By Carolyn L. Rosenblatt, R. N., Attorney at Law

Whether you are across town or across the country from your aging loved one, the need for help may arise as your loved one's condition changes.  The elder's physical frailty, mental decline, and loss of independence are all factors which can affect your ability to help your loved one.  For those who have no training in the care and management of elders, the complex matter of safeguarding one's parent while assuring quality of life can be too overwhelming to handle alone.  Your relationship with your aging parent may not have been comfortable before he or she began to decline with age.  Or, there may be the problem of physical distance, your own work and busy life, or your sadness at seeing your parent so frail, so unable to manage alone. The difficulty of getting involved in your parent's or loved one's life at the necessary level can seem like too much for you. Whatever the reasons, it is important to know that professional geriatric care managers exist, that their purpose is to serve the needs of your aging loved one, and that this kind of help can do a lot to relieve your stress.

Many families in our society are scattered in different locations.  You may be "the responsible one", in a group of siblings, or you may be the only child.  You may be the person who is most capable of making competent decisions.  Perhaps you have the Power of Attorney and now must exercise it.  If you find yourself in the role of having to figure out what your parent or loved one needs, and do not have the background to make a clear assessment, it is a good idea to get some help with this.  A competent assessment by a professional geriatric care manager can provide a perspective you might never have on your own.  It can fill in the gap between what the elder's doctor can do (checkups, treatment of illness, prescribe medication), what the family can do on its own, and what your elder wants or needs.  Many people have never heard of a professional geriatric care manager (PGCM).  You will not typically meet a PGCM through your doctor or health clinic.  You will not find their services covered under Medicare, or most other health insurance plans.  At this time no license is required, and PGCMs are not monitored by state Departments of Health or Social Services.  Yet, this kind of service can make a world of difference in what happens to your aging loved one, and how he or she is cared for.  A PGCM can do a great deal to help you.

So, just what is a PGCM? A professional geriatric care manager is usually a registered nurse or social worker, though some are professional money managers called "fiduciaries".  The care manager can visit the senior at home, do a comprehensive assessment of his/her needs, evaluate the safety of the home environment, determine how to meet the senior's needs, and provide a written plan of care.  The PGCM should be familiar with all the resources in the community which are available to the elder.  If you are a distance caregiver for your parent, for example, the PGCM can serve as your eyes and ears, and can keep track of your parent between your visits, reporting any changes to you on a regular basis.  The PGCM can also hire and check on any in-home helper you or your elder loved one need, to help your loved one remain in her own home.  PGCMs do not provide direct care themselves.  Rather, they are the ones who can see that care is provided.

What can a PGCM do for you and your aging parent or loved one?

Some of the things a PGCM can do for you include the following:

          1. Make doctor and dentist appointments for your elder, and accompany your elder to the appointments. They can talk to the healthcare provider about health problems that need attention, especially if your elder loved one is forgetful of the problems, or has difficulty explaining them.  They can report to you what happened, and ask any questions you want asked of the healthcare provider.  If your aging parent keeps telling you "everything's fine" after doctor's visits, when you know everything isn't fine, having someone qualified to accompany Mom or Dad to the doctor or dentist can be very useful.   PGCM's can also provide transportation to appointments for those who have no other alternatives and who do not drive.

          2.  Interview, screen, and monitor in-home helpers, such as companions, aides and other workers.

Getting a little help at home can assure that your aging loved one remains in his or her home as long as possible.  However, the difficulty of locating a safe, honest in-home helper can be beyond the capability of some impaired and frail elders.  The very reasons your elder may need help in the first place can interfere with his or her ability to get that help independently.  For example, plenty of elders have impaired vision, hearing and memory.  Your mother may not use the internet.  Your father may not be able to recall whom he spoke to on the telephone yesterday.  Therefore, having a PGCM can solve the problem of hiring, supervision and ongoing monitoring of the work the helper is doing.

          3.  Visit the elder when you want them to, even if you are unable to do so yourself, and report to you how your elder is doing. 

Because there are many adult children who do not live in the same community with their aging parents, a problem arises when it becomes clear that someone needs to watch over the aging person.  Neighbors and friends can be wonderful resources for out-of-area family members to call on to find out from an objective source how their parent is doing, but it may not be enough.  Sometimes, the neighbors and friends are themselves elderly and less than observant of changes in the parent's condition.  The best friend or neighbor may not be trained to look for ominous signs of danger needing healthcare attention.  A PGCM can look in on the elder on a regular basis, whether it be monthly or weekly or what is indicated by the aging person's condition.  A verbal or written report to you can be useful in making decisions, as well as putting one's mind to rest.  Unfortunately, guilt seems to operate in these situations.  The adult child feels responsible, yet cannot take the parent into the child's own home for various reasons.  Sometimes, the elder has no interest in moving, even if moving in with an adult child is better than staying put.  A geriatric care manager can be helpful in relieving the guilt associated with "not taking care of" the aging parent.  Perhaps, if the relationship with the elder is good and the time is right, the PGCM can lay the groundwork for persuading a change in the parent's living situation.  Regular visits can do much to build trust, and trust is essential if a person must give up his or her home at the suggestion of another.

