Geriatric Care Managers in High Demand

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Marilyn Wideman, RN, MSN
Monday December 17, 2007

Mrs. Quinn has been a widow for many years, and her two adult children live out of state. She prided herself on her independence and ability to maintain her household. Her children became concerned about her ability to care for herself. During a visit, the children discovered unpaid bills scattered on the kitchen table, very little food, and clutter in their mother’s usually tidy house. Mrs. Quinn was adamant about staying in her home. They wondered what to do since their mother had moderate financial resources and they don’t live close by.

Mr. Clark was the caretaker for his wife, but his health had started to decline. The Clarks’ children, who live nearby, were concerned about how to help their parents. They all have jobs and children of their own. They were unsure about the extent of their parents’ needs, and they had little knowledge about available resources.

These scenarios are examples of situations in which a geriatric care manager (GCM) can help older individuals and their families with long-term care planning. A GCM is most often hired by a family member after an elderly individual has experienced a decline in mental or physical status. Families commonly seek these services because they are unsure about options, they are in disagreement about a plan of action, they live too far away from their elderly relatives to be of assistance, or they have too many responsibilities of their own and need help.

The helper’s helper

A GCM helps elderly individuals and their families navigate the continuum of care and available resources for long-term care planning. A GCM could work with a family as briefly as one to two months or many years, depending on the needs and desires of the family. Some short-term cases may involve acting as a consultant to the family for initial long-term care planning and resource finding, while longer-term involvement may include care planning, plan implementing, and ongoing monitoring. In either case, contact between the GCM, the family, and the elderly individual tends to be more frequent in the beginning while stabilizing a crisis or finding solutions for a client’s situation.

The care management process starts with a comprehensive assessment that evaluates the individual’s healthcare and psychosocial needs, day-to-day functional status, living environment, financial matters, and family involvement and concerns. Once this is done, a plan of care is established that addresses current and potential future problems. The plan could involve the use of in-home caregivers; medication monitoring; use of community resources; structural changes to the home for safety, such as ramps and grab bars; or relocation of the patient to an assisted-living facility or a nursing home.

The next step is to implement the plan, which involves finding, starting, and coordinating services in a cost-effective manner that takes into account the family’s wishes. In Mrs. Quinn’s case, it was discovered that she had a long-term care insurance policy that would help pay for a caregiver a few hours a day. The GCM helped her interview caregivers and also arranged for Meals on Wheels and found volunteers from Mrs. Quinn’s church to do daily checks and help with errands. Mrs. Quinn agreed to this plan and to a complete evaluation from her primary care physician. Some medical issues were identified and treated, which helped to stabilize her mental status.

At other times a plan of action could mean helping the family relocate the elderly relative, as was the case for Mr. and Mrs. Clark. During the assessment process, the Clarks told the GCM they were ready to sell their home but they did not want to go to a nursing home. They were happy to hear about assisted living options that were within their financial limits and that fit with their physical needs. The GCM helped the family to plan and organize the move.

Ongoing oversight and evaluation assures the plan remains relevant and is working.

Not just a pencil pusher

GCMs are problem solvers, resource managers, and advocates, says Mary Beth Hardy, RN, MPH, the central regional director for LivHome and a long-time GCM.

“We have a case in which one of our GCMs literally saved the limb of one of our clients,” says Hardy. “The client, who has diabetes, was told that he needed to have his leg amputated and that there were no other options. Our care manager researched treatment options and found a new laser surgery treatment offered locally that could save the limb. I am happy to say the client had the treatment and six months later is doing well.”

“I find the job of a care manager to be highly creative and very satisfying,” says Paula Brottman, an advanced practice nurse and GCM with CareGuide. “Care managers help improve the quality of life for elderly individuals and their families by assessing the whole picture, working together with the patient and family, and coordinating care among many providers that meets the patient’s and family’s goals.”

GCM services are usually not covered by long-term care or other types of insurance plans. This service is an out-of-pocket cost, but because GCMs are helpful in decreasing overall health costs over the long term, families on tighter budgets often use GCMs.

“Many families have told me and my staff that our services have saved them money, time, and emotional toil,” says Hardy.

GCMs can reduce overall care costs by identifying low-cost or no-cost community services, assisting with assessment for eligibility for benefits, and suggesting less costly care options that are quality services and meet the elder’s needs.

Most GCMs are RNs or social workers; many work on an independent basis or for private GCM companies. Local senior centers or aging centers can assist in finding a GCM. Also, family members can check with employers to see if assistance in finding and paying for GCM services is offered as a benefit.

“Many people do not realize that some companies have added care manager resources as a benefit to assist their employees with their caregiving responsibilities,” says Brottman.

Another important resource is the Geriatric Care Management Organization’s website at The website provides general information about GCMs and listings of GCMs.

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