Elder Care: Focuse on Care Managers

I've written a couple of posts on caregivers for the elderly and infirm. There's much that can be said on that subject and I will be returning to it. For right now, I'd like to draw attention to Care Managers who assist caregivers for the aged, those with dementia and others.

A Care Manager is an essential element of the parental eldercare package. This is particularly so for those who live far away from their parent, or who are so tremendously busy with work and family that they cannot do all the things that their parent needs. I also want to offer my opinion that, as our parents age and lose abilities, it becomes next to impossible to know what's really going on if we're not there every day. This pertains not only to how they're doing in their home, but also to their medical care and their medical needs. I'm talking about objective information here, not the subjective view of friends and neighbors who themselves may not be fully "with it."

In my experience, a quality Care Manager becomes your surrogate, doing what you'd otherwise do if you lived nearby. They also become your advocate with various services, ensuring your parent's living situation is as good as it can be. And they can become your medical watchdog, keeping tabs on chronic and acute medical issues so that changes in health are quickly identified and treated.

So, we have:
Surrogate
Advocate
Watchdog

Phew! That's a lot to ask of one person. And where would one find such a gem anyway? I have worked with Care Managers (CMs) from two different sources: through a caregiver agency and privately.

1. Agency CMs: Many agencies who provide caregivers also assign a Care Manager to each client. Generally speaking, the agency CM's job is to be the main client contact with you, i.e., they are the one to call with new needs, complaints, changes. etc. As well, they introduce new caregivers when needed, help ensure your parent is watched if a current caregiver is unexpectedly absent, check that whatever program is in place is actually being followed, handle emergencies, and, possibly, help setup medications.
Agency CMs typically have a heavy client load, being assigned as many as 25 clients at one time. You can see immediately that, even with the best will in the world, an agency CM has only a very limited amount of time they can spend with any one client. In my view, that's a serious drawback. My experience has been that, even though agency CMs give their all to their jobs, they are able to do only very basic supervision and monitoring, along with appearing in the ER if there's an emergency, and little else. Thus, in my view an Agency CM is best suited for low-maintenance cases only.

2. Private Care Managers: Care Managers who work independently rather than under the auspices of an agency, typically do so because they want to be able to focus more attention on fewer clients. As with caregivers, there is no specific degree or certification that a CM must have in order to take on such work. However, the more capable CMs tend to have a background in nursing, geriatric care, psychology or social work, each of which provides appropriate experience and a good personality type for working with the elderly. Private CMs take the risk of potentially not always having a full workload, but gain the reward of being able to determine a client load for themselves that maximizes their ability to serve each client well. A private CM may be well-used to high-maintenance cases, or situations where your parent's needs shift over time.

Regardless of whether you use an independent or agency CM, it's up to you to establislh how much or little involvement from your CM you require. Our mother's CM is an LVN. She's a trusted resource for scheduling and attending doctor appointments, relaying the doctor's report to me, attending ER visits, checking the medications and general health info at the nurse's station at my mother's assisted living facility, keeping tabs generally on how my mother is doing, meeting with my mother's companion caregivers monthly, explaining medical procedures to me, and more. She's an excellent sounding board for ideas, because she has broader exposure to elder care issues through her work than I could possibly have. Her time may fluctuate from a few hours over 2 weeks, to much more if there's an emergency room visit to attend. She's a friend and a professional, whom we rely on implicitly.

Finding a private care manager takes some networking and interviewing. A good resource to start with is the National Association of Geriatric Care Managers http://www.caremanager.org/ Many cities have a Jewish Family Service, an invaluable resource for assistance. There's also the Social Services department at your local hospital. As with caregivers, be prepared to spend as much time as you possibly can networking for options, interviewing and talking to references.

My final suggestion is assess for yourself where a CM can make the most meaningful contribution to your time and your peace of mind. Perhaps it's attending doctor appointments only. Maybe it's just managing the caregivers you've hired. Be creative and be flexible. Give the relationship time to develop, so you can observe for yourself what your CMs strengths are. A CM can be a wonderful addition to the care team. And they become a true lifeline if something should go wrong with your parent and you can't be there.

I'd love to know about others' experience with Care Managers. Do you have anything you can share on this aspect of elder care?