Options For Elder Care

Hiring In Home Caregivers for Older Adults in Pittsburgh

When your parents start having difficulty with every day tasks, most families feel the solution is to bring in someone to assist in caring for your parent in the home. This may not always be the best course of action as there are numerous medical, environmental, psychosocial and financial issues that have to be considered to assure in-home care is the best option. Options For Elder Care has the expertise to complete this evaluation to assure the best long term decision is made www.optionsforeldercare.com.

A qualified caregiver overseen by a RN who has the clinical knowledge to establishing a professional plan of care and offer direction to the caretaker would be in the best interest of the older adult.

CARETAKER QUALIFICATIONS:

You will see several terms utilized to describe In Home care providers and you may see the job descriptions overlap. Caretakers of all types do not have the education to function independently without over-site by a qualified professional.

1. Certified Nursing Aides (CNA): Have medical training and must pass an exam to get certified. CNA's can check vital signs, care for wounds, transfer techniques, and help with activities of daily living (ADL's) like bathing and dressing. CNA's typically received training under a registered nurse. When working in the home most are agreeable to assisting with household tasks and meal preparation.

2. Home Health Aides: May have some formal training provided by aemployer or can be "self taught" with experience. Typically Home Health Aides can assist with ADL's but did not receive formal training on medical issues. They can also assist with household chores and meal preparation.

3. Personal Care Attendants/Companions: Usually will not provide direct patient care but rather companionship. They can assist with cooking, cleaning, and shopping.

OPTIONS IN CARETAKER FINANCIAL ARRANGEMENTS:

• Hiring a Caregiver directly: Hiring a home care aide through word of mouth or through the classified is usually the least expensive option and the one families think will solve all their problems.  This arrangement can creates legal liabilities for the family which becomes the employer. For instance, you can be held liable for any injury that happens on the job including medical and disability. If you choose to hire them as a contractor you will need to file a 1099 on any wages you pay over $600. You will need to conduct a background check, check prior employment history, complete drug testing, and most importantly, arrangements of this nature may not be the long term solution you are looking for. If you treat them as an employee you will be responsible for paying taxes and benefits such as Social Security and Medicare, income tax withholding, and unemployment tax.This industry has a high turnover rate and there is not a back up should this person leave unexpectedly or become ill. There are always bad apples who will take advantage of vulnerable clients - so make sure you do not unwittingly hire one! It is a good idea to make sure the individual you are hiring is a CNA so you know a registered nurse has trained the person in the basics of care. With that said, hiring someone on your own can be a good idea if you have the time to be the employer, medical education to over see the caretaker, and strong endorsement from someone you know who has used their service.
• Agency Caretakers: The rate an agency charges for staff tends to be higher but agencies will pay for the FICA taxes, cover worker's compensation insurance and screen potential employees backgrounds. You want to make sure the agency bonds and insures their caretakers and that their caretakers have received training on CPR and first aid skills. Most agencies have a large number of caretakers so you may be able to "try out" a few to find a good match. Additionally, the agency should offer you a guarantee of a substitute caregiver if your primary one is sick or on vacation. A quality agency will have a RN who follows up on the care plan, oversees and offers advice to the caregiver.

SETTING CLEAR EXPECTATIONS:

Caretakers are employees, do not try to make them your friends - keep it professional. If your employee thinks of herself as your pal, she may likely take liberties of a friend, not an employee of vulnerable adults.

Set clear expectations as to what she should be doing every moment she is working for you.

• Use a notebook all can write in regarding the care provided for a client
• Have a RN develop a plan of care and assure there is a method for the caretaker to record that she is following the plan of care.
• Should the caretaker bring their own lunch, should they remain 100% awake when working the night shift, run errands, shop, clean, cook?
• What personal care should they provide and using what methods.

As RN Geriatric Care Manager the most common call I receive is from adult children who have concerns about their parent's safety and are looking for in home care to solve this concern. The adult children want to know how much care their parents need and how they can get their parent to accept it. Most of these calls are precipitated following a crisis such as a fall or hospitalization.