          4.  Act as an advocate for your elder at the hospital, assisted living facility, or other location where your elder may not be able to speak well for himself.

Hospitals can be dangerous places, as can other long term care facilities.  The chronic, nationwide nursing shortage is no small contributor to the danger of being in a hospital.  Unfortunately, about 100,000 people a year die in the United States as a result of preventable medical errors.  If your elder loved one needs to go to a hospital, and you live far away, it is safest to have someone visit every day, for as long as family members and friends are available.  If they are not available, a geriatric care manager who is a nurse can do this task and report to the family members, until they are able to be in attendance or for as long as the family desires and can afford to have this specialized help at hand.

          5.  Maintain records your elder may need, such as medical, prescription, financial, or legal papers, and make them accessible to you when you need them. 

If your aging loved one has trouble keeping track of paperwork, such as bills, bank statements, or other documents, it can create a serious problem.  In our practice, one client's mother had been paying her Medicare supplemental insurance until she fell and was hospitalized.  The adult child nearby could not find any organized paperwork, so she did no bill paying.  The supplemental insurance was cancelled for lack of payment of premiums.  The hospitalization generated enormous charges, many of which were not covered by Medicare.  We were able to advocate for the elder and get the supplemental insurance reinstated, but it was an expense for the family members and the elder to pay for professional legal services to straighten out the mess after the fact.  It would have been far more efficient and less expensive to retain a geriatric care manager to organize all of the bills and monthly expenses ahead of time before disaster struck.  Then, the adult children would have had the necessary information in one place when Mom had to go to the hospital, and the insurance premiums would have gotten paid on time, averting the cancellation.

          6.  Help you with the decision to move your family member out of the family home when the time comes, and assist with all the details of moving.

If Mom, Dad or your beloved Aunt Jan is not able to manage safely at home any longer, she or he must go to another location which provides supervision.  Locating the right place can be a very time consuming chore.  It should involve visiting prospects with and without your elder, to see how they feel to you.  Reading the contracts, understanding what is involved in the move and planning ahead for the many details of moving out of the family home can be very daunting.  A geriatric care manager can take on some or all of the load off your shoulders.  As someone outside the family, the PGCM can offer advice to the elder which may not be as suspect as advice from adult children in dealing with a parent who is resistant to change, as many elders are.

          7.  Provide information about social activities, safety, adult day health services, senior centers, equipment, transportation, meals, and other things your elder's community may offer to enrich and improve your elder's life.

If you live in the same neighborhood as your aging loved one, you may not need help with knowing how to find suitable activities for your elder.  However, most people of the elders' children's age have not involved themselves with activities for seniors and may not know the community resources or how to find them.  Doing what you can to prevent social isolation can keep your elder safer physically and healthier mentally.  A local PGCM should know how to find enjoyable activities for your parent, and can take him or her there to get acquainted if you are unable or not ready to do it.

          The PGCM is typically available to you seven days a week, twenty-four hours a day.  In many ways, it is an investment in the safe keeping and quality of life of your elder loved one to hire this kind of assistant to you and your family.

What are PGCM's not allowed to do?

A GCM is not a lawyer and cannot give legal advice.  A PGCM does not give direct financial advice, though some PGCM's assist with budgeting, and household money management, such as paying bills, and even help with selling the family home.   However, a PGCM is generally not a money handler for the elder's estate, and must avoid any impropriety concerning the elder's finances.  PGCM's are not financial advisors or accountants. It is not advisable to permit a non-family member to have complete control over any elder's bank accounts, unless there is no family.  An exception is when no relative of the elder is in a position to serve competently as someone in control of the elder's money.  In those cases, the court should be involved to assure that the elder with no family is not abused financially.  That is done through a court monitored process called conservatorship, or in some locations, guardianship, which will be discussed in another chapter of this book.  The PGCM can serve as a "pay agent" for the elder.  The PGCM can also serve as a financial Power of Attorney for a senior who is not competent to pay his or her own bills or manage money.  However, it is imperative that systems are in place to prevent abuse by any Power of Attorney handling money.  A representative of the elder, usually a family member, must monitor all expenditures and review bank account statements, checking account records and credit card bills.   A Power of Attorney for finances, in the wrong hands, is a license to steal.  Unfortunately, this applies to family members, as well.  The subject of financial abuse and how it can be prevented is discussed in a later part of this book.

