The Care Management Career Path

A question that I, and many of my care manager colleagues frequently receive: "So, how did you get into this field, anyway?" Unfortunately, care management is a profession about which most of the public is still unaware, and when people learn about our critical role as advocates for disabled adults in the health and long term care systems, I usually get one of two responses: "I wish I'd known about you five years ago when I was caring for my own mother!" or "Sounds like interesting work. What kind of training does it require?"

It's a great question, with a complicated answer. Professional care managers come from a variety of backgrounds, including social work, nursing, gerontology, therapy, and psychology (among others). Professional care managers have several years of experience working with disabled adults in a supervised, clinical setting. And professional care managers are certified through one of four recognized programs.

A certified professional care manager differs from a patient advocate, a senior advisor, a patient navigator, or an elder advocate, designations without the same education, experience, or stringent certification requirements. There are many good people who care deeply about the health and well-being of our elders working in these fields, but effective advocacy through a complicated diagnosis or difficult family dynamics requires more than a kind heart, or some personal experience in caring for a member of one's own family. It requires clinical knowledge, a deep understanding of the health and long term care systems, the ability to maintain an objective perspective, and accountability to a set of professional standards and ethics.
 

Every member of Elder Care Guides'
clinical team is a member of NAPGCM:
Amy Abrams, Jean Alton, Terry Ehlke,
Cassie Farrell, Norman Hannay,
and Susan Valoff

There are many paths that one can take to becoming a professional care manager, and we work in a variety of settings, including private companies and non-profit organizations. The work is challenging and demanding, but individuals who enjoy problem-solving find it very rewarding. Membership in the National Association of Professional Geriatric Care Managers (NAPGCM) is an important first step.

If you or someone you know are interested in learning more about the profession of care management, NAPGCM will be hosting a free informational webinar on Tuesday, October 15th. 
Click here for information and to register.

Ten things you might not know about Elder Care Guides

Proud to have been nominated as a top ten finalist in this year's "San Diego's Best" Union-Tribune readers poll, we'd like to share ten things that you might not know about Elder Care Guides, and why we are deserving of your vote as the top In-Home Eldercare Services provider in San Diego County:

1) Independently-owned: We are an independent, locally-owned company, which affords us the freedom to be flexible, creative, and keep our clients at the center of our business at all times.

2) Interdisciplinary team: Our professional team represents a variety of disciplines, including social work, nursing, gerontology, recreation therapy, and counseling. Our collaborative approach to geriatric care management means that each of our clients benefits from the experience, training, and perspective of this well-rounded team.

3) Access to the top professional caregivers: We have a staff of experienced and vetted professional caregiver employees, and are also able to partner with some of the top home care agencies in San Diego as needed in order to find the perfect match of skills, experience, and personality for each of our clients.

4) Leadership: Each member of our clinical team is an actively involved member of the National Association of Professional Geriatric Care Managers (NAPGCM). Our President is a Fellow of the association, our Vice President of Client Services is on the association's Board of Directors, and our Vice President of Clinical Services is the chair of NAPGCM's local unit. We are committed to promoting high standards and ethics for professional care managers across the country.

5) Certification: All of our care managers are either certified, or are certification-eligible and actively working toward the completion of their certificate under the supervision of Susan Valoff, LCSW, our Vice President of Clinical Services. Although certification is voluntary, Elder Care Guides covers the cost of certification for our staff, and believes that there is value for our clients and their families in the ongoing supervision and education that certification requires.

6) On-call system: Our clinical team is available 24-hours per day, 365 days per year, to respond and assist our clients and their families in the event of an emergency. We handle our after-hours on-call system internally, meaning that day or night, when families reach out to Elder Care Guides for assistance, they will reach a professional who is familiar with their individual situation, and ready to respond.

7) Service areas: Elder Care Guides provides comprehensive assessment, care planning, and care management services not only to older adults with physical and cognitive disabilities, but also has the expertise to work with adults with serious mental illness and developmental disabilities. We have been providing care management services to families throughout San Diego County since 2004.

8) CAHSAH certification: Elder Care Guides is a certified home care provider through the California Association of Health Services at Home (CAHSAH), a voluntary certification that demonstrates our commitment to sound business practices that protect the safety and welfare of our clients.