In most instances, a parent will not acknowledge they need nor accept the idea of a "stranger in their home." Adult children frequently try to convince their parents they need in home care, resulting in a frustrating experience. In many cases Geriatric Care managers must mediate between the older adults desire to remain independent and their adult children concern for their safety. Through my 35 years of experience I have learned how to work with older adults in ways that respect their need to feel in control of their lives along with helping them recognize that accepting help actually allows them to maintain independence.

To find out more about  how Options For Elder Care can assist you with the in home care of your parent please refer to our web site: www.OptionsForElderCare.com  or          Phone: 412-443-1365

One in Three People Over 70 Have Memory Impairment

Duke University Medical Center

 

 

    
                                                                         

New study illustrates that nearly every family will be faced with the challenges of caring for a family member with some form of memory impairment.

______________________

 

 

More than a third of people over age 70 have some form of memory loss, according to a national study by a team of researchers at Duke University Medical Center, the University of Michigan, the University of Iowa, the University of Southern California and the RAND Corporation. The group performed the first population-based study to determine the number of people who have some form of cognitive impairment, with and without dementia.

 

While an estimated 3.4 million Americans have dementia, defined as a loss of the ability to function independently, the researchers estimate that another 5.4 million over age 70 have memory loss that disrupts their regular routine but is not severe enough to affect their ability to complete the activities of daily living (ADLs).

 

"These findings illustrate that nearly every family will be faced with the challenges of caring for a family member with some form of memory impairment," said Brenda Plassman, Ph.D., associate research professor of psychiatry at Duke and the study's lead author. "Among the people aged 71-79, a sizeable number had cognitive impairment. This is an age at which most people expect to have many productive years ahead."

 

The frequency of memory loss without dementia increased with advancing age and with fewer years of education—similar to the trends seen in dementia.

 

Plassman explained that throughout the course of the study, individuals with cognitive impairment without dementia progressed to dementia at a rate of about 12 percent per year. On average, the mortality rate for the study group was 8 percent annually, but varied across the subtypes of cognitive impairment without dementia. Said Plassman, “While the overall rate of progression to dementia is in line with findings from other studies, the surprising finding here is that some subtypes of cognitive impairment without dementia progressed to dementia at much higher rates, around 20 percent, within one year."

 

Chronic Illnesses Named as Cause

 

Nearly a quarter of those with memory loss without dementia also had a chronic medical condition, such as diabetes or heart disease, that appeared to be the cause of the cognitive impairment. The researchers speculate that this group is one of the most underdiagnosed subtypes of cognitive impairment because doctors are likely focusing on the primary health issue.

 

"Given how common cognitive impairment without dementia is, physicians should be alert to this problem as they evaluate and treat the patient for other medical problems," said Robert B. Wallace, M.D., the study's senior author from the University of Iowa. "This may have significant ramifications because it means that patients may not be able to accurately portray their symptoms and may not retain important information about their treatment."

 

The data, published in the Annals of Internal Medicine, is from the Aging, Demographics and Memory Study, which is part of the larger Health and Retirement Study conducted by the University of Michigan Institute for Social Research and funded by the National Institute on Aging.

 

"As the population ages and works longer, understanding the extent of cognitive impairment in the older population is critically important," notes Richard Suzman, Ph.D., director of the NIA's Behavioral and Social Research Program. "Research is now beginning to suggest that interventions—such as controlling hypertension and diabetes or perhaps cognitive training—might help maintain or improve mental abilities with age. As such interventions are tested and widely applied, we should be able to track their impact through this type of research."

 

"With such a sizable number of Americans with some form of cognitive impairment, many of whom will get dementia, it's imperative to increase research funding that could lead to breakthroughs in Alzheimer's diagnosis, prevention and treatment," said William Thies, Ph.D., vice president of Medical and Scientific Relations for the Alzheimer's Association.

 

Co-authors on the study include Kenneth M. Langa, Gwenith C. Fisher, Steven C. Heeringa, David R. Weir, Mary Beth Ofstedal, James R. Burke, Michael D. Hurd, Guy C. Potter, Willard L. Rodgers, David C. Steffens, John McArdle and Robert J. Willis.

