As a director of a geriatric care management company, I am often requested to provide an overview our services. Because the role and scope of a geriatric care manager can vary greatly depending on the needs of the specific client, I have typically responded with a short list of the important tasks we perform on behalf of our client families, as well as a general description of our staff’s credentials.
Care Management Defined
I was recently asked by the owner of a home care agency to provide a concise definition of care management. As my mind struggled to synthesize and condense our very intensive and responsible role into a single phrase, I found it very difficult to compress so much energy and action into a few words. Upon further reflection, this is the most accurate and succinct definition I could provide:
“Care management is the proactive use of family and community resources to optimize health and well-being.”
Let’s take a moment to peel the onion and examine the key words in the definition of care management – especially as it relates to the field of private geriatric care management.
Proactive Use – Don’t Wait for a Crisis
It is our experience that many families wait too long to consult a care manager. Very often we are called by the “adult kids” after a crisis arises, and Mom or Dad were faced with an emergency visit to the ER or an unexpected hospitalization. Why? Seniors prize their independence, and many times resist the probes and questions from well-meaning family members. It is difficult for a family member to know when a senior says that “the doctor didn’t say very much” whether they are hiding information or simply could not remember what the doctor said.
At the request of the family, a geriatric care manager can perform a comprehensive assessment. This is a proactive evaluation of a client’s situation, which at a minimum should cover specific areas such as medical history, home safety, cognitive abilities, and socialization. Additional areas for investigation and review may include financial and legal issues such as the existence of appropriate documents such as health care surrogate and power of attorney if appropriate. By being proactive, a care manager can recognize telltale signs and head off a crisis before it starts.
Family & Community Resources – Value of a Local Expert
With “internet expertise” abounding, one may arrive at the logical conclusion that there is sufficient information on social and medical resources to “do it yourself.” There is certainly much that the extended family can do to support a loved one, and we always encourage their active involvement.
There are a couple of catches. First, it’s easy to obtain a comprehensive list of local resources such as acute rehab facilities, assisted living, or specific specialists such as geriatric psychiatrists. What is more difficult is determining the quality of these resources. To play on an old adage, you will find many resources that are high quality, readily available, and cost effective – just pick two out of the three.
The accessibility, quality, and ultimately the real value of these local resources is best understood by a professional that has multiple real life experiences using them. We were contacted by two sisters after six weeks of an exhaustive search to find an acute care facility that would meet their father’s requirements as he was discharged from a ninety day hospital stay. Highly educated and extremely savvy, they took a self-directed approach using half dozen local resource publications and the internet to conduct their search. They made several hundred calls and met with multiple facilities, but after two months of searching, had reached a dead end. A professional care manager, utilizing their local knowledge and contacts in the health care field, was able to find an overlooked viable option within an hour.
A top tier geriatric care manager provides value to a family because they are much more than a static list of hospitals, doctors, and living facilities. Their role includes understanding the financial constraints of the family, and matching community resources to their needs. A care manager with a deep understanding of the care continuum and extensive knowledge of resources in the community will provide options of which the layperson is unaware.
Optimize Health & Well Being –
Many elder clients resist the involvement of an adult child in their health and living affairs, at times due to their reluctance to burden their children, others simply from their preference for personal privacy. This point of resistance may be the best time to introduce the services of a third party professional.
Because the care manager is considered an arms-length professional, the potential negative perception of a child “parenting their parent” is mitigated. Many times a parent will more openly share their feelings of concern with a knowledgeable expert in the field.
It is important to pick a professional who not only can serve as an effective listener, but also has the skill sets and credentials to make immediate recommendations to optimize both their health and well being. For example, when dealing with geriatric psycho-social issues, a social worker or RN with formal training and background in psych may be best prepared to assist. When dealing with serious medical issues such as a stroke or traumatic injury, it may be advantageous for the family to work with a Registered Nurse or Nurse Practitioner Care Manager with experience in recovery & rehab.
Finally, in selecting a professional care manager, it is important to note that the term GCM – Geriatric Care Manager – is a generic term that describes a career path – but it is not a professional designation. Geriatric Care Managers come from a wide variety of backgrounds and professions – the most common being social work and nursing. The initials “GCM” or “CM” should not be used as a title after one’s name because it is not a certification.
At this time, the NAPGCM (National Association of Professional Geriatric Care Managers) allows anyone with an interest in care management to be a member, so it is important to look beyond a care manager’s membership and understand their professional credentials. However, the NAPGCM is currently in the process of taking important steps towards certification requirements. At this time, the NAPGCM recognizes only four certifications as a “Certified Care Manager.” They are CCM (Certified Case Manager), CMC (Care Manager, Certified), C-ASWCM (Certified Advanced Social Work Case Manager), and C-SWCM (Certified Social Work Case Manager).