 A PGCM, even if she is a nurse, cannot provide direct nursing care in her capacity as a PGCM.  The "hands on" care is provided by others, though the PGCM may be in frequent or regular contact with the caregiver or assistant for the elder.  The PGCM is not an employer of an in-home caregiver, but is a monitor of the caregiver.  The PGCM can report to you, the person who is responsible for your senior loved one, about the quality of what the in-home caregiver is doing.  The PGCM who has a nursing background can also report to you about the effects of medications and the quality of care he is receiving from the physician if the PGCM goes to the doctor with your aging loved one.  As many elders are hesitant to question their treatment, or may lose track of which medications they are taking, a PGCM  who is also a nurse can be a valuable advocate for your loved one and can provide necessary information to the healthcare givers, physicians, nurses, therapists, and dentists.  A nurse-PGCM's observations about your loved one may be lifesaving and life prolonging.  Regardless of background, a PGCM can alert you to dangers, changes and things about your elder which need attention.

What Kind of PGCM is Best?

There is no one kind of PGCM and no one formula that is suitable for every aging person who needs a care manager.  To be a good consumer, you need to ask yourself some questions.  First, can I/my elder afford this kind of service?  In California, PGCM's may charge rates from approximately ninety dollars per hour to one hundred twenty-five dollars per hour.  If your elder loved one has the resources, and wants to stay in his or her own home, this option may help you to accomplish that for your loved one safely.

Next, you need to ask what is the most obvious need my parent has at home?  If it is for in-home help with companionship, shopping, cooking cleaning or transportation, and you cannot be there to supervise the helper, a PGCM with a social worker background may be just fine. If your parent is physically infirm, has dementia, has a history of mental health issues, or suffers from multiple, more complex medical conditions, a PGCM with a nursing background may serve your needs better.  The skill of assessing changing medical conditions, discussing treatment alternatives with physicians, offering recommendations about medications, and advising your elder about treatment is most likely that of a licensed nurse.

If your elder is able to manage fairly well physically, but is forgetful about paying bills, and keeping track of finances, and is vulnerable to being taken advantage of financially, ask whether the PGCM handles money. Some do not.  A professional fiduciary may be the person you need, rather than a care manager.  Some care managers do all tasks needed, including paying bills for the elder.  Ask, and be sure to describe to the prospective care manager all of the problems your aging loved one has, without making excuses or glossing over the problems.  A competent care manager will visit the elder and do her/his own assessment.  A written report should then be made to you, and the decision to go forward can be based on the report.

How do you find a qualified and experienced professional geriatric care manager?  A search in your local community is one place to start.  A national organization does exit, and a check of the website will enable you to compare and contrast before you contact someone you might want to interview.  If you are a distance caregiver for your elder loved one, coordinate a visit to your elder with interview time for prospective care managers.  As a consumer, it is imperative that you have a face-to-face look at the person you may be hiring.  Do you feel comfortable with this person yourself?  Does the personality and style of the PGCM seem to be compatible with your elder loved one?  How accessible is the care manager?  Does the skill set of the PGCM match the needs of your parent right now, and for conditions you expect to be ongoing, such as dementias?  If your parent is difficult, is the care manager equipped to handle such personality traits as resistance and stubbornness?  If you are the responsible one for choosing this kind of help for your loved one, be a good consumer, and do the necessary homework.  It can help your aging parent, as well as bring peace of mind to you.  Keep in mind that with any kind of help you choose for your loved one, you have an ongoing responsibility to assure that the helper is doing the job properly, and as you expect.  Stay in touch and pay attention.  Do not assume that hiring a care manager relieves you of all responsibility for keeping on top of what is happening with your elder.

The National Association of Professional Geriatric Care Managers is located at:

www.caremanager.org

1604 N. Country Club Road

Tucson, AZ 85716-3102

520-881-8008

Recap:

Seven tips for finding and using a good, professional geriatric care manager

1.     Figure out what you/your aging parent can afford.  If the resources are there, think about the most pressing problems your aging loved one has which make it difficult for her or him to manage independently.

2.     Use a national organization or local organizations to begin your search for a care manager.  Review qualifications, price, background and experience level.

3.     Plan the questions you need to ask the prospective care manager at the interview.  Does he or she handle money?  Does she have social worker skills, nursing knowledge or other special skills?

4.     Find out by your interview what the care manager's philosophy is about.  Is there respect and patience?  Will this be a good match for your mother, father or other loved one?

5.     Pay attention to your own comfort level with the candidate for the care manager job.  If you are not comfortable with him or her, chances are your parent won't be either.  Regardless of how qualified someone looks on a resume, sometimes it doesn't "click" when you meet the person face-to-face.

6.     If you are a distance caregiver, be sure the care manager you are considering is available 24/7.

7.     Once you hire a care manager, remember that you have an ongoing responsibility to monitor what the manager is doing, to receive reports and determine whether this is working for your elder loved one.

Ms. Rosenblatt is a Registered Nurse, and a licensed attorney.  She has been in legal practice for 30 years, and currently is a consultant with her husband Dr. Mikol Davis helping elders and their families at www.HelpWithElders.com.

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