Finding Good Solutions

Professional advisers can help you sort through the different choices for an elderly loved one

By: Shira Toeplitz

Like many young adults, I couldn’t remember ever being in a nursing home. I couldn’t even name one in my area. But there I was standing over my father as he lay in a hospital bed, trying to make a decision about who could best take care of him.

An elderly parent’s health problems can be as predictable as aging itself, but sometimes health emergencies take us by surprise and we’re forced to make hard decisions about a loved one’s care quickly and without much information.

Three years ago, my father had a benign brain tumor. Two weeks after a biopsy—a simple procedure that required a one-night hospital stay—he got an infection from the surgery, which caused his brain to swell to the point where doctors had to remove part of his skull. He spent months in the hospital, rehab, and a skilled-nursing facility before he was ready to go home.

But he wasn’t able to live completely on his own. He had temporary brain damage and had to relearn how to walk, drive, and do other routine tasks. My parents are divorced, and my dad lived in western Massachusetts while I was in Washington and my little sister was in college in Boston.

I was 23. None of my friends had ever battled insurance companies or hired nurses, and they were in no position to give me advice. My father was only 63, but his condition was similar to that of an elderly person except that he was improving every month. Doctors said his recovery could take up to five years.

Because his problem arose so quickly, I didn’t have time to do careful research to find the best care. But I hired a geriatric-care manager to help me sort through our options. It was one of the best decisions I’ve ever made.

>> Next: What does a care manager do?

What Does a Care Manager Do?
Geriatric-care managers are private consultants who advise clients on how to care for aging parents or other loved ones. In some cases, a care manager will help a client pick a home nurse or suggest ways to make a house easier to navigate. In other cases, care managers will help clients select a nursing home, assisted-living residence, or short-term medical facility. Care managers can also act as a liaison between the client and his or her parents, especially if the children live far away.

I didn’t know that care managers existed when my sister and I chose a nursing facility near Boston that turned out to be a terrible—and expensive—environment for my father. When it was time for him to move back home, I knew I needed help.

A care manager typically starts by evaluating the client’s current situation. Linda Aufderhaar, a care manager in Fairfax, says her first step with clients is an in-depth assessment—including health, social, financial, and legal issues: “We put all of that information together and come up with a comprehensive care plan.”

I hired a care manager in Boston who helped me figure out what kind of care my dad needed. She referred me to another care manager near my father’s home in western Massachusetts to help set up in-home assistance. With their guidance, my younger sister and I decided my father didn’t need a 24-hour nurse.

We hired a visiting companion who could drive him to the grocery store and doctors’ appointments and keep him company. My dad found Dave Howe through Home Instead, a senior in-home care company. Dave supplied the perfect level of care for him: companion, driver, and housework assistant for an hourly fee.

>> Next: Who hires care managers and when should you hire one? Who Hires Care Managers?
Care managers sometimes get cases through attorneys or health-care professionals who come across a struggling older person with no one to help them. More often, adult children hire a care manager for their parents—often, as in my case, from a distance. 

Irene Jackson-Brown, a care manager in DC, says she sometimes plays the role of surrogate daughter for a senior when the children don’t live close by or don’t have the time to figure out a care plan for their parents. If the parent routinely goes to the hospital, she says, it’s helpful to have someone who can keep the kids informed.

When Should You Hire One?
Debra Levy, who has been a geriatric-care manager in Silver Spring for more than two decades, says the most obvious time to ask for a consultation is when parents are beginning to have problems doing daily tasks at home—when they forget to take their medicine or to turn off the stove. “Usually people call when their problems are beginning to build,” she says. But care managers can come in at almost any stage.

The nursing facility where my father stayed gave us only a couple days’ notice before he was released, but with the help of our care managers we were able to arrange assistance for him within a week.

Children often call care managers when a parent is moving closer to them. Julie Wadler knew she needed a care manager to help move her mother and father to an assisted-living facility near her home in Alexandria. Just a few years earlier, Wadler had watched her sister go through the painstaking process of trying to find the right facility for her parents near her home in New York. “I wish we had used a care manager in New York,” Wadler says. “I didn’t even know they existed until I was trying to figure it out down here.”

>> Next: How to choose a care manager and how much does it cost? How to Choose a Care Manager?
There are about 60 nationally certified care managers in the Washington area. A good place to start is the directory on the national association’s Web site, caremanager.org, which lists only members it has certified. 

Many care managers say much of their business comes from word of mouth. I was referred to mine by a family friend who had used her for her own parents. Given the urgency of my father’s needs, I didn’t have time to interview several people before hiring one.

Although my situation turned out well, Aufderhaar says it’s important to get at least basic information before hiring someone, such as how long he or she has been in business and whether the person is licensed or certified in a specific field. “You want to do due diligence with anybody you are trusting to assist you with major decisions regarding your loved ones,” she says. “One of the questions I would ask in terms of vetting is ‘What are your professional credentials?’ ”

Some care managers specialize in Alzheimer’s or dementia, while others have a background in social work or nursing. Those with national certification have at least one advanced degree plus a separate certification in care management, case management, or social work. There are also national care-management companies with branches here that can provide or help to find an in-home caregiver.

How Much Does One Cost?
Each care manager prices services differently, but most charge by the hour. Local care managers interviewed for this arti cle charge an average of $100 to $200 an hour. Some clients just ask for a care plan, which can amount to a few hours, while others need help several hours a week for months on end.

It’s a good idea to get fee information up front and in writing. Clients almost always pay out of pocket for a care manager’s time because health-insurance plans and Medicare don’t cover it. A small number of long-term-care insurance policies cover care-manager services, but they’re rare.

I spent about $500 on the two geriatric-care mangers—a small price to find the right solution for my father. Three years later, Dad is well on his way to recovery and we’re still using the advice they gave us.

This article first appeared in the November 2010 issue of The Washingtonian. 

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