Time for Elder Care? The Wall Street Journal on Care Management & Assessing Needs


Time for Elder Care? | The Wall Street Journal


Pay close attention to your aging parents on a holiday visit this year. Does the normally tidy house now seem neglected? Is there hoarding? Do you notice memory problems, confusion or physical unsteadiness?

Discovering that a parent's physical or mental health is declining can be heavy on the heart. It also can be hard on your finances.

"The first thing we tell our clients is don't panic," says Byron Cordes, president of the National Association of Professional Geriatric Care Managers, and a geriatric-care manager in San Antonio. "Come up with a plan."

Feeling overwhelmed may prompt you to spend money on the wrong things, such as full-time care, when your parent just needs delivered meals or someone to run errands a few times a week. Here are some tips:

1. Assess needs

Ask your parent's physician what his or her physical and mental deficits are—assuming your parent allows you to sit in on appointments or consents to the release of his or her medical records. You can always send written concerns to the doctor, and if you have power of attorney for a parent's health care, attach a copy of that document, says Linda Fodrini-Johnson, a geriatric care manager in Walnut Creek, Calif.

Also consider hiring a geriatric care manager—a social worker, nurse, psychologist or gerontologist with additional training and certification—for a consultation or an assessment. They know the nuances of elder care and local organizations that can help seniors remain independent, says Ms. Fodrini-Johnson.

A one-time consultation costs about $150. An assessment typically runs $500 to $700, Mr. Cordes says. You can find a geriatric care manager near you at caremanager.org.

2. Take stock of benefits.

Visit BenefitsCheckUp.org, a site run by the National Council on Aging, to find out what benefits, discounts and programs your parent may be eligible for.

A search for a Medicare beneficiary who owns her Arizona home and has three chronic medical conditions turned up 11 programs, including a discount drug program, free legal assistance and caregiver respite.

Your local Area Agency on Aging (www.n4a.org) offers information on in-home support, transportation, adult day care, skilled nursing facilities and senior nutrition programs.

Is your parent a veteran or the widow or spouse of one? Eldercare.gov, a government-sponsored site (1-800-677-1116), can direct you to your local veterans' resource center for help applying for benefits, among other services. If your parent is low-income, he or she doesn't have to be on Social Security's Supplemental Security Income (SSI) program to be eligible for in-home supportive services, Ms. Fodrini-Johnson says.

And don't forget your benefits. Some employers offer elder-care referral services or cover need assessments for a parent.

3. Timing is everything

Medicare doesn't cover most long-term care costs. Medicaid covers them under certain conditions.

If your parent needs Medicaid coverage, timing matters," says Gregory French, president of the National Academy of Elder Law Attorneys, or NAELA, and an elder-law attorney in Cincinnati.

Eligibility can be harmed if your parent makes cash gifts or transfers assets within five years of applying for Medicaid, he says. In a best-case scenario, families work with an elder-law attorney before the aging parent loses the ability to make decisions, Mr. French says. Find a NAELA member at naela.org.

4. Factor in hospice care

If you're looking into an assisted-living facility or residential care home, which typically offers individualized care to a small group in a home setting, find out if it works with hospice—if or when the need arises. Not all places are equipped to do so, Ms. Fodrini-Johnson says.

Write to Kristen Gerencher at kgerencher@dowjones.com


What Care Managers are Bringing to the Table by: Sound Options

1. Options in Care. For many people, the image of a rundown and depressing facility for “old” people is burned into their mind. Negative comments and stigmas like, “putting someone away” exist in our lexicon for aging. However, this outdated imagery and language of aging is stopping real conversations in their tracks. Care Managers excel at balancing safety with quality of life for your loved one and will present options in care that align with their wishes, values, and desires for the later portions of their lives. Their care plans address the whole person, from their physical care needs, to their financial parameters, to their mental, emotional, and spiritual well-being.

2. Neutral Ally- A Care Manager outside the family can act as a neutral party in the situation. Often it is easier to take direction from a professional, even if the same recommendations are made by the family. Aging adults who have an ally in their corner, listening to them, advocating for their wishes, and presenting them with options can provide enormous sense of comfort, control, and empowerment and move decisions forward. 

3. Navigate the Healthcare System. Care Managers are a huge ally in breaking down a complicated list of to-do’s into manageable pieces. Whether it is discussing the healthcare aspects of future planning, such as setting up a durable power of attorney and advanced directives, or applying for Medicare and Long-Term Care Insurance, Care Managers have guided many families through the complicated paperwork that comes with eldercare planning.

4. Advocate for Quality Care. A Care Manager with a healthcare background can act as a wonderful advocate for your loved one as doctor’s appointments and medications increase. They often liaison between all the healthcare professionals and families to make sure loved ones receive the best quality care, and to make sure families are remaining informed and understand their loved ones’ condition. At every step, a care manager can advocate for a loved one’s wishes and values to be carried out in the care they receive. 

5. Problem-Solving.  Complicated family dynamics, high physical needs, or complex wishes from a loved one may overwhelm a family having the discussion on their own, but the creative and informed problem-solving skills of a care manger can move the dialogue forward with out of the box ideas, suggestions, and mediation tools.

6. Long-Distance Support- As families are living more and more spread out from one another, your loved one may live in another state or across the country. You may experience panic and guilt and at times feel torn between your responsibilities to your own family, work, and your far away loved one. A care manager can ensure your parent or loved one receives the best suited care on your behalf. As your eyes and ears, we can provide consistent communication and eldercare coaching over the phone for further guidance and emotional support.  


Published on May 2, 2013.