A Helping Hand

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When an aging family member falls ill, a geriatric-care manager can be a godsend.

Two years ago, Carl Gorski, 39 years old, learned that his elderly aunt was suffering from Alzheimer's disease. A doctor told Gorski that his aunt could no longer live alone without at least some assistance. Like a good nephew, Gorski was only too happy to lend a helping hand. But there were a couple of obstacles he needed to address. He lived 400 miles away in Virginia. (She resided in New York.) And he had four kids to raise.

The doctor recommended Gorski call a geriatric-care manager (GCM) to coordinate his aunt's care while he was in Virginia. Gorski, who'd never heard of GCMs before, knew he needed some assistance and took the physician's advice. The care manager helped Gorski come up with a short-term plan using home health-care aides until he could move his aunt closer to where he lives.

Then he called Linda Aufderhaar, a GCM based in Fairfax, Va., to help him transition his aunt into an assisted-living facility that specializes in Alzheimer's patients. He also hired her to monitor her care and help out whenever emergences arise.

"I can call (Aufderhaar) at any time," Gorski says. "With four kids, I have a pretty busy schedule. It's nice to know there's someone there when I can't be in two places at once. She can help take the burden off."

Gorski isn't alone. There are some 50 million Americans caring for loved ones, according to the National Family Caregivers Association. Seven million of them are caring for a relative who lives far away. If you find yourself a member of this club, know that help is just a phone call away. While a GCM can never take the place of a loving family member, he or she can ease the burden that contributes to 50% of care givers reporting at least some level of burnout.

What's a GCM? Think of it as your own private consultant who can help guide you through the highly complex and fragmented health-care and long-term-care systems. GCMs are usually nurses or social workers. Their primary functions are threefold. First, they assess the situation. A practitioner will meet with the elderly family member (who's referred to as the client) and the family caregiver to determine what health-care services are necessary.

A GCM will then develop a plan that will ensure that all of the client's needs are met. And if the caregiver wants some added assistance, the care manager will even make the phone calls and set the program in motion. He or she can supply the names of the three best home health-care agencies in the area, or go so far as to hire an appropriate aide for the client.

For an added fee, a GCM can also monitor the client's care. This is especially helpful for people who live far from Mom or Dad. This service includes everything from stopping by unannounced — a strategy that's sure to keep aides on their toes — to attending a nursing home's monthly case-planning meetings and monitoring the daily log to ensure the client is getting the medications he or she needs.

"When a facility knows someone is coming in, visiting, keeping an eye on the situation, the data shows that (the patient) gets better attention," says Steven Barlam, a Los Angeles-based GCM.

How much will this cost? GCMs typically bill their services by the hour. Customers should expect hourly fees ranging from $100 to $250, says Barlam. Many practitioners will, however, charge a flat fee of $250 to $500 for an initial evaluation. While such fees may seem expensive, experts argue that a care manager can save people money. How? GCMs are well-versed in pubic benefits and can put clients in touch with free services in the community. They're usually knowledgeable when it comes to long-term-care policies and Medicare's ever-changing rules as well.

Aufderhaar, for example, saved one client some money by debunking the myth that home care is cheaper than therapy in a nursing-home setting. After a client fell down and broke her hip, the client's son thought it would be more cost effective for his mother to move back home and hire home health-care aides. What he didn't realize, says Aufderhaar, was that Medicare would pick up the bill if she went to a nursing home to recover. While the government health-insurance plan would also cover some home therapy, in that case she'd still need to hire someone to help her with other daily living activities.

Even in less acute situations, GCMs can save clients money. "Often we will walk into a situation where someone has employed the wrong level of care, care that doesn't match their needs, and they are paying through the teeth," Barlam says. It's not uncommon, he says, for a family to employ a pricey registered nurse when only a housekeeper or home health-care aide is necessary.

When's the best time to hire a GCM? Lenise Dolen, a GCM based in Tarrytown, N.Y., says she gets most of her calls when a family is in crisis — say, a parent has fallen down and can no longer live alone. In these situations, a care manager can be a godsend, making all the necessary calls that would take family members hours to accomplish. Ideally, however, it's better not to wait for the crisis, says Dolen.

Finding a Good GCM
There's nothing more valuable than a good recommendation. Consumers should ask friends and neighbors, hospitals, and elder-care attorneys for the names of people they've worked with in the past. They can also go onto the National Association of Professional Geriatric Care Managers' Web site and search through the directory.

When interviewing GCMs, consumers should realize that practitioners have different specialties. A nurse, for example, might be better attuned to monitoring Alzheimer's than coordinating adult daycare-center visits. And just like hiring any consultant, a good fit personality-wise is almost as important as a candidate with the perfect credentials. Keep in mind that you need a professional who'll get along with you and your loved one. For more guidance and a list of questions to ask a prospective GCM, go to the national association's Web site.

Like financial planners, GCMs aren't regulated. Anyone can hang out a shingle and call himself a geriatric-care manager. And as the industry grows, more and more unqualified people are likely to don the title. To differentiate themselves from the opportunists, trained GCMs are joining the NAPGCM, which has a strict ethical code and standards of practice for its members. There are also two major certifications that sprung up during the 1990s: a Care Manager Certified (CMC) and a Certified Case Manager (CCM). Since certification is still in its early stages, the best you may be able to hope for is finding someone who's licensed in their other profession, usually nursing or social work.

As we mentioned earlier, GCMs charge by the hour. Problems can arise, however, when a care manager calls to discuss a client and gets to chatting. Such pleasantries can be costly. AARP's Elizabeth Clemmer learned this the hard way. She really liked the GCM she hired to help her care for her father. So when the care manager would call, she never thought to cut the conversation short. Then she received the bill. "I think you have to remember this is a business," Clemmer says. "She is selling a skill, not a fixed-price service." In the future, Clemmer says, she'll ask more questions about pricing — specifically regarding phone consultations.

Once you work out the financial side of the equation, you can focus on the benefits a care manager can provide. The biggest one Gorski discovered was that, with a GCM's assistance, he could stop worrying about his aunt's care and focus on enjoying his visits with her. That kind of peace of mind is priceless.