Pittsburgh Registered Nurse Geriatric Care Manager Offers Advice on Older Adults and Driving

Pittsburgh Registered Nurse Geriatric Care Manager Offers Advice on Older Adults and Driving

By Barbara (Bobbi) Kolonay RN, BSN, MS, CCM

Elder drivers are more likely to get into multiple vehicle accidents than younger drivers and suffer more serious injuries. As we age, our ability to drive safely can be limited by many factors, including visual decline, loss of hearing, mental functioning, limited mobility, and medication side effects.  Frequently family members recognize the older adults limitations before they do and it is important that the adult children and family members carefully monitor the situation and driving limitations. The below information should help you determine whether you should take steps to encourage the senior to stop driving.

Risk Factors

1. Visual Decline: Vision declines with age, which includes one’s ability to focus on objects, shift focus quickly, focus on fine detail, reduced peripheral vision, and decreased depth perception, all necessary to drive safely. You will frequently hear older adults complain of poor night vision and sensitivity to glare, as a result of their eyes loosing the ability to process light.
2. Hearing Loss: Over one-half of older adults over the age of 65 have some type of hearing impairment and this increases with age. Loss of hearing happens gradually and the older person may not realize they are not hearing well. Older adults that are hearing impaired can be inattentive to their surroundings, and are not hearing important cues when they are driving. The first sign of hearing loss is one’s ability to higher pitched sounds, such as a horn, a car turn signal and emergency siren.
3. Limited Mobility: Numerous diseases including but not limited to arthritis, Parkinson’s disease, diabetes and heart disease can affect ones ability to drive safely. One needs to be able to grip a steering wheel, move ones feet from the gas to the break, and look completely over your shoulder. A full range of motion is critical on the road. Additionally, most older adults drive sedans that are the most difficult to get in and out of and control on the road. 
4. Medications: Certain medications, as well as combinations of medications, can increase driving risk. Analgesics (pain relievers), antihistamines, antiarrhythmics (irregular heart beat), and antihypertensive drugs all have the potential to affect driving ability. The main factors in collisions involving older drivers are slow response, not seeing a sign, car, or pedestrian, and interaction with other drivers. Medications can make a driver more susceptible to any of these factors - and those over age 65 take an average of nine medications daily, including prescription, over-the-counter and herbal.
5. Mental Functioning: By the age of 85 close to 50% of older adults have some type of dementia. Those with dementia are 5 times as likely to be in a accident than their noncognitive impaired aged-matched individuals. Dementia can be defined as “an acquired persistent impairment of intellectual function with compromise in at least three of the following spheres of mental activity: language, memory, visual-spatial skills, emotion or personality and cognition. Impairments in the above areas may cause delayed reaction to sudden or confusing situations on the road or in dealing with complex, confusing intersections.                                           Memory can be divided into short-term and long-term. Decreased mental functioning is initially seen in the short-term memory. Older adults call upon their long term memory to recall such skills as how to start a car, driving a familiar route from point A to point B, and where the stop signs are along the route. On the other hand, you call upon your short-term memory while driving in unfamiliar territory, confronting a detour, or finding your car in a parking lot. This requires holding on to short-term information, which can be difficult in the early stages of dementia.     Visual-spatial skills include a component of memory as well as depth perception; the ability to judge distance and speed, the ability to stay in ones lane, along with the concept of sense of direction. Cognitive impaired individuals also are at particular risk for accidents while making left turns across traffic, a maneuver that requires one to quickly process large amounts of rapidly changing spatial information. Those with early stage dementia lack insight to realize they are driving poorly.  It is these individuals who need to stop driving that have the least personal awareness that they are incapable drivers.

                                                                              

Warning Signs Of Unsafe Driving

• Unexplained dents, dings and scratches on the car. These can be a sign of more serious accidents waiting to happen
• Car paint on mailboxes, sides of garage door, curbs, etc.
• Failing to use turn signals or keeping the signal on without turning
• Abruptly changing lanes, breaking or acceleration
• Trouble reading signs or navigating directions
• Range-of- motion issues – looking over the shoulder, holding on to the steering wheel, moving the feet or hands
• Increased nervousness with driving, fear while driving, or feeling of exhaustion after driving
• Other drivers honking; oblivious to the frustration of other drivers, not understanding why they are honking
• Reluctance of other to be in the car with the senior driver
• Getting lost more often
• Slow reaction to changes in the driving environment

