Many seniors need help with things ranging from routine money management to guardianship, but do not know where to get it. Just as our elder population is burgeoning, our health care system is confounding its users with new layers of bureaucracy and a dizzying propensity for change.
Geriatric clients are vulnerable. Not only are they faced with an increasingly inaccessible health care system, but many do it alone. More than ever before, nuclear families are geographically separated, and seniors cannot rely on sons and daughters as liberally as they might have in the past. Family members, even those in close proximity, sometimes find they cannot work full-time themselves and sustain the level of care their older relatives need. Pressure builds, crises erupt, and hands need holding.
America is aging at a rapid rate, and more and more attorneys find themselves confronted with the issues and complexities of elderly clients.
Estate planning, investment oversight, selection of health care providers, property maintenance, changes in living situations — these are the facets of geriatric life that require ongoing, active management. Although frequently the first line of defense, attorneys are not always equipped to handle the day-to-day entanglements — from hiring a housekeeper to the negotiation of hospital costs — which their elderly clients present.
The Role of the Care Manager
This is where Professional Care Managers become indispensable from the perspective of Benjamin Alschuler, an attorney at Wildman, Harrold, Allen and Dixon in Aurora. "As the lawyer, I can draw up the papers and plan the legal ends of it, and the trust officer can handle the finances, but we’re not in a position to get involved in the day-to-day life of the client. Care Managers are a God-send."
Geriatric Care Managers, a new breed of professionals who populate a growing world of alternative care for seniors, are equipped to manage both the intricacies and the dailiness of client situations. This industry, now experiencing impressive growth, fills an important gap: helping older clients discover that they do have options where few existed before.
With the help of Care Managers, the elderly see their choices broaden in spite of physical and mental frailties that make full independence unfeasible. Instead of rushing for the nursing home, where 15 percent of all residents have been placed for safety reasons, rather than for health issues, seniors can now choose to live at home with whatever degree of assistance they need.
The goals of Care Management are simple: Keep clients in their home environments for as long as possible, address their health care and life-management problems, and maximize the quality of their lives. Unlike case managers, who are primarily driven by insurance companies and the companies’ consuming desire to keep costs at bay, care managers put clients, and their individual needs and wishes, first.
Geriatric clients are not the only beneficiaries of care management. As disease control improves, so do life spans. Those coping with Down’s syndrome, cancer, AIDS, and Alzheimer’s disease are living longer and requiring extended supervision and care. They need advocates, skilled professionals who can coordinate the services that prolong and enrich their lives.
Far-Reaching Skills, Wide-Ranging Services for the Elderly
Care Managers are typically registered nurses and/or social workers who hold advanced degrees in their fields. These professionals have a high level of knowledge in health care and life issues, and a strong sense for the machinations of the health and insurance industries. Compensated at a rate of $75 to $100 per hour, care managers are supported and complemented by assistance-level caregivers, whose services are roughly $30 to $50 per hour.
The services offered by Care Managers cover the full spectrum of geriatric needs. Included under the umbrella of available options are:
Assistance with living arrangements
This encompasses the assessment of living conditions, determination of an appropriate level of assistance (home care versus an assisted-living facility, for example), and the implementation of any necessary changes.
Life care management
This covers housekeeping, lawn maintenance, miscellaneous property repairs and transportation needs. Care Managers will frequently contract with housekeepers, landscapers and other professionals who understand senior problems and demonstrate sensitivity to this special population.
Day-to-day money management
This encompasses monitoring of routine expenses, check book management, and establishment, if needed, of dual-signature accounts to protect clients from unscrupulous opportunists.
Health care management
This involves the selection of doctors, management of medical care, the hiring and supervising of on-site care givers, and transportation to and from doctor’s appointments.
This enables Care Managers to negotiate with third-party payers for health care benefits, to act as Guardian of the Person and/or agent for Health Care Power of Attorney, assist with public aid applications and otherwise support clients as they navigate various state and medical systems.
Once major life and health issues are addressed, clients are treated to the kinds of services that boost their morale and quality of life. Assistance-level care givers will take clients out for lunch, to movies and plays, shopping for clothes, and to the homes of friends and relatives they might not otherwise be able to see.
Case Studies: Maggie and Cora
Maggie is in her eighties and was, until recently, living in the direst of conditions. Although she has $1.5 million dollars in cash, Maggie had no clothes, no food in her cabinets, and was surrounded by the fringe characters her drug-addicted granddaughter brought home to their shared, squalid environment.
Having encountered a steady stream of resistance from both Maggie and her granddaughter, the attorney and trust officers involved chose to explore another avenue in bringing the situation under control. They hired a Care Manager.
Rapport was established between Maggie and the Care Manager, and progress was immediately registered. Maggie gave her lawyer Power of Attorney of Property and the Care Manager the Health Care Power of Attorney. Direct accounts were set up with necessary vendors — the grocer, local stores, etc. — along with a dual-signature checking account that precludes exorbitant payments to ghost contractors. The cast of characters encircling Maggie, using her, are gone. She is now residing in a safe, supervised facility, where her physical and mental needs are met consistently. Her life has been restored.
Cora was identified by the Council on Aging as a vulnerable senior. Crippled by arthritis and in the grip of Alzheimer’s disease, Cora did not understand that her niece kept her in a bug-infested, third-floor walk-up where she had been robbed three times so that Cora’s money could become her niece’s inheritance.
Cora’s attorney and trust officer reviewed the case with a Care Manager who promptly identified and documented the ways in which Cora’s niece was misusing her funds. Cora gave the Care Manager the Health Care Power of Attorney and the Care Manager assisted Cora in moving to a first floor, assisted-living environment that supports rather than enfeebles her. An Order of Protection was secured against Cora’s niece, and the abuse of her assets and her person was stopped.
The case was complex and yet simplified by the Care Manager’s input. According to Helen Sigman of Helen Sigman and Associates, Ltd., Chicago, the Care Manager’s legwork and careful documentation were "keys to winning the case. The Care Manager was the eyes and ears in regards to the client," says Sigman. "She united the important facts of the case because of her intimate insight into the day-to-day life of the client."
The End, and the Beginning
Geriatric clients, and the legal and financial agents who serve them, now have a new range of custom-built, empowering options.
The use of Care managers can expand the choices that elder law attorneys can offer to seniors, the chronically ill, the mentally impaired, and their families. It is an option which elder law attorneys should be aware of and consider for their senior clients.
Shay Jacobson, is a licensed Nursing Home Administrator. She is the President of Health Care Innovations of America, Inc.; a care management company in Aurora. She may be reached at firstname.lastname@example.org.
Martha Kern is an Assistant Care Manager at Health Care Innovations of America, Inc.