Monday, August 31, 2009

The Elderly: Finding a Good Geriatric Care Manager

Such professionals can be a tremendous help if you're trying to take care of ailing parents but live far away

By Lauren Young

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On a Tuesday night in late July, Jon Meyers, 42, got the call every child with an elderly parent dreads. His 84-year-old mother, Ruth, who suffers from dementia, had fallen in her kitchen and was heading to a New Jersey hospital by ambulance. But instead of agonizing over not being able to get there quickly—it's four hours from his home in Washington, D.C., to Point Pleasant, N.J.—Meyers took comfort in the fact that Stephen Mielach, a geriatric care manager, was following the ambulance, ready to take control.

Before 2007, Meyers had never heard of geriatric care managers (also called geriatric case managers). But then his mother developed problems that required hospitalization, and Meyers couldn't keep taking days off from his job as an art director at the Cato Institute, a Washington think tank. On the recommendation of his mother's physician, Meyers, an only child, hired Mielach. He accompanies Meyer's mother on doctor visits, looks after her dog on occasion, and even helped with the paperwork for a reverse mortgage so that she could stay in her home.

The role of a geriatric care manager goes well beyond that of a home health aide. The primary job of home health aides is to administer medication and provide companionship. By contrast, care managers oversee many things busy or far-flung family members might not be able to stay on top of: vetting nursing homes and assisted living facilities, overseeing home health aides, providing guidance about applying for federal, state, and other benefits. They may also tend to more day-to-day tasks, like making sure that rugs in a parent's home don't slip and that refrigerators are stocked.

An estimated 7 million people care for adult relatives from a distance, according to the National Alliance for Caregiving. On top of the logistical benefits of hiring a care manager, preliminary research indicates that elderly patients who have a geriatric care manager get more thorough care than patients who do not. Evercare by UnitedHealthcare (UNH), which hooks up patients with care managers, conducted the research in conjunction with Santa Monica (Calif.) think tank Rand Corp.


What kind of expertise do geriatric case managers bring to the table? They often have some background in nursing or social work. Linda Fodrini-Johnson, president-elect of the National Association of Professional Geriatric Care Managers, estimates that 35% of the group's 2,000 members have nursing degrees and 50% have social work or counseling backgrounds. The other 15% have experience in fields such as physical therapy or occupational therapy, or have advanced degrees in gerontology and related fields.

When choosing a care manager, find one with experience dealing with issues similar to those of your relative. If a parent has a complicated medical history, consider hiring someone with a nursing background to coordinate care among doctors, who often don't talk with each other, says Julie Davis, managing editor of, a caregiving Web site. And make sure there is good chemistry with your family.

The network of caregivers in most communities is fairly small, and many people say the best referrals come from their parent's doctor, local hospital, or nursing home. Jan Rosenbaum, 53, a molecular pharmacologist working in the life sciences group at CincyTech in Cincinnati, which invests in technology startups, got a recommendation from a psychologist working at her dad's independent living facility in Orange County, Calif. "We were concerned—and rightly so—that the facility would not be paying careful attention to the details of his case and that as his memory worsened, he might not be properly understanding or communicating everything the doctors were saying," she says.

Rosenbaum's advice is to include the elderly parent in the selection process—after all, he or she is the one who will have the most direct contact with the professional caregiver. " The relationship will only work once a high level of trust is established between the two of them," says Rosenbaum.

It's also a good idea to ask potential care managers if they receive financial incentives from nursing homes or other providers for directing clients there. "Make sure you are dealing with a care manager who is most concerned with recommending the appropriate care for your parent vs. someone who might have a special financial relationship with a facility," says Paul Hogan, co-author of Stages of Senior Care (McGraw-Hill), to be published this November.

Caregivers kick off the process with an assessment. This includes a review of the medical history, and, if your parent is living at home, an evaluation of the setup, looking at stairs, lighting, and other issues. Care managers may even take a peek at the checkbook to find out if bills are being paid on time (some people give care managers power of attorney and the right to make medical decisions, but that's unusual).

Hiring one of these professionals isn't cheap. Initial assessments, which last a few hours, range from $200 to $850, depending where you live. Hourly rates can range from $80 to $200. While most payments are out-of-pocket, check your parent's long-term care insurance policy to see if it covers the expense, and check your employer's elder-care benefits.

In the end, finding someone to help you take care of an elderly relative can benefit your health as well as theirs. Suzanne and Peter Cooper of Upper Saddle River, N.J., are raising their five-year-old son while living with her 84-year-old mother, Irma, who has Alzheimer's disease. Suzanne, 49, says her own mental and physical state has improved dramatically since she hired Nancy Bortinger, the director of geriatric services at Vantage Health System in Dumont, N.J.

Bortinger plowed through a list of 20 local day-care facilities to get Suzanne's mother out of the house for stimulation and socialization. Now Bortinger is helping Suzanne place Irma in a respite care center for a week while the family takes a much needed vacation. Suzanne equates the role of a geriatric care manager with a global positioning system for your car. "Even if you have maps in the glove compartment, the GPS gets you right to the place you need to get to," she says.

To see a geriatric care manager discuss her role in assisting families with caregiving, go to

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