Steps To Take If You Are Concerned About The Safety Of A Senior Driver

Most older drivers when intelligently engaged on the issue will lessen, self-monitor or stop driving when it is time to do so--but some may require more persuasion than others. It is important to keep in mind that resistance has a positive side. It indicates that an older driver is determined to be self-reliant, and wishes to demonstrate their ability to run their own lives. In few instances, however, an older driver will refuse to stop or alter driving practices even when they are becoming dangerous. Below is a list of recommendations to consider when dealing with a reluctant individual:

• Improve existing skills by taking a refresher course offered by AARP or their insurance company
• Go to the state Department of Transportation (DOT) for testing
• Appeal to an authority figure such as the older adults family physician
• Get an independent evaluation from a healthcare provider. Most rehabilitation facilities have occupational therapists that conduct driving testing for those believed to be impaired. You will need a physician order for this testing.
• Focus on the money they will save by using public transportation, car-pooling, or taxi services. You want to look at the cost of gas, insurance, car payments and repairs when calculating the cost of a car.
• Explore ways to reduce driving, such as making purchases through catalogues or on-line. There are many services available now that offer home delivery of groceries also.
• There are numerous alternative transportation systems for older adults through your local area on aging. Some may offer reduced taxi service, reduced van services, and free public transportation.
• Offer rides and find others who can offer rides. Ask family members to commit to one day a week to drive their parents/relative.
• If family isn’t available, consider hiring outside caretakers to drive your loved one to places like the doctors office, grocery store, or mall. Chances are if they are having problems with driving, they may also be having problems navigating the confusion of these areas and these individuals can help.
• In the worst-case scenario, take away the keys, disable the car, or remove the car from the premises. 

Most adults view their car as a powerful source of independence and mobility that they do not want to loose. But as we age changes can take place that make this source of independence potentially dangerous for the older adult and those on the road. It is important to recognize those factors that limit an older adults ability to drive safely and minimize them before an accident occurs. Family members and friends may be the first to be aware of these limitations, so it is important to listen to them voice concern for the older adults safety and assist with finding alternatives to maintain that sense of independence.

Barbara Kolonay RN, BSN, MHRM, CCM is the owner of Options For Elder Care, a Geriatric Care Management firm that assists families in managing the entire spectrum of care for their aging relative. For more information visit her web site: www.OptionsForElderCare.com

40% LOWER PRICES FOR MEDICARE PART D FOR 2008. WILL THE PITTSBURGH INSURNACE CARRIERS (BLUE CROSS AND UPMC) PASS THIS SAVINGS ON TO THEIR CLIENT'S????

Medicare Expects to Recover $4 Billion from Part D Plans Following 2006 Plan Reconciliation

The Centers for Medicare & Medicaid Services (CMS) announced today that the agency will collect $4 billion from Part D drug plan sponsors due to lower-than-expected drug costs in 2006, the first year of the Medicare drug program. This collection results from the payment reconciliation that CMS has completed for 2006, including the application of risk sharing created under the Medicare Modernization Act (MMA).

For the 2006 contracting year, Medicare will be collecting funds from plans due to the fact that actual drug costs for almost all Part D plans were below expected levels in their 2006 bids. A number of factors led to this lower spending, including the fact that 2006 marked the first time that plans were bidding on the new Part D program and the fact

there are higher levels of generic drug utilization in Part D than anticipated. Plans submitted their bids for the 2006 contracting year in June 2005. At the time, there was limited information available with respect to the costs associated with beneficiary utilization in the new prescription drug benefit or the number of beneficiaries who would enroll. The 2006 bids, despite being developed based on the plans' best expectations and having been extensively reviewed by the CMS Office of the Actuary, were nevertheless somewhat uncertain predictions of what would actually happen when the drug benefit began in 2006.

Part D payments to plans are designed to be adjusted for the actual experience of the Part D program. Under the MMA, CMS is required to pay the plan sponsors prospectively based on their bids, and can only complete a final reconciliation of accounts after the end of the calendar year. Final payment reconciliation involves several different activities. For example, monthly subsidies paid by Medicare for low-income beneficiaries and for individuals who incur catastrophic spending are paid on a prospective basis based on estimates in each plan's bid. After the end of the contracting year, when all the claims data are available, the prospective payments are compared to actual incurred costs and other related data, and appropriate adjustments are made to the plan payments. In addition, monthly premium subsidy payments to the plans are adjusted at the end of the year to reflect updated data about beneficiary health status and enrollment.

