What a geriatric care manager does, and when families hire one

A geriatric care manager is the person a family hires to see the whole picture of an aging parent's care and keep it moving. Most families start looking for one at an unsettled moment: Mom has fallen, or Dad is in the hospital, or a parent's memory has changed and the adult child trying to organize everything lives three states away. This guide covers what a care manager actually does, what it costs, the credentials worth checking, and how a care manager works alongside a home care agency.

The role in plain terms

A geriatric care manager assesses an older adult's health, memory, mobility, safety, finances and support network, writes a care plan, and then coordinates the doctors, caregivers and services that carry the plan out over months or years. The National Institute on Aging describes them as usually a licensed nurse or social worker who specializes in geriatrics, and notes that they can be especially helpful when a caregiver lives far away.

They don't do the hands-on care. They make sure the right hands-on care is happening, that someone understands what the specialists said, and that the legal and money pieces aren't forgotten.

You'll also see the titles aging life care manager and aging life care professional. The trade group, the Aging Life Care Association, was called the National Association of Professional Geriatric Care Managers until May 2015, when it changed its name because baby boomers didn't identify with the word "geriatric." The work is the same.

What a care manager does week to week

No two clients look alike, but most of the hours go to six kinds of work.

The assessment. The first visit happens in the home. The care manager walks the rooms, looks in the medicine cabinet, asks what your mother ate yesterday and watches her get up from a chair. Medical conditions, medications, memory, falls, finances, legal documents, the people who help her and the safety of the house all go into a written report that everyone works from afterward.

The care plan. The plan says what needs to happen, who is responsible and what to watch for. It gets revised after every hospital stay and every real change in health or memory. For many families it's the first time everything three siblings and a primary care doctor each knew in pieces sits in one document.

Medical appointments. Care managers go to doctor visits, take the notes no one else remembers to take, ask the question the family would have asked, and chase the referral that would otherwise sit in a drawer. When a parent sees four specialists, the care manager is often the only person holding the full medication list.

Hiring and checking on help at home. They choose and supervise home care agencies, drivers and housekeepers, review schedules and stop by to see how things are going. This is the job adult children most often overestimate their ability to do from out of state. A phone promise that a substitute aide is coming on Tuesday is not the same as seeing her arrive.

Hospital stays. A good care manager shows up at the emergency room, talks with the hospital doctor before discharge, weighs in on rehab or a return home, and rewrites the plan for whatever has just changed. Families who first hire a care manager during a crisis often keep them on afterward for this reason.

Keeping the family informed. A regular call or email to the family contact, a fuller note after anything significant, and one steady voice when siblings disagree. Much of what families pay for is this communication. A manager you rarely hear from isn't managing much.

Credentials worth checking

In most states, "geriatric care manager" isn't a licensed title, and anyone can print it on a business card. Certification is the one thing you can check before you pay for an assessment. The Aging Life Care Association requires its Advanced Professional members to hold one of four:

• Care Manager Certified (CMC) from the National Academy of Certified Care Managers. The exam is accredited by the National Commission for Certifying Agencies, and holders renew every three years with 45 hours of continuing education.
• Certified Case Manager (CCM) from the Commission for Case Manager Certification, common among nurses who come to care management from hospitals or insurers.
• Certified Social Work Case Manager (C-SWCM) and Certified Advanced Social Work Case Manager (C-ASWCM) from the National Association of Social Workers, for social workers at the bachelor's and master's level.

Ask which credential the candidate holds, when they earned it and when they last renewed it. Association membership alone, without one of these, tells you less.

Five situations that bring families in

Distance. You live in another state and have been running things on weekend visits and late-night calls. Nothing fails on any given day, but the arrangement isn't enough over a year. A care manager becomes your trained eyes nearby.

Complexity. Your father has several diagnoses, sees four or five specialists, takes a long list of prescriptions and has been in the hospital twice this year. No one is holding the full chart. Our guide to medication management for seniors explains why that list matters so much.

