I recently received an inquiry from someone considering starting a business managing the medical, legal, and financial affairs of retirees, who sought my feedback regarding the feasibility of such a consultancy. He has several years of experience managing his father's affairs, and a business education; he is a person that I know, and for whom I have a great deal of professional respect. I sat down and sent him a thoughtful response and, when it was sent, realized it was a great reflective exercise that may have some value to others. And so I decided to post parts of it here (with adaptations made for a wider audience) as an open letter to those who would consider a career in this unique service to our aging population:
Care management is more than an interest in the well-being of elders, or a passion for service. It is a profession, and requires education and supervised experience, as well as a healthy dose of discretion -- we need to know what we don't know, and work collaboratively with others to create a support system that protects and honors the elder client. The management of an individual's medical, financial, and legal affairs should not be provided by one person or organization (unless it is under the careful supervision of the courts), and while it's generally acceptable - although not ideal - for an individual family member to serve in multiple roles when necessary, it is inappropriate for a professional to do so. A single entity that helps members of this vulnerable population make decisions regarding their long-term care, provides and/or manages those services, and then arranges for payment to be made for the services has a very clear conflict of interest and a lack of objectivity.
As geriatric care managers, we are usually the hub of a team of professionals working together in service to our client, often alongside devoted and hard-working family members. We assess and manage medical, psychiatric, cognitive, social, and care needs, while private fiduciaries manage financial affairs and can serve as legal representative (power of attorney, conservator, guardian, etc.) when necessary. Estate planning and elder law attorneys assist in the preparation and continuous update of documents such as the estate plan and advanced directives, and there are often other professionals involved as well, including financial advisers or trust administrators.
This might all sound like overkill (does one client really need all of these people involved in their affairs?), but the fact is that young and healthy seniors do not want or need this type of assistance. Families that hire care managers are usually dealing with complex circumstances, often after years of familial strife and decline due to advanced age and a chronic, disabling condition (usually several). Every day, we are negotiating long-standing family conflicts, working with physicians regarding complicated medical conditions and treatments in an increasingly fragmented health care system, and shepherding people through the spiritual journey at the end of their lives, helping them continue to find meaning and purpose. These are not simple transactions.
As an adult child, one has the time (albeit limited) to do one's research, to learn what needs to be known about a parent's health insurance coverage, medical conditions, and financial/legal affairs as one goes along. There is also an understanding, a permission of sorts, to make mistakes along the way: to hire a home care company that did not fulfill their commitments, to churn through several health care providers before finding the one with the right skills to manage your loved one's medical situation. Expert consultants do not have this time or permission. Families rightfully expect a paid professional geriatric care manager to understand the national and local health care landscape, to know which facilities in their area provide the best dementia care, how to effectively supervise in-home caregivers, which medications are considered unsafe for elders according to the Beers criteria, the basics of applying for Medicaid, how to help a conflicted family reach consensus regarding a plan of care, etc. When we come to a new client untrained in these issues, or without the skills to efficiently obtain necessary information or services, we are not being good stewards of their resources. Experience as a family caregiver is an enormous asset to a professional geriatric care manager, but it is not enough.
My advice (for those who would seek it) is to find a service niche that makes the best use of your interests and skills, and seek out the education, training, experience, and certification/licensure that is required. It is a road that may take several years, but it will be a rewarding journey that will serve you and your clients in countless ways.
For more information, please visit the websites of the National Association of Professional Geriatric Care Managers, and the National Guardianship Association.
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