Bunni Dybnis is director of professional services with LivHome (http://www.livhome.com) one of the largest providers of services for seniors and their families. Ms. Dybnis is on the board of directors of the National Association of Professional Geriatric Care Managers which certifies qualified professionals. Here she offers expert insight and advice on how to navigate geriatric services.
Q. What is a geriatric care manager?
A. Geriatric care managers are professionals that specialize in helping older adults and their families. They're typically people with nursing, social work, gerontology, or mental health backgrounds.
They get called to find solutions that can be as simple as going out into the elder's home after hearing what the issues are. Geriatric care managers do an assessment--create a roadmap or plan for the client. The plan can include full-time supervision, mediation, and oversight for the client.
Q. When do families typically reach out to a geriatric care manager?
A. Although contacted when there are minor concerns, care managers are often hired when situations become critical. There are three major instances:
- Families want to do the right thing, but are not sure what it is.
- Adult children live at a distance or are overwhelmed due to other responsibilities, such as their careers or families.
- Family members are in conflict or there is dysfunction (where parents should live, safety vs. autonomy, end of life decisions, spending, resistance by parent, suspected abuse or undue influence). Even though most of intervention is with older adults, it really is the support of what care manager's call "the client committee": the professional, the family, and the client.
Q. Describe the special certifications a family should look for in their care manager?
A. There is certification through the National Association of Professional Geriatric Care Managers. This is an organization that has been dealing with private care management since 1989. In this field, there is not licensing, but there are standards of practice that are certified. Most care managers are often licensed in another profession. When choosing a care manager, look not only for certification, but also their level of experience, education and knowledge.
Q. How would a family find the right geriatric care manager for their needs?
A. A good starting point is the website for the National Association of Professional Geriatric Care Managers. (http://www.caremanager.org/) In order for care managers to be a full member they must have a certification from one of four certifying bodies.
Q. Describe some of the benefits in using a care manager to navigate senior services.
A. The number one benefit is objectivity. Care managers have the knowledge, the experience, and the understanding of the main issues, including specific programs, like Veteran Affairs, senior housing, government benefits, and so on. Most family members can't dedicate the amount of time necessary to deal with all the caregiving issues but a care manager is hired to support the family- and the loved one - to get the best care available.
What typically happens is a family member will fly into town. They may spend two weeks trying to access all the information possible, visiting various senior centers. You can do it, but it takes a long time. You may also miss something. At a time of crisis, when family members are short on time and knowledge, care managers are well equipped to assist family members in making the best decisions for their loved ones.
Q. Seniors who need help sometimes do not want to admit they need help. When does a family need to intervene?
Typically, care managers get calls early on from adult children that have some concern--maybe mom is slowing down, maybe she's fallen a few times. Nothing very serious has happened except that mom or dad is getting a bit forgetful. Mom or dad wants to hold on to their independence.
But at some point, it hits a level of crisis and then a care manager will get a call that they have fallen and they've broken their hip; or the neighbor is calling because mom or dad has been locked out of their house several times; or they're involved in some kind of elder abuse scam where someone has taken advantage of their finances. Also, many times there are issues between family members, such as adult protective services calling because the senior is neglecting himself or herself. So now the care manager can't wait any longer. Even though some calls come in earlier, 90% of calls are crisis generated.
Q. How much does it cost to hire a geriatric care manager?
A. Assessments can range from about $250-$1000 depending on the time involved, the complexity of the case and whether a written report or formal legal document is necessary. They can either be charged at an hourly rate or flat fee. Rates for care managers can be anywhere from under $100/hr in rural areas to upwards of $250/hr in cities like Manhattan. The average tends to be between $100-$150/hr.
In many instances, care managers, using their experiences and resources, can step in to support the family at a critical time in their search for the best care for their loved one.