By Debra Wood, RN, contributor
An aging population has created opportunities for experienced nurses to venture into private practice as geriatric care managers, providing assessments and long-term monitoring of an older adult.
“I like the idea, as a geriatric care manager, that I can make an elderly person and his or her family more comfortable and can help them avoid some of the pitfalls of aging and the pitfalls of our health-care system,” said Sue Meeks, RN, MS, MA, CMC, owner of Sue Meeks & Associates of Memphis, Tennessee.
Meeks began her health-care career 40 years ago, concentrating her efforts in elder care. She has earned master’s degrees in nursing and gerontology. Before starting her business in 1994, she spent 10 years as the director of nursing at a long-term care facility.
After being hired by a family member, attorney or other responsible entity, geriatric care managers provide an initial assessment of the elder’s physical and functional abilities, including activities of daily living and instrumental ADLs; medications taken; the home situation; and the person’s needs. They may review medical records and speak with the person’s physicians.
“I absorb where the patient is on their life-care journey and then provide them a summary of what we see and recommendations toward resolution of some of the problems,” said Joan Richardson, MSN, RN, CCM, CS, who opened Advanced Care Management in Alexandria, Virgina., in 1990, after many years in public health. “We offer professional, objective guidance.”
After the assessment, care managers suggest services to help the older adult continue living independently or to assist with placement in a nursing home or assisted living facility. Long-term, care managers monitor clients at regular intervals, monthly, weekly or as needed, and adjust care plans accordingly.
“My most rewarding cases are the ones that stay with us for years and incorporate us as part of their family team,” said Richardson, who helps people anticipate changes and plan for them, such as discussing end-of-life issues. “We bring everyone to the table to deal with their feelings and issues around morbidity and mortality.”
Care managers may accompany a client to a doctor’s appointment, especially if they are concerned about the number or type of medications the elder is taking or to facilitate clear communication between the patient and physician.
“The main reasons a care manager has to go with the patient to the doctor is to make sure the communication is accurate in both directions and to make sure the patient is not written off as old,” said Jae E. Lawrence, BS, RN, CSA, CMC, a geriatric care manager at Florida Hospital Home Care Services in Orlando.
Geriatric managers must be familiar with available community health and support services, payor policies and entitlement programs. Meeks recently spent considerable time assisting clients sign up for the new Medicare D, prescription drug program.
Elders typically respond positively to the extra attention, the three care managers said. They like having someone they can talk to and trust.
“As nurses, we have a big advantage, because anyone who has been in the hospital usually has a high regard for nurses,” Richardson said. “We let them know we are caring and compassionate and work for them only. I may tell them, ‘We’re going to help you get home, or we’ll make sure you live the rest of your life the way you want to live it. For the most part, we’re well accepted. We’re embraced.”
The exception may be if there already exists a lot of angst in the family. Rivalry, greed and hidden agendas present challenges.
In addition to visiting with clients, care managers must handle the business side of their practice, invoicing and collecting fees, creating assessment forms, keeping records, and marketing.
“You have to be prepared to be poor for a while or have an alternate income stream while you build up your services,” Lawrence said.
Lawrence began his care management career by establishing a private practice eight years ago, but found it difficult to grow the company and tend to family obligations. He approached Florida Hospital about three years ago about establishing and running a care management program as part of its home health division.
Care managers also may work in attorney’s offices or for banks.
Most care management services are paid for privately from the client’s funds or by the family. Some long-term care policies will cover a portion of the services.
Most people hear about care managers through word of mouth or networking. Care managers often offer educational programs to community or professional organizations, as a way of spreading the word about their services.
“It’s good when another professional refers, because usually that’s a trusted person,” Richardson said. “The family member and the older person will have more confidence than if a neighbor tells them or they read about it in the newspaper.”
Geriatric care management typically attracts nurses and social workers, but anyone can proclaim him or herself a care manager. Currently, no licensure exists for geriatric care managers.
Anyone hiring a care manager should carefully evaluate the person’s credentials and check references. Asses whether the potential care manager belongs to and ascribes to the standards of practice established by the National Association for Professional Geriatric Care Managers and if the professional has achieved certification from the National Academy of Certified Care Managers or the Commission for Case Manager Certification.
“Certifications require [someone] be able to demonstrate through years of experience and testing that they at least know the information needed to do care management,” Lawrence said.
Richardson recommends talking with the potential care manager to determine if he or she shares your same beliefs, is compassionate and connects with you. Some care managers are more clinical, while others are hands on and quickly become involved.
Nurse geriatric care managers enjoy independent practice, while regularly drawing on their nursing assessment and interpersonal skills. They offer elders opportunities for prolonged independence and provide families peace of mind.
“It’s rewarding,” Lawrence said. “Because every once in a while I make a difference.”
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