By statute, risk sharing limits the unanticipated losses or unexpected gains by Part D plans. For the first two years of the Part D program, if a plan's drug spending is 2.5 percent or more higher than projected, Medicare makes additional payments to cover a portion of the unanticipated costs. If drug spending is 2.5 percent or more below the levels projected in a Part D plan's bid, Medicare recoups a portion of the unanticipated cost savings. These risk corridors, which apply during the first two years of the Part D program, reflect the intent to not only mitigate plan risk through additional reinsurance, but also to assure that during the initial years of starting the new benefit, taxpayers would share more fully in any unanticipated savings.

Plans can appeal the final reconciliation calculation by contacting Strategic Health Solutions (SHS) by October 22, 2007. SHS will perform follow-up analysis of any disputed matters; the final decision on reconciliation issues will be made by CMS.

CMS expects that, as plans have further experience with the Part D program, their bid submissions will in future years will more accurately anticipate their actual costs to provide prescription drug coverage. In fact, the 2007 bid submissions were significantly lower than those submitted in 2006 and were a reflection of the actual 2006 Part D drug program experience. Accordingly, CMS anticipates that amounts collected from or paid to plans in future years as a result of final reconciliation and risk sharing will be significantly lower than the reconciliation for the 2006 plan year.

Beneficiaries in the Part D program continue to enjoy excellent value and consumer choice, due in large part to strong competitive bidding by plans. As previously reported, the actual average premium paid by beneficiaries for standard Part D coverage in 2008 is expected to be nearly 40 percent lower than originally projected when the benefit was established in 2003. Further, the program is 30 percent less expensive overall for the first 10 years than originally estimated.

CMS recently launched the 2008 national enrollment campaign. Working with State health insurance assistance programs (SHIPs) and other partners, this year's campaign is targeted toward beneficiaries with limited means who are eligible for additional assistance. The 2006 plan reconciliation, the 2008 enrollment campaign, and all other parts of the agency's efforts related to Part D are focused on fine-tuning the program to assure that it continues to deliver high value and lower costs to seniors and taxpayers.

Choosing a Medicare Insurance Program

My first stop in the older adult Continuum of Care is Health Insurance; probably the first and one of the most important decisions you will make when become eligible for Medicare at age 65.

                                                              Medicare Part A

Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters in which they paid Medicare taxes while working.  Medicare part A covers inpatient care in hospitals,  skilled nursing facility, home health and hospice care

                                                              Medicare Part B

Most people pay a standard monthly premium for Medicare Part B. However, some people may pay a higher premium based upon their modified adjusted income. Most elect to have this premium taken directly from their social security check. For most items and services covered under Part B, you must also pay a COPAY, COINSURANCE, and a DEDUCTIBLE. Part B covers those services not covered under Part A such as outpatient services, doctor services, emergency room services, and office visits.

                                                           Medigap Policy

Medigap policies are designed to "fill in the gap" to pay for COPAY, COINSURANCE, and the DEDUCTIBLE and with some policies, services not covered by Part A & B. Medigap policies typically do NOT cover prescription drugs. The positive implication of purchasing a medigap plan is you have total freedom of choice, you can receive care anywhere you want as long as the provider accepts Medicare. You also do not have a "Managed Care Agency" monitoring your usage of coverage from hospital length of stay, to durable medical equipment. The most common medigap policy in Pittsburgh is offered by Western PA BC/BS. You do not need to purchase a medigap policy if you have a Medicare Advantage Plan. RECOMMENDATIONS: I believe the negative of extremely high cost for the medigap policy, less coverage for Skilled Care, along with with the need to purchase a part D supplement far out-weights the benefit of freedom of choice in the Pittsburgh area where we have excellent Medicare Advantage Networks with two large providers.

