Care Managers: Professional Guidance for Caregiving Families

The scenario is similar from family to family: Your parent or parents may be living far away and may be beginning to develop medical, health and psychological issues related to aging. One or both parents may be having trouble handling their daily routines, including dressing, cooking, cleaning, shopping and financial matters. You visit whenever you can, and help long distance in whatever way possible, but it is just not enough. Maybe a crisis situation has already happened, or you are concerned that a crisis may be imminent. What do you do?

To help with this type of situation, many adult family members are realizing the benefits of hiring geriatric care managers, or “case” managers as they are often called. Geriatric care managers are professional health and human service specialists with expertise in geriatrics who help families care for their aging relatives by managing the issues and situations that may be impacting the elderly relative, including doctors’ appointments, medications, hospital visits, housing options, in-home care and much more.

Having a care manager can be a “life saver” for both you and your parent. “My father might have died if the care manager didn’t step in and insist that he wasn’t ready to go home from the hospital alone,” says Bob Silver, co-founder of Parentgiving and son of Lou Silver.

Typically, people find their way to care managers in times of crisis, “although some people may be calling to plan ahead,” says Lisa Reznick, LCSW, geriatric care manager working for Generations Care Management in New Jersey. “Often someone will call with an initial request, for example to help find a nursing home, but it’s never as simple as that. There are family dynamics and care choices involved. My job is to sit on the call and get an idea about medical, psychiatric, cognitive and family issues and sort out the help they might need. Maybe mom or dad needs to go to a nursing home, but there might be better options that are less costly and easier to manage.” She adds: “Often when we finish the first call I hear a big sigh of relief from the family member.”

_{The care manager process}
Whether your parent is in crisis or you have general concerns regarding his or her health and well-being, a care manager can help by first consulting with you, then meeting with your parent for a comprehensive assessment. The care manager will conduct a detailed interview then will develop an individualized plan and possibly suggest referrals to medical professionals for further evaluation. The first step is finding a care manager. Parentgiving.com offers a toll-free number that allows family members to take the first step and have a phone consultation with a professional care manager. A fee-based service, 1-800-GET-CARE connects family caregivers with professionals who can evaluate the current situation, make recommendations and suggestions, and then refer the caregiver to more localized services if necessary.

If and when you contract with a local care manager company or individual care manager, expect to receive written information on specific services they will provide and details about cost. Most care management services charge hourly for consultations. There may be additional charges for travel time to and from meetings.

Care manager services typically are private consultations and are not covered by Medicare or regular health insurance. On occasion care manager services may be covered by a long-term care policy. Family members should consult individual insurance providers for more specific information.

_{Care manager qualifications}
Care managers’ backgrounds vary. Some are licensed clinical social workers and others are Registered Nurses. Families also may be able to receive a team approach to care management and have more than one qualified professional care manager available, depending on the current need.

The care manager also should be very familiar with local resources. “They should know and understand the problems people face in the community they live in in order to connect them with the resources they need to continue living in that community,” says Donna P. Jernigan, MS, BSN, RN, with Carolina Case Management in North Carolina. It’s also important to go to the parent’s home to assess safety issues. “Particularly if the parent is committed to staying in their home, they must first have a safe environment. I will go into the home, see if there are any safety issues then address those with the child or caregiver.”

If the parent is not able to continue living at home, the caregiver can help find the best housing situation. “It helps to have someone who understands that particular community do site visits,” says Jernigan. “Usually I will give the family members a list of facilities to research, then when they have narrowed the list to two or three, I may go in and talk to the administrator of each facility.”

_{Care manager services}
Care managers can help with a number of tasks including but not limited to:

• Assessing the elderly parent’s current medical and psychological condition
• Managing medications and doctor communication; accompanying your parent to doctors’ appointments
• Modifying the home to accommodate safe, independent living
• Ongoing communication and counseling with family members
• Coordinating outside financial management and/or legal services
• Interviewing and hiring in-home care providers
• Researching out-of-home housing placement
• Assistance in the hospital with emergencies or in-patient care

The number of hours families may require for localized care management varies from case to case. Typically, each case will include an initial consultation with the family member or members, plus an initial in-person consultation and assessment with the parent. Following those two meetings, the care manager will make recommendations regarding ongoing care management, and should keep the family apprised on hours accumulated. The family is entitled to limit hours if necessary.

If the parent or family members expect to need assistance during emergencies or in the hospital, those issues should be discussed ahead of time. If requested by the family, care management services should be available 24 hours a day, so if your parent is taken to the emergency room at 2 a.m., the care manager will meet him or her in the emergency room and help your parent through the process of hospital care and the return home, to a rehabilitation facility or to an alternate living arrangement.

_{Developing a good rapport}
Although individual care managers will have different approaches and different personalities, the one you choose should be adept at developing a productive rapport with your parent and family members. “When I first visit a home I like to sit down and say ‘What do you want from this?,’” notes Jernigan. “Different families have different needs. And I like to ask both the parent and the family members together because I think sometimes the child or family caregiver may have a totally different picture of the goals. It helps to have conversations both together and separately.”

It also helps to have a third party involved in the process. “It can be invaluable to have professional input from a neutral party that doesn’t have a vested interested in terms of emotional need,” says Nancy Bortinger, LCSW and licensed care manager in New Jersey. “Especially with physical distance between the family members and the parent, the professional can help maintain a balance in terms of decision-making and communication.”