Geriatric Care Managers: A Collaborative Resource to the Physician Practice

The Emergence of Private Sector Geriatric Care Management

Geriatric Care Management, a multidisciplinary profession made up primarily of nurses & social workers, first emerged as a professional field about 15 years ago when experienced clinical professionals, accross the country began, to leave traditional third party settings. Disillusioned with the large caseloads typical in non-profit and publicly funded agencies, and the limitations of third party payors such as Medicare, a group of about 100 practitioners in 22 states had begun to set up private consulting practices to help family caregivers of frail elders. They met to share ideas and to discuss how they conducted their private clinical gerontology practices. The result of these early meetings led to the formation of the National Association of Professional Geriatric Care Managers (NAPGCM). NAPGCM currently consists of more than 1500 professional geriatric care managers nationwide with a vast majority in individual or group practices. The national association exists to foster the profession of GCM through marketing and public relations, legislative activism and professional development. NAPGCM facilitates a yearly national conference, publishes a practice journal and several other publications. Additionally, individual state and regional chapters host regular chapter meetings and some also hold chapter conferences.

What is a Professional Geriatric Care Manager?

A Professional Geriatric Care Manager (GCM) is a human service professional who specializes in assisting elders and their families with long term care issues.

Geriatric Care Managers:

1. Conduct care planning assessments to identify problems, eligibility for assistance and need for services
2. Screen, arrange and monitor in-home help and additional health and mental health services
3. Review financial, legal and medical issues and offer referrals to other professionals for dealing with problems and conserving assets
4. Provide crisis intervention
5. Act as a liaison to families and long-distance care givers
6. Offer guidance in identifying alternative housing options and facilitating transitions
7. Provide counseling, psychosocial support, education and advocacy for elders and their families.

Case Example Part 1

It was 4:45 p.m. on a Friday afternoon and Dr. Jack Braun had just hung up the phone after speaking with Susan Moore, a nurse with the local Visiting Nurses Association (VNA). Dr. Braun said to himself, "Flo again!” Susan had informed Dr. Braun that his patient, Florence Clark, had been found in her home by an elder protective service worker confused, short of breath and with seriously edematous legs and acute cellulitis in her left leg. Susan explained that there was evidence that Florence had not been taking her lasix for up to two weeks and she had recently fallen. Dr. Braun recommended that Flo be taken to the Emergency Department at the medical center for evaluation.

Dr. Braun had just seen Flo the week before. She seemed to be improving. Flo, a 92-year-old widowed woman, living alone in her own home, had been hospitalized twice this year, five months apart for congestive heart failure (CHF) after failing to correctly take her medications. While Flo's hospitalizations were relatively long, she had improved both times after transfer to the same skilled nursing facility (SNF), where she received rehabilitation and nursing care for about eight weeks. Dr. Braun expected the same course would be repeated. Flo was adamant about not giving up her home and moving to an assisted living community. She was still independent with self care and was actually able to drive herself around town. Flo had lived with and been helped by her son, until his death two years ago. Flo was estranged from her only other child, a daughter, who lived out of state.

Dr. Braun said to himself, "there has to be somebody who could help this lady on a regular basis, someone who could give her support and encouragement, help her to be organized and deal with her when she gets noncompliant with her medications.” While Flo did have involvement with VNA, this help was intermittent as the VNA would take her on each time that she was discharged from the SNF. However, due to a recently imposed capitated reimbursement system for Medicare payments, and Flo's relative stability after post acute rehabilitation, the VNAs involvement never lasted more than a week or two. Flo also had a case manager from the Area Agency on Aging (AAA) who, due to funding cuts, could only respond when a crisis emerged. Flo's income, from dividends and social security, far exceeded the public agency's income guidelines for ongoing case management. Dr. Braun remembered that Flo had a trust officer at a local bank, who handled her finances. The trust department also served as Flo's Power of Attorney.

Dr. Braun called the trust department toexpress his concern about Flo's inability to live independently and his idea for some type of ongoing professional involvement. The trust officer assured Dr. Braun that he would check into this possibility and get back to him.

Flo was hospitalized for eight days and then transferred once again to a SNF for rehabilitation and nursing care. A week after her transfer to the SNF, Peter McClelland called Dr. Braun to say that he had retained the services of a professional geriatric care manager to work with Flo.

Over the years, the field of geriatric care management has has identified a range of effective methods for helping elderly clients. GCM's have learned to stay abreast of the rapidly growing and changing array of long term care alternatives. GCMs typically identify problems that distinguish their clients such as: failing health and physical function, increasing problems with mental function and unmet need for care and assistance and often inadequate housing. Additionally, clients commonly have either no family or diminished family involvement, some times due to estrangement but more commonly because of geographic distance in our increasingly mobile society. GCMs are rarely hired by the person needing care. They are far more likley to be retained for the client by a family member or another professional such as the client 's attorney, trust officer or accountant.
The Growing Profile of Geriatric Care Managers

GCMs in well established practices are likely to be members of the National Association of Professional Geriatric Care Managers at the "Advanced Professional Level” of membership. Advanced Professional members of NAPGCM hold a masters or doctorate degree in nursing, gerontology, psychology, social work, or another health or human service field and have had two years of supervised experience in the field of gerontology (NAPGCM Directory of Members‘00).

Read On: GCM Elderly Care and Physician Collaboration

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