When You Need Help Navigating Senior Care
by Nanci Hellmich
For years, Helene Solomon juggled running her public relations company in Boston and supervising the medical care of her parents in New York City. When her father’s medical problems started to increase, she helped her mother set up her father’s doctor appointments, keep track of his health issues, and hire home caregivers. She raced to the hospital during emergencies.
Then things really snowballed. First, he had a bad fall that caused a head injury and landed him in the emergency room. A few years later, he was back in the hospital with the early stages of colon cancer and signs of cognitive decline.
The competing demands left Solomon frazzled. “I navigated it all until I reached a breaking point. Then I hit the panic button in terms of needing extra help,” she says.
A colleague recommended she consider hiring a geriatric care manager, and Solomon reached out to Nancy Avitabile, owner of Urban Eldercare in New York City. She has a master’s degree in social work and a post-master’s certificate in gerontology.
Avitabile began with a home visit to see Solomon’s father, 93, in his own environment and assess his needs. She raised concerns that he might be overmedicated. She recommended that he see a geriatric medical specialist to evaluate his prescription medications.
She took over hiring and monitoring the home caregivers and found day programs for him to attend, as well as other government services available to the World War II veteran.
Avitabile now accompanies the elderly couple to doctors’ appointments, tells the physicians about Solomon’s concerns, and reports back to her. Plus, she’s on call if the couple has a medical emergency.
Solomon’s father and mother still live in the home they have been in since they got married, partly thanks to Avitabile.
Her help has been incredibly valuable on many levels, Solomon says. “Unless you are making this a full-time job, it’s hard to go through this journey without help.”
Avitabile is part of a field of specialists who act as guides and advocates for families who are caring for older relatives, disabled adults, or others with chronic health problems or ongoing medical challenges.
They go by many different titles, including geriatric care managers, aging life care managers, care managers, aging life care professionals, geriatric wellness coordinators, and nurse care managers. They often have degrees in nursing, social work, psychology, geriatrics, or gerontology. Many are certified by one of several different professional organizations.
They provide a wide variety of services, including health and medical assessments, caregiver supervision, crisis intervention, medical-care coordination, and medical-care and housing advocacy, says Avitabile, president of the Aging Life Care Association, formerly known as the National Association of Professional Geriatric Care Managers.
They are usually hired by adult children who want help with their parents, but others, such as attorneys, physicians, trust officers, and wealth management advisors, also reach out to them on behalf of clients.
“We are in a unique position to provide objective, realistic, and honest guidance to the family,” Avitabile says. “We are always working in the best interest of the person in need.”
Kathleen Dempsey, a care manager, a nurse, and owner of Pathfinder Care Management in Minneapolis, Minnesota, agrees. “We are the quarterback of the team that cares for the client, including the family, physicians, home-care companies, assisted-living professionals, home caregivers, and others.”
Assessing the Situation
When aging life care professionals get a new client, they usually do an initial assessment, including evaluating physical and cognitive functioning, medical history, living arrangements, support systems, home safety, lifestyle preferences, financial resources, and other issues.
That assessment helps them decide what living situation is best for the senior—aging in place at home, a residential living arrangement, an assisted-living facility, a nursing home, or a memory care center. “I spend a lot of time assessing the appropriateness of a move, because often relocating is unnecessary. I want to find the absolute best option for the client,” Avitabile says.
Care managers create an action plan, discuss it with family members to make sure it meets their expectations, and implement it. The plan may include hiring and monitoring home caregivers.
“It’s an overview,” Avitabile says. “We need to know what resources we’re working with in order to make the right recommendations. We want the recommendations to stick, and we don’t want them to run out of money.”
“Aging life care professionals generally don’t do the day-to-day personal care,” she says. “If we have created a good, solid plan of action and have excellent communication with the family, then the aides can provide the hands-on care.”
Offering Comprehensive Services
Some families want comprehensive services for their relatives, including having the care manager accompany their family member to doctor appointments and providing the family with a full report of what transpired. They also want the care manager to make visits each week to the client’s home or living facility to make sure everything is going well.
It’s reassuring to adult children to have someone drop in to see their parent a couple of times a week, Dempsey says. “We are the eyes and ears for the family members who aren’t there but want to know how their parent is doing.” If a client has to be taken to the emergency room, a care manager goes with them, she says. “We are available 24 hours a day for them.”
There are other families looking for general guidance rather than full-service managed care. Dempsey works with adult children who want a two-hour consultation either because they need direction for the care of their parent or because they want a sounding board for the plan they’ve worked out on their own.
Sometimes families are overwhelmed by the number of different facilities in the community, and they want an expert’s help to pick the best place for their family member, she says.
Getting Needed Help
Tracy Plowman of New York City has used the services of two aging life care professionals.
She was spending at least 30 hours a week on the phone trying to handle medical and personal issues for an aging relative who lives in the Southwest when she discovered her relative was having health problems because she wasn’t taking her medications properly. “That’s when the light bulb went off for me, and I realized I needed help,” she says.
Plowman hired a geriatric wellness coordinator, a registered nurse who has an advanced degree in gerontology, to supervise the woman’s medical care.
The coordinator found a new, attentive doctor who got the woman’s medications straightened out, and she set up an electronic medication device that disburses prescription medications twice a day based on a pre-set schedule.
The coordinator oversees aides who make sure the woman eats enough, drinks plenty of water, and takes her medications. They take her grocery shopping and out to lunch, drive her to her weekly hair appointment, and even make sure her cats are being cared for.
As a result of these changes, the woman’s health is much better.
Plowman recently consulted with Avitabile about the best options for her 87-year-old father who is living with her in New York. “She gave me all the general information and resources I needed to help my dad.”
Plowman wishes she had known about geriatric wellness coordinators when she helped two other aging relatives navigate their senior years. “If I had known about geriatric wellness coordinators then, it would have enhanced their lives and saved me hundreds of hours.”
Weighing the Costs
The cost of a care manager varies widely depending on the area of the country, but generally the rate is between $100 and $225 an hour, Avitabile says. The services are not covered by insurance, Medicare, or Medicaid, so most families pay for it themselves, she says. Occasionally long-term care will cover some care coordination.
Avitabile recommends looking for an aging life care manager who has formal training, is a member of a professional group like the Aging Life Care Association, and holds a certification from an organization. “I can’t emphasize enough how important it is to check out a person’s qualifications before you hire them,” she says.
In the long run, care managers can save people money by providing the appropriate services at the appropriate time, Dempsey says. “We are proactive helping them avoid crises and emergencies. We help establish a stable situation and keep it stable.”
Solomon agrees that the payoff of hiring a geriatric care manager has been huge. “It’s both a service and investment,” she says. “It’s an investment in the quality of life it provides for my parents and my brother and me, and it’s also doing a real service for all of us.”
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