9) BBB accreditation: Accredited members of the Better Business Bureau since 2008, we are proud of our A+ rating.

10) Company culture: For the members of our team, Elder Care Guides is more than a place of employment. It's an opportunity to grow, learn, and be of service while working alongside some of the best professionals in the field. We are dedicated to a company culture that emphasizes professionalism, autonomy, collaboration, and full employee engagement.

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The voting process is simple. CLICK HERE to visit the "Healthy Living" categories of the poll, and go to "In-Home Eldercare Services," where you will find us listed. You'll need to register on the website (it only takes a moment) the first time you vote. You can vote daily between now and July 7th, and to place future votes you need only log on with your email address and password. We appreciate your support, and welcome you to tell friends, family, and colleagues about the contest as well.

If we may answer any further questions about our company or the services that we provide, please feel free to leave them in the "Comments" section below, and we'll be glad to provide further information.

Long Term Care Planning: What's Covered, and What Isn't

We were invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we provide a copy of the article here as well. Please share the information with someone you know who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care.

Volume VIII: What's Covered, and What Isn't

In previous issues, we’ve described the various settings in which long term careis provided, often referred to as the “continuum of care.” Many are caught off guard in the midst of a health care crisis by a sudden and surprising lesson inwhich types of care are covered by Medicare or other forms of health insurance, and which require private payment.

The simplest way to understand whether a particular type of care will be covered is generally this: if a physician orders it, it requires the services of a licensed healthcare provider, and its goal is to treat an acute condition, then Medicare or health insurance will cover at least a portion of its cost. If those conditions are not met, then it is not covered.

Care provided within a skilled nursing facility (SNF) is frequently an area of confusion. Up to 100 days of a short-term rehabilitative stay in a SNF while recovering from an acute illness or injury after a hospitalization will in large part be covered by Medicare, but long-term “custodial” care for an individual who requires assistance with daily tasks that cannot be provided within other settings is not, and must be paid for privately. Home health care (licensed nursing or therapy services provided on a short-term basis for rehabilitative purposes) is generally a covered health insurance/Medicare benefit, as is hospice care.

Care provided within residential care facilities, including assisted living apartments, board and care homes, continuing care retirement communities, and residential dementia care, is not covered by Medicare or other health insurance. Non-medical home care services are also not covered; this includes services to assist with activities of daily living such as bathing, toileting, and ambulating, and is often referred to as “custodial” or “private duty” care. Professional services such as those provided by a geriatric care manager or fiduciary require private payment, as do most community-based adult day programs and transportation services. These “non-medical” settings are where the majority of long term care services are provided, so thoughtful planning about how they will be financed is essential.

Next month we’ll wrap up this series with a look at the costs of long term care, and tips for developing a personal plan.

Long Term Care Planning: Bringing in a Professional

We were invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we provide a copy of the article here as well. Please share the information with someone you know who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care.

Volume IV: Bringing in a Professional

This month we continue to outline the array of options for those planning for the care of an aging or disabled loved one at home. In addition to hands-on assistance with the activities of daily living, various professional supports are available to help families navigate the maze of long term care and manage complex caregiving situations, including fiduciaries and geriatric care managers.

Professional fiduciaries are licensed individuals who serve by court appointment as guardians, conservators, or personal representatives of an estate. They may also be designated by an individual to serve as trustee, representative payee, or agent under powers of attorney. If a disabled person is no longer able to manage their finances or health care decision-making, and no family members are available or appropriate to assume this role, a fiduciary may be brought in to undertake these essential functions.

Geriatric care managers are certified specialists trained in nursing, gerontology, social work, or psychology, with expertise in issues related to aging and elder care. Services include in-home assessments and care planning, arranging and monitoring care services, 24-hour availability for assistance during emergencies, liaising with long-distance family members, and health care advocacy. For many families and professionals caring for a person with chronic physical or cognitive disabilities, a professional geriatric care manager serves as an experienced guide and resource.

For more information, visit http://www.pfac-pro.org/, or http://www.caremanager.org/.

We've now covered some basics for planning for care at home, and next month we'll explore community-based resources that can serve as a bridge between home and facility.

