Using A Care Manager To Enhance Service To Clients In An Elder Law Practice

With Americans living increasingly long lives, coping with the physical, emotional, cognitive and financial issues attendant to the aging process is a challenge faced by a growing number of elders and their loved ones. While elder law attorneys are well-equipped to navigate the legal aspects of the process, it is often helpful to turn to a care manager to address related issues involving long-term care.

The National Association of Geriatric Care Managers defines a geriatric care manager (“GCM”) as follows:

A Geriatric Care Manager is a health and human services specialist who helps families who are caring for older relatives. The Geriatric Care Manager is trained and experienced in any of several fields related to care management, including, but not limited to nursing, gerontology, social work, or psychology, with a specialized focus on issues related to aging and elder care.

The Geriatric Care Manager assists older adults and persons with disabilities in attaining their maximum functional potential. In addition, the Geriatric Care Manager is an experienced guide and resource for families of older adults and others with chronic needs, including helping those suffering from Alzheimer’s Disease or Parkinsons or exhibiting symptoms of dementia.

Although some attorneys have chosen to employ in-house professional care managers to help the attorney navigate through support systems that are available to the elder and disabled population, a more common approach is to refer the aging or disabled client to a professional care manager.

Determining When To Obtain The Help Of A Professional Care Manager

The best time to obtain the help of a professional care manager is before your client’s situation reaches the point of crisis. “Their role is essential when ‘there are a lot of decisions, the person is in the midst of a crisis or at a crossroads such as a hospitalization and it is unclear whether someone can go home.’” There can be many factors indicating the need for a professional care manager to assist in the assessment of an elder’s physical, mental, and financial situation.

For example, when families meet with an elder law attorney, they are often seeking information regarding finding–and financing–the appropriate long-term care for the elder. A professional care manager can assist the family in order to make informed decisions about the elder’s housing and care needs, and the cost of those needs. If the elder is residing at home, the GCM can assess whether the elder can continue to manage at home, and what supports will be necessary. The GCM will observe how the elder functions in the home, and what kinds of day-to-day services or care the elder may need: is he or she able to cook, navigate hallways and staircases, manage medications? Are there modifications that can be made to the home to allow the elder to navigate, even if wheelchair-bound? Will he or she require assistance with medications or food? Should “grab-bars” be added, throw rugs removed, doorways widened, stair lifts added, bedrooms moved to the first floor?

A geriatric care manager can help the elder locate and evaluate a potential home health aide, accompany the elder to medical appointments, assist in choosing and transitioning to long-term care, and help prepare Medicaid or Medicare paperwork or long-term care claims. The GCM can arrange for services such as Meals-on-Wheels, or visiting nurses services, and assistive devices such as hearing aides or lifeline devices, and are thought of as “bridging the gap” between independent living and long-term care.

Reports estimate that, of the more than five million Americans who suffer from Alzheimer’s disease, more than 75 percent live at home and receive the majority of their care from their own family members. Although family involvement is thus the norm, rather than the exception, the family dynamic may bring its own set of issues. The involvement of a professional care manager can help the family members communicate and resolve those issues.

“The care manager can take some of the brunt of the anger that can occur in a family when a decision has to be made…. They get to buffer some of the emotional stress as well as go in and unify a family when there is a long distance situation.”

For example, let’s say your brother lives in California and you’re in New York, and whatever you tell him about Mom he doesn’t believe because he doesn’t want to. Then he gets a call from the geriatric care manager, and she very factually lays out your mother’s condition. What’s going to come up in the future. What her needs are now, so your brother doesn’t have a chance to say, “Oh, that’s just my sister being hysterical or complaining.” The manager can also say, “Listen, this is too much work for one person. Let’s have a meeting or a conference call and talk about assigning responsibilities.” If siblings really can’t stand each other, they don’t even have to talk to each other. The person in the middle, the professional, can help coordinate.

How To Find A Qualified Person For The Job

When choosing a care manager, determine whether the person is a member of a national association, and find out the membership requirements of that association (master’s degree in a field such as social work or nursing; years of experience; and certifications or accreditations). Check to see if the care manager works alone or is part of a practice, and what their weekend and nighttime availability is, in cases of emergency. Obtain a brochure and schedule of fees.

The National Association of Professional Geriatric Care Managers website,, will provide a list of GCMs by zip code; clients can also seek recommendations from the elder’s doctors or local senior centers. Choosing the right care manager will involve consideration of the elder’s needs. For example, if there are complex medical issues involved, consider a care manager with a nursing background; if the elder has cognitive or behavioral issues, consider a care manager with a background in social work.

Gauging The Value Of Professional Care Management Support

GCM services are not covered by Medicaid, Medicare, or many long-term care insurance policies. One source estimates that initial assessment fees for a GCM range from $300 to $800. Services provided thereafter are billed at an hourly rate of $60 to $200.

The scope of a GCM’s retainer can be tailored to fit the needs of the client and the finances available. A GCM can be used to provide advice on a concrete issue, such as whether the elder is able to remain living at home. A more comprehensive assessment of the elder, including consulting with family and medical providers, may be obtained to provide a more complete and formal assessment of the elder’s needs, including a written report with recommendations. Continuing care may be provided by the GCM, including carrying out the GCM’s recommendations (home renovations, finding an appropriate long-term care facility).

A geriatric manager can swoop in, figure out what needs fixing and move on to the next case. Or the manager can provide continuing support for situations that cannot be resolved quickly. Because care managers charge by the hour … what you pay will be based on how long you choose to keep them on the case.