of Standards and Ethics at the NAP-GCM.  So, buyer beware.

If you would like a copy of the questions one may use to assess geriatric care managers, post your email below or send a request to jsimpson@colpartners.com

Have you had any experience using a geriatric care manager?  Let us know the comments section below!

©Circle of Life Partners™

Nursing Homes, Assisted Living, & Retirement Communities: When an Elder Must Move

by Jan Simpson

Recently I got a call from a friend in California.  He told me that he and his sisters were worried about their 88- and 86-year-old parents who live on the East Coast.  Concerned about their ability to remain safely in their own home, this circumstance is a familiar one: his parents are approaching a tipping point where a housing change  is necessary.  How each family makes this decision is unique, but it’s useful to evaluate alternatives before a crisis forces a hasty change.

What are those housing alternatives? Some adult children have their ill or widowed parents move in with them. Today, more than 3.6 million parents live with their adult children, according to David Horgan and Shira Block, authors of When Your Parent Moves In: Every Adult Child’s Guide to Living with an Aging Parent. While the book gives strategies for creating a harmonious living arrangement, it also cautions the reader about jumping into this arrangement without first considering the long-term implications.  They offer the reader a “Moving In Quiz,” a sample of which is below.

Guilt: Using a scale of 1-Never, 2-Almost Never, 3-Sometimes, 4-Almost Always, and 5-Always, how often do the following apply?

___  Why am I the only one who steps up to the plate? If I don’t take care of Mom, no one will.

___   Dad refuses to go into an assisted-living facility or even let us send a home health aide to see him. What choice do I have?

___   My spouse doesn’t say it, but I know he/she expects me to take care of his/her mother. I don’t want to upset anyone, so I’ll just go along and try to make the best of it.

___   I can’t abandon my parent. I couldn’t live with myself if I did.

___   I know my mother thinks I don’t care about her. That’s not true, but she is always trying to make me feel bad.

According to the authors, if you score an average of three or higher, you may be walking into “a minefield of guilt leading to resentment, frustration, and the potential breakdown of your own well-being.”

While housing elderly parents may be the right choice for some, assisted living facilities, elderly apartments, and continuous care communities are other housing choices to seriously consider. Who can you contact to get a quick list of available options and guidance?  Physicians, friends, social workers, and nurses are all helpful resources, as is www.eldercare.gov.  Here are three other sources of free information:

  • Area Council on Aging—In addition to offering activities for seniors, local Councils on Aging have a trove of information about local home care services, elder law attorneys, local assisted living, and skilled nursing homes (see www.ncoa.org). Arrange to speak or meet with the director and explain your parents’ situation. They will help you develop a short list of options and provide insight into how best to evaluate choices.
  • Social Worker affiliated with a local hospital or the Visiting Nurse Association—If your parent has had a recent hospital stay, schedule a telephone or face-to-face appointment with the hospital’s social worker. Ask about local facilities and other services that may be of help. A quick call to a social worker affiliated with the local Visiting Nurse Association (www.vnaa.org) may also be useful.
  • A Place for Mom—A social worker who advises families that are dispersed geographically recommended this organization, a free service for families who need to evaluate a range of housing choices. They do not charge the callers, but rather are compensated by the facility where your parent may move (see www.aplaceformom.com).  Skeptical at first, I contacted them recently about a complex family situation that included a loved one with dementia, and I was surprised to find how helpful and how quickly they were able to identify potential facilities that the family could evaluate. (A reminder, I do not have any financial arrangement with this service; they are simply another resource easily accessible.)

In the end, my friend and his sisters evaluated their options and decided, collaboratively with their parents, to move them into an assisted living facility.

Have your parents or older loved ones had to make a housing change? If so, share your thoughts about how best to make that transition.

©Circle of Life Partners™

The Village People: Aging in Place

I’m one of the village people.  No, I don’t sing “Y-M-C-A” and I definitely don’t dress like a cowboy.  Rather, I’m part of a new movement afoot to create virtual retirement villages in communities across the country to help people successfully age in place.

The first village was established at Beacon Hill in Boston (www.beaconhillvillage.org) in 2001, and since, over 50 have appeared across the US.  For an annual fee ranging from $25 to $600, 50-year-olds and older can join a network of neighbors that work together on a largely volunteer basis to allow residents to engage more fully in their communities.  Akin to a concierge service, each village is a non-profit that provides exercise classes, wellness seminars, transportation, household repairs, trips to museums and concerts, and more, mostly operating with grants, membership fees, and volunteers. Vendors such as plumbers or electricians, dog walkers and  home care providers are carefully screened and their work  is monitored by the local village for quality and safety.