Care Management Featured in the New York Times

An article titled "When Elder Care Problems Escalate, You Can Hire an Expert" appeared in Saturday's New York Times Health Section (9/26/09). It provides some excellent, concrete examples of situations in which the interventions of a professional geriatric care manager can make a positive impact on the lives of elderly parents and their adult children who are caring for them. The author provides some guidelines for identifying a good match, and a list of questions to ask when interviewing a professional geriatric care manager.

We encourage families to call Elder Care Guides with their list of concerns, and the particular criteria they seek in a care manager for their aging parent. We welcome the opportunity to meet face-to-face at our office or in a parent's home at no charge, to discuss the needs and how the services of a care manager may be of assistance, and to determine whether there is a good personal "fit" between the family and the care manager.

Geriatric Care Management: A Profession, and Not Just a Business

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.

"Only the needs have changed"

My colleague Bonnie recently wrote of the concept of aging in place, which is gaining traction in the United States. Geriatric care managers are frequently consulted to help a family pull together the supports and resources that are necessary to facilitate an elder's ability to age in place. This usually means supporting an older person who wishes to remain in their family home, but can also involve facilitating a relocation to a congregate living community and ensuring that the community and its staff are prepared to adapt to the person's changing needs over time. Beyond the physical adaptations that may need to be made to a home environment, there are important psychological and emotional adaptations to be made as well, new agreements to be forged between the elder and those who care for them. As ramps are built, tubs are cut out, and grab bars are installed, it's important to remember that all physical and cognitive changes aside, who we are as we age remains essentially unchanged. William Thomas, MD, addresses this idea in his 2004 book, What Are Old People For?

"Elders whose health has declined to a substantial degree are the same people they have always been; what has changed is the manner in which they collaborate with others. Their longevity has changed the nature of their daily lives, making close cooperation essential ... the person is the same and only the needs have changed ..."

A home safety evaluation is an important feature of Elder Care Guides' assessment process. While identifying safety risks that can be mitigated through adaptations to the home, we're also looking for opportunities to foster our clients' continued development in whatever physical space they occupy. Does the home provide opportunities for the elder to safely pursue their interests and passions, and maintain relationships with others? Can the person easily access their much-beloved garden? Is it a space that is comfortable for their grandchildren to visit? 

While different relationships of give-and-take are being negotiated between elders and their spouses or children, or new relationships with paid caregivers and/or facility staff are being established, maintaining our focus on the essence of that recipient of care - who they have always been and continue to be - ensures that we will create a modified environment that supports their continued development as an elder. 

Restraint Use Declining in Nursing Homes

There was an article in USA Today recently that described a decline in the use of restraints in nursing homes in the United States. This is good news for nursing home residents across the country, and for those of us who advocate for seniors.

Restraints were once commonly used in nursing facilities to control the behaviors of residents with dementia or other psychiatric conditions and to prevent falls. The use of restraints in facilities has declined over time, but education is still needed to help families and health care professionals seek alternatives. In fact, California is one of the U.S. states with the most room for improvement. The most recent data from Medicare in 2007 indicated that 10% of nursing home residents in CA were restrained, while the national average was 5.5%

What is a restraint? The National Consumer Voice for Quality Long-Term Care (NCCNHR) defines a physical restraint as an object or device that an individual cannot remove easily and which restricts freedom of movement or normal access to one's body. Common restraints include: seat belts on wheelchairs, vest restraints, geri-chairs, hand mitts, side rails and lap trays.

Many families and health care providers believe that restraints help nursing home patients to be "safer," though research shows that often times the opposite is true: individuals who are agitated frequently become more agitated when they are restrained. Behavioral approaches such as validation and redirection, as well as activity engagement, can often help agitated people to become less agitated.

As a Geriatric Care Manager monitoring the well-being of clients in nursing homes and in the home setting, it is my responsibility to advocate for no restraint use, or minimal restraint use that is re-evaluated frequently and discontinued as soon as possible.

Finding the Right Nursing Home

This morning's Today Show (NBC) featured an interview with Sarah Baldauf, who wrote a comprehensive, step-by-step guide to finding the right nursing home for U.S. News & World Report. Click here to read the article and watch the video.