                                               Medicare Advantage Plans (Part C)

Medicare Advantage Plans are private insurance companies approved by Medicare to provide this coverage. When you join one of these, you are still in Medicare. Medicare Advantage Plans provide all the coverage of Part A & Part B and generally offer extra benefits that may include Part D drug coverage. These plans have networks, which means you need to see doctors in the plan and go to hospitals in the network for care. In many cases, the cost for these plans can be lower than the original Medicare Part B premium. Recommendations: Make sure you live in a service area of the plan you join and that the plan has a large established network. You can't go wrong if you live in Allegheny County and choose one of the two largest providers in Pittsburgh - UPMC Health Plan (UPMC for Life)or Highmark (Security Blue HMO or Freedom Blue PPO)...more about these plans below:

HMO -  Health Maintenance Organization - a type of health plan where you you can only go to doctors and hospitals in the plans network to receive coverage, with the exception of an emergency. If you choose the UPMC for Life coverage you can only receive care with UPMC providers or facilities. (you cannot receive care in the West Penn/Allegheny Health System) Security Blue's Network also includes the West Penn/Allegheny Health System along with UPMC facilities.

PPO -Preferred Provider Organizations - with this type of plan you have the choice of using hospitals and providers in the network or can choose to go outside of the network for additional costs. freedom Blue is an example of this type of PPO in Pittsburgh.

Final words: I have worked for both major and some minor providers of health care in Pittsburgh. As a previous insider, my recommendation is the Medicare Advantage plans. If a decision regarding care is ever made that you disagree with, you have the ability to appeal this decision immediately in most cases.

If you need assistance in determining the best Medicare plan to meet your individual needs, Options For Elder Care would be glad to assist. 412-443-1365 web:  www.optionsforeldercare.com or e-mail: info@optionsforeldercare.com

Lets tackle Medicare Part D next time!

my Best,

Bobbi

The Vision of a Geriatric Care Manager

I am a runner. That is how I solve my day to day problems. I find the solution for everything when I am on my five mile run at North Park.

After dropping my nine year old off at school I head for Panera's for my morning coffee. There is always a group to welcome me as I enter. The first hello is usually from John who had bypass surgery a few years back and is caring for his mother who is residing in a personal care home. Teddy is having problems with his right knee and will probably need a another knee replacement. There are other's, one caring for a wife with MS, another who's wife was just diagnosed with breast cancer. They all appreciate the advise of a RN Geriatric Care Manager.

After getting my caffeine boost, I am ready for my run and stretching in the parking lot by the boy scout house. There are the "regulars" like Bob and his wife who have been dealing with managing the care of their aging mother on their own for almost a year and Mark who is 90 with rheumatoid arthritis, but still walks 3 miles 5 times a week. As I make the five mile loop, I am stopped several times by the "regulars" for advice on medical or elder care concerns. I am not only assisting them with their concerns but solving my problems in this hour of running. After my run when I am cooling down in the parking lot there is  poor Paul. He  has a tiny dog, Buddy, who appears to have a very enlarged liver and extreme difficulty breathing. Paul and Buddy  are "regulars" to North Park. Buddy hangs out in the car until Paul is done running. Paul and I discuss Buddy regarding aggressive therapy vs palliative therapy. Buddy is in the geriatrics of his life and Paul comes to the decision he will do anything to make Buddy comfortable, but does not want to inflict any treatment that would cause pain or suffering. He also decides that he will not keep Buddy alive for his own personal need to have a companion, but try to make all decisions with what would be best for Buddy. We part on those words.

As I drive home I see a vision of Geriatric Care Management across the Continuum, but I wonder where does it start and when does it end? Let me think about this on my next run.

Until next time, my best,

Bobbi

Geriatric Care Management in Pittsburgh, PA

I just returned from the National Association of Geriatric Care Managers annual conference in Boston, MA. While at the conference, discussing Geriatric Care Management with all my colleagues, I came to the realization that Geriatric Care Management is a term easily recognized in other areas of the United States but not in Pittsburgh, PA. So I decided my first blog should be to help define what a Geriatric Care Manager is and the services they can potentially provide.

What is a Geriatric Care Manager?

The National Association of Professional Geriatric Care managers define a Professional Geriatric Care Managers as:

A Geriatric Care Manager is a health and human services professional, such as a gerontologist, social worker, counselor, or nurse, with a specialized body of knowledge and experience related to aging and elder care issues.  A Professional Geriatric Care Manager (PGCM) is a geriatric care manager who is a member of the National Association of Professional Geriatric Care Managers (GCM) and had committed to adhering to the GCM Pledge of Ethics and Standards of Practice,

The PGCM assists older adults and persons with disabilities in attaining their maximum functional potential.  The PGCM strives to respect the autonomy of the individual and delivers care-coordination and support services with sensitivity to preserve the dignity and respect of each individual.  In addition, the PGCM is an experienced guide and resource for families of older adults and others with chronic needs.

