Geriatric CM is a fast-growing field

As baby boomers age, the need will become acute

The profession of geriatric care manager has evolved because of the tremendous challenges that health care professionals and families face in managing the care of senior citizens, says Beverly Bernstein Joie, MS, CMC, president of Elder Connections in Philadelphia.

"In the 1980s, a group of social workers saw that seniors were in and out of the hospital frequently because of problems at home. Our profession tries to keep people safely in their homes. It's one thing to take care of a senior's physical problems but there are a lot of other dimensions to providing care," Joie says.

It's a profession that has been rapidly growing as today's senior citizens outlive their counterparts of a generation ago. As the baby boomer population ages and the health care field is challenged to provide care for them, the need for this niche profession is likely to increase.

Geriatric care managers usually are hired by the children of senior citizens and are paid an hourly fee for their services.

"A geriatric care manager is the middle link who can provide family members with peace of mind by assessing the situation, identifying the senior's needs, and helping them connect with the services they need. We have a vast knowledge base of gerontology, including medical problems, pharmaceutical problems, and mental health issues faced by the elderly. We can identify what the patient needs and communicate their condition to all the health care providers," says Susan Fleischer, LCSW, DCSW, CSWM, CMC, chief operating officer for Rona Bartelstone Care Management and Home Healthcare in Fort Lauderdale, FL.

The services of geriatric care managers are needed especially in areas where there are a lot of retirees with children living in other parts of the country, says Pearlbea LaBier, MSW, ACSW, owner of Elder Options, a Washington, DC, geriatric care management firm.

"Adult children find themselves flying back and forth through one crisis after another. They can't stay on top of their parents' problems and need someone locally to manage the situation and provide them with information," she says.

When adult children talk to their parents and things don't seem right or they visit and see changes they don't understand, they may call on a geriatric care manager to help manage the care, Joie says.

"There is a tremendous need for answers about what steps people need to take when they see a change in status with their parents," she says.

The decisions that family members will make will affect the rest of the patient's life. As a geriatric care manager, Joie often coaches families about the right thing to say when they talk to their parents.

"There are ways of communicating that are more successful. The children need to have realistic expectations and to understand what the senior is going through. Our job is to be a coach who teaches the family how to communicate to make change occur," she says.

When a geriatric care manager is called in, he or she will perform a comprehensive geriatric assessment to determine the status of the person. The assessment is conducted face-to-face wherever the senior is residing.

"I can't emphasize enough the value of face-to-face care management. Seniors don't really hear well, so phone conversations may produce accurate information or they may not be able to process all the information you give them," says Amy Siegel, RN, CCM, CRRN, owner of Advocare Geriatric Care Management of South Florida, `with headquarters in Fort Lauderdale.

In some cases, the geriatric care manager conducts the assessment in the hospital and works with the discharge planner to develop a plan of care for the patient.

Assessment looks at many areas

The comprehensive assessment looks at many areas, including financial status, spiritual needs, legal issues, and end-of-life decisions, as well as physical health, safety in the home, and medication management.

A comprehensive geriatric assessment looks at finances to make sure the senior has the funds to cover the care they need and if they qualify for community resources.

Aging in place is important to most seniors, and they need to have the resources necessary to continue to live in their own homes.

One of the most important things that a case manager can do for an elderly client is to adequately support the resources that the senior has available, Joie says.

"When people get to be a certain age, all their money is going out and not coming in. I don't like to see people make mistakes on where to spend money," she says.

A legal assessment ensures that the seniors have advanced directives and a living will in place and that they have designated someone who can have power of attorney.

The care managers conduct a medication assessment, but it's more than just asking the senior what they're taking.

"We look in the kitchen, the bathroom, the bedroom to make sure we identify every medication that the client is taking. We call on a pharmacist to evaluate all the medications we find and advocate with the client's doctors and other health care professionals about what we find," Fleischer says.

Home assessment

Seniors often have safety issues in their homes or physical disabilities that impair their ability to complete the activities of daily living, such as personal grooming, toileting, or dressing without some assistance. Or, they may need total hands-on assistance — someone who can cook, clean, and take them to the doctor.

"When a care manager goes into the home, they can see what really happens. We're kind of like Sherlock Holmes in our clients' lives and homes, putting together clues and discovering minor changes that may cause a major change in the future," she says. "We become the eyes and ears for the doctor and for the family members," Fleischer says.

After the assessment is completed, the geriatric care manager develops an individual plan for the client that includes setting up any community resources needed, such as food deliveries or transportation to and from the doctor or a senior center. They call in consultants, such as financial gerontologists or life care planners, when necessary, and develop a timetable for when they'll be back in touch.

"One client may need to be seen in the home once a week. Another may require a phone call once a week and a visit each month. We develop an individual plan that can change at any moment, based on problems and issues," Siegel says.

Resources

For more information about geriatric case managment, contact: