What is Geriatric Care Management?
Geriatric Care Management, also known as Aging Life Care Professionals, is a profession which provides a holistic approach for elders and other dependent adults. Areas of focus are: caregiving and family, health and safety, values and well-being, advocacy, housing, legal, financial, local and national resources, and crisis intervention.
What is the difference between Geriatric Care Managers and Aging Life Care Professionals?
They are the same. Our National Association, Aging Life Care Association www.aginglifecare.org, several years ago changed the name in an effort to clarify what we do as a profession and separate us from those who call themselves geriatric care managers or care managers for the elderly and various other names or state in their advertising they provide geriatric care management, without the credentials.
What are the credentials for Geriatric Care Managers?
Most Geriatric Care Managers have expertise in a related profession, that they bring to their work. We are Registered Nurses, Marriage and Family Therapists, Social Workers, Gerontologists, Physical Therapists and from other associated fields. We carry the license, credential or certification those professions require.
Additionally, in order to join the Aging Life Care Association (ALCA), our national professional organization, they must have an additional credential. Either from the National Academy of Certified Care Managers (NACCM), Commission for Case Manager Certification (CCMC) or the National Association of Social Workers (NASW).
Also, we are required to update our clinical skills through annual education. ALCA as well has professional and ethical standards required of its members.
When you hire a GCM that is a member of ALCA, you know you have someone with the necessary education, experience and expertise to serve you and your family well.
Why do families hire Geriatric Care Managers?
The reasons vary. Very often family reach out to a GCM as they are concerned about something or many things. By far it is best if the spouse or adult children (or other family or very close friends) reach out early, when concerns are small. As always, issues are much easier and less expensive to address early, before they become a complex burden or an actual crisis.
However, we do have families reach out when a situation has been going on for many years and the problems are complex and significant.
And I do get the occasional call from families in a crisis situation. For example, their loved one is being discharged from the hospital much sicker than before they went in and they do not know what to do. Or the primary caregiver is sick or is recently deceased. Those are the most painful cases; as time is short, options are few and it is likely going to be very expensive for needed services. It is always better to reach out and get an assessment and care plan sooner rather than later.
Who is the GCM’s client?
The family member who hires and agrees to pay the GCM is their client AND the elder is their client. Sometimes, but not very often, it is the same person.
The GCM is mandated to work in the best interests of the elder and the primary caregiver.
How are GCM’s paid?
Geriatric Care Management is almost always paid for privately. This means the family pay for the services. If they have access to the elders’ finances, they often use that, as the service does benefit the elder directly.
One exception is that some Long-Term Care Insurance policies pay for limited geriatric care management. If you are fortunate enough to have a long-term care policy, check with them. If your plan does cover GCM work, they will reimburse you some or all of the costs. The GCM is paid up front for services. The family must wait to be reimbursed from the LTC company. GCM’s will submit any needed documentation for the policy to pay the claims.
Does Health Insurance, or Employee Benefit Plans pay for Geriatric Care Management?
No, at least not yet. I am unaware of any entity or program that pays for geriatric care management, except some long-term care insurance policies.
Do GCM’s accept referral fees from long term care facilities, like assisted living or nursing homes?
By our ethical standards, we are precluded from accepting fees for referring our clients to particular care facilities. This way you know, when we recommend certain places, we are doing so because we believe it is the best fit for your loved one.
Are GCM’s the same as Placement companies? Like A Place for Mom, for example?
No. We do not accept fees from the facility for referring families to them.
I will say that placement companies serve a needed function. If the situation is straightforward with no issues, and all they want is some housing options to choose from, I have referred families to placement companies.
For example, IF the senior is fine with moving to long term care, they have no behavior issues, family are united with the course of action and if a responsible and available family member is nearby the new home to assist with the inevitable challenges, I will refer them to a placement company.
This is especially If families (and the elders) have little resources and are looking for the least expensive Board and Care Homes.
Do GCM’s offer coaching on how to make things happen in the best interests of the elder?
Absolutely yes. This is what we do. Based on our experience we coach on a variety of issues. From family dynamics to dementia and other health issues, to ER and hospital and rehab issues, to how to work effectively with other professionals and what questions to ask.
I had a client recently who was prescribed an anti-depressant for anxiety (very common) and stopped the medication after the first month as they thought that was all that was needed. In this case GCM’s can help avoid these misunderstandings and educate families on the reasons for the prescriptions and being in the room with the doctor and patient can clarify the need and how medications should be taken. When we are involved, things typically go smoother.
What is the process once we hire a GCM?
Most GCM’s will start by conducting an assessment and careplan. This will often consist of interviewing all the stakeholders, especially the elder(s) themselves. Typically, this involves the person who hired us, usually an adult child, any other involved family members, other professionals, such as physical therapists and of course, repeated interviews with the elder(s). If they have paid caregivers or reside in a care home, we would talk with them as well.
We will request a list of medical conditions and medications. Information on any recent ER visits, hospitalizations and/or rehabilitation facility stays and any relevant medical records details. We ask for very general financial information to help determine the ability to afford the current care costs and the future care costs. We ask about veteran status and other questions to educate families on all potential resources available.
We work on obtaining as much relevant information to gain a holistic assessment of the needs of the elder and their primary caregiver(s). I provide a professional report at the end of the assessment and care plan that includes current recommendations and future resources. This process takes two to three weeks, which is dependent on the availability of those I need to interview and any requested records.
What is NOT included in the Assessment and Careplan?
Most GCM’s will not entertain past family challenges in the assessment process. I say to families, “I do not do decades of dysfunction.” I only want to hear about what is happening now in regards to the elder and people’s roles in their lives. What they bring to the table.
What is the typical cost of the assessment and careplan?
The cost is different for each GCM and should be discussed before engaging in the assessment and careplan.
I charge $1000. This way the family knows the cost and does not have to be concerned about a bill much larger than they anticipated. This model has also helped with my being able to obtain what I need, as family are not reluctant to engage for concern elevating the cost.
What is the typical hourly cost for Geriatric Care Management?
The hourly fee ranges from $100 to $250 per hour. I charge $100.
What if the family or elder cannot afford this cost?
For those that qualify for the low-income and asset federal program, Medicaid (called Medi-Cal in California), you are assigned a social worker. See if you qualify here: https://www.cms.gov/
For those who do not qualify for Medicaid, many healthcare plans, such as Dignity, offer limited care management for their patients.
For those with Mental Illness, there are social workers through local agencies that are often free or low cost. You can find them through AAA (below).
For those who qualify for hospice, you will be provided care management through the social worker assigned to your case.
Also, some counties, cities or community centers/ senior centers offer limited free or low-cost care management. Call your local Area Agency on Aging to locate them. This is a national program and can be reached here:
For California here: https://aging.ca.gov/Providers_and_Partners/Area_Agencies_on_Aging/
There is also Elder Locator here:
What happens after the assessment and careplan?
Once the report is delivered, family decide if they wish to continue working with me at my hourly rate.
Most do and we work together on implementing the care plan in reasonable stages. As you might imagine, there is more time invested in the beginning and then as the situation stabilizes, we typically go to maintenance. Maintenance for me is 1 hour per month. This can be done in-person, phone or Zoom. I require in person with the elder at least once a quarter.
Is there a minimum number of hours per month or quarter?
Most GCM’s require 1 hour or one visit per month. This is proactive care management and helps to avoid issues from becoming big problems. This way the GCM is aware of the elder’s status and can jump in quickly if there is an urgent development, such as an ER or hospitalization or if their medical or behavioral status changes abruptly. This model of care management helps the family shift from reaction to proaction and helps avoid suffering and costly mistakes.
Do Geriatric Care Managers (GCM’s) provide legal and financial services directly?
No, GCM’s refer to elder care attorney’s and financial and wealth consultants. We typically provide at least three resources. We often have a basic understanding of the typical issues, such as Medi-Cal and advance directives. Otherwise, we refer to the professionals in those fields.
Do GCM’s provide counseling to families?
Sometimes. If the GCM is also a Marriage and Family Therapist or another type of talk therapist they may very well offer therapy as one of their services. For those who do not have this area of expertise, we refer to a professional.
However, we do provide coaching. For example, if dad is not wanting to provide financial or medical information, we can coach on how to make that happen. Many families do not know that HIPPA does not preclude them on communicating directly with the doctor. Many families do not know the complex rules and expectations of an ER, hospitalization, rehabs and home health after a hospitalization. We do.
Our years of expertise provide a gateway for families to become more engaged and educated and to avoid suffering and costly mistakes. We also will become the advocate for the elder and family. Often if an ER, hospital, rehab or long-term care facility know a GCM is involved, this creates a streamlined and collaborative relationship for the benefit of the elder and family.
Other questions? Contact me at email@example.com or 805-441-7550.