I start my definition with “Caveat Emptor” as we are not all alike in our practice or, in my opinion, equally qualified. In my social interrelations with local Geriatric Managers and National Geriatric Care Managers I have found there is a range of PGCM’s – from those who have the lesser credentials of working as a nurses aide and then obtained an on-line certificate in Gerontology, to those with the highest credentials of a PHD in gerontology in combination with a RN Nurse Practitioner.

So, when you are looking for assistance for your parents, be sure to determine exactly what the PGCM’s background is prior to retaining them for service. Of course my opinion is biased being a RN, but if I were to choose a PGCM for my parents care I would want someone who could not only manage the social aspects of their care but also medically coordinate their care and act as a liaison with all parties involved in this coordination. Only someone with an Undergraduate Degree or Masters in a field of Science is able to do this. (Registered Nurse, Physical Therapist, Occupational Therapist, to mention a few). If the services you need are purely social in nature (assistance with shopping, counseling, immediate placement, Medicaid applications) then a social worker with a Masters Degree or a Masters Educated Gerontologist might be your best choice.

Additionally, I would assure the PGCM you are considering hiring has a certificate in Care or Case Management (CCM - Certified Case Manager or CMC - Care Manager Certified). To become certified, a professional has to meet the requirements to be called a Case Manager and then take an exam to obtain the certification. They also have to be re-certified every so many years, which requires proof of continual education in the field of case management.

What do Geriatric Care Manager’s do?

What PGCM’s do varies depending on the qualifications of the PGCM. Here is the National Society of PGCM’s Definition:

Care management services are offered in a variety of settings.  Professional Geriatric Care Managers (PGCMs) can serve the needs of their clients with the following services:

• Short-term or on-going assistance for long distance caregivers or other requiring assistance.
• Personalized and compassionate services focusing on the individual's wants and needs.
• Accessibility: Care is typically available 24 hours a day; 7 days a week.
• Continuity of care management by facilitating family communication, reducing the burden on families and preventing unnecessary expenditures.
• Efficiency and flexibility based upon a client-centered approach eliminating bureaucratic constraints.
• Cost containment by avoiding inappropriate placements, duplication of services, and crisis intervention to avoid hospitalizations.
• Quality control: care management services that follow GCM's Standards of Practice

Options For Elder Care (OptionsForElderCare.com) only employs Registered Nurses with a minimum of 15 years experience in case management and geriatrics. In addition to the above services this is the definition of services we provide:

• We are the medical coordinators of care for the geriatric client
• We are the liaisons with all the parties, family, doctors, caregivers, etc.
• We are the education and support system for geriatric client and his family.
• We're that one person that all the parties can call and understand the long-term plan and the steps to get there.
• We’re continually planning and implementing, always evaluating what we're doing as well as the outcomes.
• We strive to do the right thing at the right time, trying to save some money for the client and yet get the best outcomes that we can, functionally, financially and in every way.

How Are The Services of a Professional Geriatric Care Manager paid for?

Hopefully in my lifetime we will see reimbursement for Geriatric Care Managers by Medicare. Unfortunately Geriatric Physicians are becoming scarce because the geriatric services cost the hospital $1,350 more per person than the savings they produced, and Medicare, the insurer for the elderly, does not cover that cost. RN Geriatric Care Manager’s may be the solution for our country’s surging elderly population. (More on this later...)

Until that happens Geriatric Care Managers service is privately paid for. The average national hourly rate for PGCM’s is $80.00 - $150.00 per hour. Again, make sure you are getting a qualified PGCM. You may also hear of care managers who work telephonically from insurance companies or Care Managers through your local area on aging. The service they provide should not be confused with the services a Professional Geriatric Care Manager can provide.

Until next time, my best,

Bobbi

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For Geriatric Care Management Assistance from Registered Nurses Contact Options For Elder Care
by phone: 412-443-1365
or email: info@OptionsForElderCare.com
or visit our web site: OptionsForElderCare.com