What The Heck Is A Geriatric Care Manager?
As the number of elderly Americans soars over the next couple of decades, millions of baby boomers will wind up providing care for parents and relatives who have grown ill or require help with activities of daily living.

Contrary to the widespread belief that today's families are turning their backs on aging relatives, it's estimated that family members still provide more than 70 percent of all long-term care received by older Americans. According to one study from 2005, more than 13 million boomers already serve as caregivers for elderly parents.

But what happens when family members live out of town, or simply can't do it all? What can be done when the care needs of an ill or frail loved one exceed the capacity of family caregivers, or when adult children are overwhelmed by caregiving responsibilities while juggling the competing demands of their own families and careers?

One resource families can turn to for help in these situations is geriatric care management.

Geriatric care management is generally defined as a service that assesses an older person's medical and social service needs, determines which services the person needs, and then coordinates the services provided by paid caregivers, physicians, attorneys, financial advisers and others.

The goal of geriatric care managers (GCMs) is to help clients live as independently and with the highest quality of life possible, either in their own homes with assistance or through alternative living arrangements such as assisted living.

GCMs are often hired by adult children or other family members who have witnessed the declining physical or cognitive health of an elderly person and may already be providing care themselves.

The relationship typically begins with assessment by a GCM of an elderly client's health, functional abilities, family and social support, housing situation and other factors. The GCM then develops a care plan, identifies appropriate services for the client, arranges for and monitors these services, and provides on-going management of the care plan.

Because of their familiarity with the healthcare and senior services landscape in their communities, GCMs can "help clients and their families make good decisions based on all the resources that are available," says Linda Fodrini-Johnson, founder and director of Eldercare Services, a care provider with offices in Walnut Creek and San Francisco. "A professional care manager can save families a lot of time and help them make realistic choices based on a client's actual needs, rather than what the family thinks the client wants."

GCMs assist clients in crisis situations, such as medical emergencies, and they regularly communicate with families, alerting them to problems and keeping them updated about clients' changing needs. They help clients and their families navigate the complex healthcare system and make sure information gets shared between doctors, home health aides and other care providers. Many GCMs also provide family counseling and assess their clients' financial resources; some offer financial planning services.

These activities not only help elderly clients, but also provide much-needed solutions for adult children and other family members. Geriatric care management can reduce the caregiving burden for local family members, and bring peace of mind to those trying to care for loved ones over long distances.

A GCM "is like a ship's captain," explains Cathy Cress, a Peninsula-based GCM who authored the Handbook of Geriatric Care Management. "Baby boomers had no clue that they'd have to deal with parent care. There's no Bible or Dr. Spock for this. Care managers can bring families a lot of relief by helping them figure things out and guiding them through it all."

But geriatric care management services, which are private pay, may be too costly for some families. Hourly rates range from $80 to $200 across the United States, according to the National Association of Professional Geriatric Care Managers (NAPGCM), and are typically priced at the higher end of this scale in the Bay Area.

Demand for geriatric care management services, which emerged in the 1980s, is growing as the population of "oldest old" Americans increases and public awareness about the profession begins to build. In response, the number of businesses offering geriatric care management - which range from individuals to large companies - has risen sharply. Membership in the NAPGCM has roughly doubled over the last 10 years, to about 2,000. In California, there are now more than 300 NAPGCM members. Fodrini-Johnson, who is also president of the NAPGCM's Western Region Chapter, estimates there are about 25 NAPGCM members in the Bay Area.

Demand for GCMs is projected to continue climbing in coming decades, as baby boomers get older and the trend toward aging in place takes hold. "Boomers want to maintain their independence and avoid nursing homes and other institutions if at all possible," explains Professor Anabel Pelham, director of San Francisco State University's master's program in gerontology. "GCMs can help keep people living in their own homes longer. Geriatric care management is an exciting place to be for people interested in community-based long-term care."

San Francisco State's gerontology master's program is the first in the United States to offer a geriatric care management concentration. The track was launched three years ago, with help from a California Wellness Foundation grant.

The number of Americans age 85 and over is expected to rise from less than 5 million currently to nearly 10 million by 2030, according to U.S. Census estimates. California, because of its size, has the largest number of elderly people in the nation. And the Bay Area's population is expected to be the oldest in California by 2040, with 41 seniors per 100 working-age adults, according to the California Policy Research Center.

The rapid growth of the geriatric care management field has sparked concerns about consumer protection and the qualifications of GCMs. Many GCMs are licensed nurses or social workers, but some are not members of any licensed profession, raising questions about the potential for uninformed advice and fraud. In most states, any person can call himself or herself a GCM and offer services to the public, and state agencies generally don't monitor potential problems

To address these concerns, the NAPGCM is phasing in a certification program. By the start of 2008, all GCMs applying for NAPGCM membership must hold at least one of four approved certifications, and by 2010 all current and renewing GCM members must hold one of these certifications.

"We're trying to raise the bar and establish some level of competence and expertise," explains Kaaren Boothroyd, executive director of the NAPGCM. With the new requirements, you'll know if you hire a [NAPGCM] member that they are certified and qualified to help you understand the complex healthcare system and guide you through it."

The geriatric care management profession "is still relatively new, and the public is still learning what geriatric care management services are and what their benefits are for consumers," continues Boothroyd. "That's why we need these standards in place."

For information about geriatric care management and where to find a geriatric care manager, see the National Association of Professional Geriatric Care Managers (NAPGCM) website. The NAPGCM's Western Region Chapter, which includes California, has a website. A 2002 report issued by AARP, titled "Geriatric Care Managers: A Profile of an Emerging Profession" is available online.

(This article originally appeared in the Summer 2007 issue of Bay Area Summit)

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