Memory changes. A parent who always handled their own affairs has started missing appointments, losing mail and making choices the family doesn't understand. It isn't an emergency yet, but they can no longer reliably speak up for themselves.

Disagreement. Three siblings hold three theories about what Mom needs, and family meetings end in old resentments about who has done the work. An outside professional assessment takes the heat out of the conversation.

Crisis. A fall with a fracture, a sudden change in behavior, a discharge to a rehab center no one chose. Care managers can often respond within a day. It's the most expensive way to start, and families often wish they had called sooner.

What the first visit is like

It usually starts with a short phone call, often free. You describe the situation, and the care manager explains how they work, what the assessment covers and what it will cost. If you go ahead, the assessment happens in the parent's home, usually with your parent and at least one family member there. AARP notes that many initial assessments take four to six hours.

Expect questions about medical history, medications, meals, sleep, bills and which legal documents exist. Expect the care manager to look at the bathroom for grab bars and loose rugs, open the refrigerator and watch how your parent moves around. They'll ask permission to speak with the doctors.

A written assessment and care plan follow, with next steps in order: which appointments to make, which home care hours to add, which legal documents to sign, which changes to make in the house and which family member handles what.

What a geriatric care manager costs

Most care managers bill by the hour, and the region sets most of the rate, so ask each one what they charge. The initial assessment is often billed as a one-time fee. Some practices offer a monthly retainer for a set number of hours.

Ask about travel time, mileage and phone calls, which some managers bill separately, and get every rate in writing before the first visit.

Medicare and Medicaid don't usually pay for private care management, and neither do most Medigap or Medicare Advantage plans. Long-term care insurance sometimes covers care coordination; look for that phrase in the policy. Some employee assistance programs cover part of the fee. Your local Area Agency on Aging may offer free or low-cost care management, and the Eldercare Locator, (800) 677-1116, will connect you to it.

Care manager or home care agency: who does what

The two are easy to confuse because both help families keep a parent at home. A home care agency sends caregivers to do the daily work: bathing, dressing and grooming, meals, medication reminders, light housekeeping, rides to appointments and company through the day. The agency hires, trains, supervises and replaces those caregivers.

A geriatric care manager sits one level up. They decide how many hours and what kind of care are needed, help choose the agency, watch how it's going and step in when something isn't working. They also handle what an agency doesn't: specialists, hospital stays, legal and financial connections, and long-range planning.

Many families use both. Others act as their own coordinator, especially when someone lives close enough to stop by a few times a week. Our founder, Teresa Sajkowski, is a registered nurse who holds the CMC credential described above, and registered nurses write every care plan our caregivers follow, starting with a free assessment at home. If your parent is coming home from the hospital, our hospital-to-home care can start with the discharge.

Mistakes families make when hiring one

• Hiring on the title alone. Ask the credential question first. A vague answer is an answer.
• Waiting for a crisis. Starting from a hospital bed at 9 p.m. on a Friday costs more and leads to rushed discharge decisions.
• Skipping the written agreement. Hours, rates, response times, after-hours coverage, who else will be involved and how you'll get updates should all be on paper.
• Expecting a stand-in for family. A care manager handles the logistics so your visits can be about time together, not about replacing them.
• Hiring the first person you call. Interview at least two and ask each the same questions.

How to find a good one

Start with the Aging Life Care Association directory, search your parent's zip code and look for Advanced Professional members. Then call the Eldercare Locator, which connects you to the local Area Agency on Aging. Hospital discharge planners and elder law attorneys are good sources too, because they see which care managers follow through.

Then interview each candidate for twenty or thirty minutes. Ask:

• Which certification do you hold, and when did you last renew it?
• How many clients do you carry right now?
• Who covers for you on nights, weekends and vacations?
• How do you bill for travel, calls and paperwork?
• Does your company also provide home care? If so, how do you keep your recommendations independent?
• What would your first thirty days with my mother look like?
• Can you give me references from families you've worked with?

Listen for specifics. If you need help at home while you search, or you aren't sure you need a care manager at all, call us or request care and we'll talk it through.