“Villages are one way people can lead the life they want to live,” Mimi Castaldi, AARP vice president for volunteer engagement, told USA Today.  “They’ve caught the imagination of people.”  According to the article, baby boomers who are caring for their aging parents are driving the movement, looking for an alternative to retirement or nursing homes.  Peace of mind and the opportunity to have a parent age in place safely are the goals.

“I don’t think it’s the answer,” says the AARP’s Castaldi, but one in a string of good options.

“We think Boomers will change retirement,” she says. “They’re getting to the age where they’re thinking, ‘How do I want it to be for me when I get older?’ ”

Visit the Village to Village Network to learn more about the villages currently operating in the US.

On November 11th and 12th, I’ll be heading to Philadelphia for a conference on the village movement and I’ll share what I learn.

Do you know anyone who is part of a village today? At what age or under what circumstances might it make sense to join a village?

photo credit: amoeba.com

©2010 Circle of Life Partners™

Clutter Clean-Up

“For Where Your Treasure Is, There Your Heart Will Be Also”

My mother was a neat-nik. When she turned 70, she spent the year purging her files and storing only her and my father’s important documents in a safe deposit box and in a filing cabinet at home. Years later, when I needed to quickly find my father’s discharge papers from the military service or a copy of the cemetery deed, I knew exactly where to find them.  As I look around my own office, I feel sorry for my children if something were to suddenly happen to me.

Are your parents thinking about downsizing or perhaps a move into assisted living or a retirement community?  Do they intend to remain in their home but could benefit from de-cluttering and organizing? It often will seem daunting and almost impossible to clear out decades of memories. Recently, I met Laura Moore, founder of Clutter Clarity.  As a professional organizer and coach, Laura helps people de-clutter and organize their homes, schedules, and lives. She teaches people how to think about it all so the physical work of holding on and letting go is liberating instead of overwhelming.  Laura makes a very necessary and sensible distinction between clutter and treasures, helping me to see that the plastic wall plaque that hung above my mother’s kitchen sink for decades is one of my treasures, more valuable to me than an antique chandelier collecting dust in the attic. Laura’s blog and tweets are full of unique, helpful ideas about how to change our relationship to our belongings and get organized.  She offers 21 ClutterClarity Tips on her website.  My top five favorites are:

  • Is It or Is It Not Clutter? Ask Yourself: Do I love it now? (not like a lot); Do I use it now? (within a year); Does it comfortably fit into my home? (if not, what can I let go of to make room?); Does it fit into my current lifestyle? (family, work, friends, hobbies, etc.).
  • Get a Timer: Pick a project you can finish in 15, 30, or 60 minutes-a drawer, a corner, or a box.
  • Buy a Shredder: Set it up at waist level so you don’t have to bend over so much. Shred for a short period of time so you don’t get bored.
  • Find a Clutter-Clearing Companion: Instead of working with someone you live with, find a good friend who will not judge you.
  • Pick a Non-Profit: Choose organizations that do work that you care about. Sometimes they’ll even pick up your stuff for you.

I personally follow all of these tips, although occasionally I do get carried away.  Just ask my teenage daughter; I shredded her driving permit and she had to wait three weeks to replace it.  Donating to non-profits that will use items no longer needed or worn by your family is very satisfying and may be what helps your parents part with some of their treasures.

Consider passing Laura’s wisdom on to others.  If you have trouble knowing what personal financial, legal, and medical documents to save or to shred, I recommend her 21 page publication “Paper Clarity at a Glance.”  I keep a copy at home as a reference guide for my own paperwork.  As always, I do not have any financial arrangement with Laura or her business; I simply think the services of a professional organizer can be invaluable.

How do you and your parents deal with clutter?

©Circle of Life Partners™

Don’t Give Up on Me!

I wrote Don’t Give Up on Me! from an outline of the 50 things I wish I had known before entering the last decade of my parents’ lives.  It’s a fast-paced, show-and-tell book that brings you ringside during those very crazy years, helping you to understand not just the what but also the how of providing support.  How do you wrestle the checkbook or the keys away from mom?  How should you and your parents navigate the medical system to get the care they need?  What happens if one shows signs of dementia?  How can grandchildren be supportive? What legal documents really matter? What influences longevity? Is the doctor always right?

Today, there are thousands of websites and dozens of books that offer information, but Don’t Give Up On Me! is a great place to start, the place to find the initial and critical pieces of information on caring for your parents.

I hope you will read my book and join forces with me to share your knowledge with others.  All profits will be used to fund programs that serve our elders and support their caregivers or care partners.

©Circle of Life Partners™