Geriatric Care Managers
Build the Bridge to Elder Law
By Beverly Bernstein Joie

Beverly is a faculty member and panelist at the
"6th Annual Legal Issues in an Age of Aging" seminar.

"Is the power of attorney I have from 1990 still valid?"
"How do I know if my father is still safe living alone?"
"Will Medicare pay for my husband's care?"
"How much would it cost me to stay in my home and have aides round the clock?"

When seniors are faced with failing health and dwindling finances, their questions are numerous and complex -- and commonly overlaid with fear, denial and family issues. Often, elder law attorneys are the first professionals to field these inquiries. Though many of these questions are not legal in nature, they are vitally important to the client's well being, and they beg to be addressed.

An elder law attorney's expertise in asset protection and estate planning is crucial to help clients protect themselves and their heirs. They design and implement a plan guided by their knowledge of Medicaid law and the appropriate timing of how, what and when specific steps must be taken. This is to insure that their client receives the best care possible considering their circumstances. Answers to the "how," "when" and "where" of care rely on a body of knowledge separate from elder law. Numerous elder law practices have incorporated geriatric care management as an integral component of their practice either informally or by hiring care managers.

Several years ago, we were contacted by an attorney after he had spent time in a drug store buying makeup for his client. That was the point in which the need for a care manager became apparent to him. The elder law attorney must decide the best use of his or her billable time and the manner in which clients are to be served. These decisions define the design of an elder law practice.

What is a geriatric care manager?

Geriatric care managers are human service professionals with degrees in social work, counseling, nursing or geriatrics. As specialists in the area of geriatrics, their work includes assessment, care planning, coordination and implementation of services with other appropriate professionals, and the monitoring of care.
These problem-solvers provide personalized service to families, typically when they are dealing with a crisis; they guide families through the process of helping their loved ones safely remain at home or finding a suitable alternative living situation. Though they are independent agents of their clients, geriatric care managers often act as surrogate family members. They are available to their clients 24 hours a day, seven days a week. Plus, they keep up with the constant changes in the long-term care industry.

How do geriatric care managers determine what a client needs?

The geriatric assessment is an in-depth, face-to-face interview performed by the care manager at the client's home. Among the issues discussed are the client's health history, medications and activities of daily living, legal issues, financial concerns and their support system. The session includes a brief mental assessment and a depression inventory. The home is explored to uncover safety issues.

As a result of the assessment, a care plan is drafted. It includes a list of the resources needed to address the client's needs. We emphasize and explain the importance of legal planning to every client we see. If we identify legal issues, we will provide a list of three elder law attorneys to contact. If we uncover a cognitive deficit, we refer the client to a geriatric psychiatric team for further testing for a definitive diagnosis. Referrals and supportive services are an integral part of each assessment.

Finally, the report is either delivered to the family in person or mailed to the client and family member if the family is not local. The report and its findings are discussed and explained.

How do you know when a geriatric care manager is needed?

Family members face the challenge of making difficult, life-altering decisions when they identify parental decline and a change becomes necessary. Long-term care is typically the most tremendous cost that a family faces. The explosion of living choices is difficult for anyone, except those in the industry, to comprehend. If a careful plan is not designed, resources can be depleted and future care can be compromised. Often, children don't have the time to devote to researching these decisions. Time constraints on two-career families are the norm, and those sandwiched between at-home children and aging parents manage a great deal of stress. Also, many families are geographically removed from one another. Each family must decide how much time and energy are available for making these decisions, investigating the options and locating appropriate resources.

Living Choices: Buyer Beware

The elder housing industry is growing at a tremendous rate, and its fluidity is noteworthy. For example, a perfectly excellent assisted-care facility or retirement community can be sold and purchased by a new company, and suddenly it no longer resembles itself. The assisted-care industry, in particular, is mostly unregulated. Consequently, the care varies greatly from place to place. In order to understand this industry, a watchful eye must be kept on it at all times.

Independent Living/Senior Residential Communities cater to the needs of empty nesters or those over 55 years of age. They tend to target younger, healthier, active seniors. They typically provide good security, transportation, dining services, banking and recreational and social activities.

Continuing Care Retirement Communities offer long-term contracts that guarantee lifelong shelter and access to health care services throughout the senior's life. In exchange, residents usually pay an entrance fee up front and regular monthly payments as long as they live. Prospective residents must meet minimum requirements based upon age, finances, income level and physical health and mobility. They enter as capable of living independently with the understanding that they will be taken care of regardless of their health condition in the future. Other types of continuing care retirement communities provide a la carte services without a life-care contract.

Assisted Living is defined as any group residential program -- not licensed as a nursing home -- that provides personal care and support services to people who need help with daily living activities as a result of physical or cognitive disabilities. They may stand alone, or be a part of a CCRC or a nursing home.
This type of living arrangement has varied names including personal care home, adult home, retirement residence and sheltered housing. These facilities may or may not provide licensed nurses and other health care professionals on staff; however, they are not mandated to do so by their licensing criteria. They do provide social and recreational activities.

Nursing Homes provide care for individuals who require skilled care on an ongoing basis. Often, these seniors do not need to be hospitalized and have often reached a plateau in their improvement. Nursing care or post-acute facilities also offer short-term care for subacute, respite and rehabilitation purposes. Care is administered by nursing professionals under the direction of a physician. State departments of health regulate these facilities.

Conclusion

Elder housing contracts differ in scope and content. They must be reviewed by an attorney, the family's financial advisor, and a geriatric care manager to determine which contract option most suits the client's situation. But the need for a team approach goes way beyond this. Almost every case brought to a geriatric care manager needs the expertise of an elder care lawyer. Likewise, attorneys have acknowledged the benefit of referring their clients to a geriatric care manager to address non-legal concerns. According to Robert C. Gerhard III, a Philadelphia area elder law attorney, "Geriatric care managers fill an important gap in the care-giving process and should be a part of the practice of elder law."