Worry-Free Care for Faraway Parents: Geriatric Care Manager Helps Ease Stress
and Get Better Care for Aging Parents

By Phyllis Mensh Brostoff, CISW, president, National Association of Professional Geriatric Care Managers
Published: February 26, 2009

If you are responsible for the care of an aging parent or relative—especially one who is sick and lives far away—you may wish you knew a wise, willing sage with answers to tough questions and the time and energy to follow through on the details. Enter the geriatric care manager. I spoke recently with Phyllis Mensh Brostoff, CISW, president of the National Association of Professional Geriatric Care Managers, to learn more about these professionals who offer expertise in dealing with the special needs of the aging. “Our specialty is based on an amalgam of nursing and social work, providing a variety of services for aging individuals,” she told me, as we talked about how to find the right care manager to help with eldercare challenges.

Who Needs Help?

Brostoff illustrated the difficulties facing families with two hypothetical scenarios: Nancy’s father lives alone, hundreds of miles from his daughter. She calls one day and he sounds confused, unsure of her identity and unable to tell her the date or even what time it is. What should she do? Then there is Louis, who juggles a busy work schedule, his own family needs and he visits his elderly mother every few months. All’s going well enough, till one day he arrives to find the usually neat home in chaos. Unpaid bills and unwashed laundry have piled up. His mother is unkempt and, of even greater concern… pill bottles are filled with medication that hasn’t been taken. Where should he turn for help?

A geriatric care manager can step in to solve problems like these efficiently and sensitively – helping, for instance, with…

• Housing. Geriatric care managers can provide suggestions for relocation, as well as advice and coordination of a combination of services, including emergency response systems and meals-on-wheels that can allow an elderly person to remain at home.
• Liaison. Geriatric care managers can act as a liaison between clients and attorneys/trust officers… physicians… social workers… home care companies… residential facilities.
• Mediation. Siblings don’t always agree on what’s best for their parents and aging parents may not want to admit they are no longer able to care for themselves. The geriatric care manager can mediate between adult children worried about a parent’s safety and well-being, and the older person who wants to maintain a sense of independence. Brostoff recalls meeting with a family who exemplified this problem. The daughters worried about their mother’s continuing ability to care for their frail father, while the mother didn’t want her daughters taking over her life. With Brostoff’s guidance, the mother came to realize that her daughters’ concern would help, not hinder, her ability to stay independent. “She was then open to suggestions, such as an adult day program or help in the home,” Brostoff said.
• Crisis management. Geriatric care managers are familiar with available resources and may have creative solutions to difficult problems. Brostoff points out that it’s better to establish such a relationship before a crisis occurs. If and when you face an emergency, such as a fall or sudden illness, you’ll then have the benefit of an impartial local expert.
• Transitional planning. Advice from someone who knows the family and circumstances is helpful when elderly patients are ready for discharge from a hospital and need advice about the next step, whether it’s a nursing home, rehab facility or their own home with outside help. Hospital discharge planners can and do assist families and patients with advice, but they don’t have a personal relationship, haven’t been to the patient’s home and cannot evaluate how realistic the care plan for when the patient returns home actually is, notes Brostoff. For example, a hospital discharge planner may assume a spouse can care for the patient returning home from the hospital, but may not know of health problems that individual has that will make such an arrangement risky for both.
• A local presence for regular check-ins. Geriatric care managers who work with a family over time get to know the details of the client’s life, their routines and likes and dislikes. The relationship that develops allows the care manager to anticipate necessary changes and perhaps even avert a crisis by providing supportive counseling and advice.

Hiring A Geriatric Care Manager

To find a geriatric care manager in your area, log onto the Web site of the National Association of Professional Geriatric Care Managers (NAPGCM) at www.caremanager.org. NAPGCM has developed Standards of Practice and a Pledge of Ethics for members that address a variety of topics including training, billing, etc. Look for a professional who has an advanced degree in nursing, social work, gerontology or psychology, and who is certified by one of these organizations—the National Academy of Certified Care Managers, the Commission for Case Management Certification or the National Association of Social Workers. Care managers typically charge an hourly fee, which varies in different communities. Fees range from $50 to $200 per hour, depending on the region.

Screening Questions

Brostoff advises asking these questions of all candidates before making a decision to hire:

• How long have you been providing care management services? Experience is essential, says Brostoff, noting that many people have been in a related profession for a long time before specializing in care management.
• What services do you provide? For instance, some organizations provide home care while others are purely advisory.
• How would you handle my problem? You want someone who presents solutions you may not have thought of or that are in accordance with your own ideas.
• How will you communicate information to me? Look for someone who provides regular updates and is willing to work with your needs—for instance, via e-mail or scheduled phone calls, if you have a complicated schedule.
• What happens if there’s a crisis after hours? Make sure there is a plan in place. Ask how problems that arise after regular working hours are handled and what backup exists for care managers.
• What is your fee? Can you send a fee schedule?

Ask for references, especially if you know nothing at all about the person you are considering hiring. And as with any kind of counseling, you should like the person you’ll be working with—the goal is to find a professional who will make the situation better for everyone, not one who adds complexity at a time that is already emotionally difficult.