May national Aging Life Care Month
Erica Smalley

May is National Aging Life Care Month, which gives us an opportunity to spotlight the role care managers play in the lives of San Diego’s seniors. Erica Smalley is the owner of A Hand to Hold San Diego, a geriatric care management agency in San Diego. Erica and her employees are nurses and direct care providers who “provide one-time care consultations, transitional assistance which assists seniors to transition safely from the hospital or skilled nursing settings back home, and on-going geriatric care management services.” In a guest post this month, Erica answers all our questions about geriatric care management, how it works, and the ways seniors and caregivers in San Diego can benefit from working with a care manager.

What Is a Care Manager?

Once an unfamiliar term, care management is gaining popularity as more people learn what a care manager is and realize the extreme value of hiring one.  Available years ago only within the hospital system, care or case managers are now available to the public often acting as independent consultants with their own practices. People often dismiss the idea of employing a care manager for fear that it is outrageously expensive and is “only for rich people.”  This simply isn’t true.  For often less than the cost of a private home health caregiver for a single day, you can have an aging expert come to your house and help you figure out the best, most appropriate care for your senior and this may save a family thousands of dollars.

Care managers answer to many names. Once known as Geriatric Care Managers (GCMs) (and stilled called that in many arenas) they are now more commonly known as Aging Life Care Managers or Professionals.  Care managers can also be referred to as care coordinators or case managers. There are several licensing or credentialing avenues to becoming a care manager. One is to go through the Aging Life Care Association which has strict application and acceptance policies and restrictions.  A professional may also get credentialed as a Certified Care Manager (CCM or CMC) or a Certified Case Manager (also CCM).  Licensing entities that certify in this area all require that their applicants have an extensive knowledge base and experience in care management. Care management is not limited to the geriatric field. Care and case managers are used in hospitals, within the insurance company realm, and in many other health care venues.  Aging Life Care Managers, however, do specialize in the aging population and are required to be well versed in the facets of aging and the special needs of our aging population. Care managers are often licensed nurses or social workers or even lawyers who obtain the certification. For our purposes in this article, we will refer to Geriatric Care Managers or Aging Life Care Managers as care managers (CMs) for simplicity’s sake. The Aging Life Care Association’s illustration below highlights many of the key knowledge areas a qualifying professional must have to belong to the Association.

How Do Care Managers Fit in Your Loved One’s Care Team?

If I had to describe what a geriatric care manager does in one sentence it would be that we act as stand-in daughters, overseeing and organizing a senior’s health care while providing the senior and their family with guidance, encouragement, and support. People hire financial advisors, lawyers, accountants, and medical specialists but rarely think of an aging expert to help with the complex needs a senior has. Bringing on a CM to head up a care team can offer significant benefits. Having “boots on the ground,” as a friend of mine likes to call management, is especially true if family does not live close by. By incorporating a CM into your team, you bring in someone who can act as the glue between all the parts, keeping it cohesive and well-functioning while focusing on keeping your senior as happy and independent as possible.

What Services Does a Care Manager Provide?

The nitty-gritty of what we do is noted below though this list is certainly not all-inclusive as most CMs offer personalized plans of care that might contain a service not listed here.  Please note that not all CMs provide all of the services listed below:

  • “Project Management.” Ongoing care management services that include the creating and implementing of a personalized care plan. A care manager will oversee all aspects of a senior’s health care- medical appointments, medication routines, participation in physical therapy, and more.
  • Serve as an emergency contact for seniors whose family does not live close by.
  • Attend medical appointments and procedures with the senior, and act as an advocate whenever needed.
  • Provide end-of-life consultations, coordination, and support.
  • Provide eldercare consultations as well as facilitate family discussions and problem-solving sessions.
  • Offer non-biased placement assistance when seniors need to move to a retirement community, assisted living, skilled nursing facility, or memory care community.
  • Coordinate, train, and supervise home health and hospice teams.
  • Provide “Well Senior” visits and calls. Aside from checking on the client, this allows for socializing and interaction which may decrease a senior’s sense of isolation and may decrease the odds of developing memory loss and dementia.
  • Provide useful resources and referrals. Experienced care managers have a network of experienced senior care providers with whom they regularly work with, trust, and call in on short notice if needed.
  • Some offer travel companionship and bucket list assistance.
  • Some care managers act as senior care experts and consultants by providing level of care and needs assessments. These assessments are used to determine the safest and most appropriate living situation for a senior that is going through a court case/ conservatorship situation.
  • Life Care Planning is provided by some experienced care managers. This is mapping out a person’s care future including medical needs, living situation, support system, health directives, financial situation, and more, often after a person has had a life-altering health event or accident.

How Does a Care Manager Provide Care?

When we first meet a client and perform an assessment for consultation purposes or to establish care management services, we do a very in-depth intake that is holistic in approach.  We address not only the senior’s wishes and goals, but look at their physical abilities, challenges, medical history and medication routine, social and family support system, resources and financial situation, emotional state (for example if they are in the midst of a grieving period, are fighting depression, or have anxiety regarding some aspect of aging) and if they have any legal directives in order. If aging-in-place is the primary goal, we approach management with a certain set of criteria that will allow the senior to do this safely.  Throughout the entire care management relationship, we frequently re-assess to make sure the plan of care we have in place is always the best, most appropriate plan. The care plan will get tweaked and updated as the client’s needs change.

The beauty of asking for a care manager’s help is that their first role will be that of elder care expert and consultant.  What we do every day and have years of experience doing, can be very new and intimidating to those not in the senior care industry.  Getting help before a major aging fail occurs (such as Joe wandering outside, getting hit by a car and ending up in the hospital with a broken hip) is ideal though it often takes a major fail for families to realize they need outside help and guidance.   My hope in writing this article is to show how employing a care manager can help families stay sane while caring for an older relative and ideally avoid any major aging fails.

We share the rest of our conversation with Erica Smalley, Care Managers Provide Aging Life Care to Seniors, Part II, in two weeks.