How to find a geriatric care manager?
September 24, 2009 3:19 PM   Subscribe

Does anyone have any experience engaging and / or working with a geriatric care manager for an elderly relative or friend? My sister and I need some help (and a little moral support) with respect to dealing with our mother, who has mild dementia (and lives in Nassau County, New York). Any suggestions with respect to finding, evaluating and / or working with one would be greatly appreciated. Many thanks to the hive!
posted by SuzB to Health & Fitness (6 answers total) 2 users marked this as a favorite
I had to move my mother to Washington state so she could move into assisted living, she has since progressed to dementia care.
I went through the state's Social and Health Services website for some general guidelines.
But it sounds like you're looking for in-home care, yes? I'd still contact/look up the NY state's elder care services. You might just google that and see what you get.
As far as evaluating - that's tricky, and generally speaking, you'll get better care (whether it's in-home or in a facility) if you're somewhat nearby and can drop in once in a while unannounced. So at some point, you may want to consider moving her closer to you or a sibling. Know also that moves are *very* hard on dementia patients - they get disoriented and anxious, so think about moving her before she's too much further along, it'll be easier, really.
Dementia is a hard road to walk with one's parent, it takes patience and presence most of all.
I wish you the very best.
posted by dbmcd at 7:04 PM on September 24, 2009

A local social worker - found through your mother's community elder services or hospital she's been treated at recently should be able to give you a list of local providers who have hopefully been vetted. It's certainly worthwhile to check references, especially for in-home care. If you aren't nearby but have any family or good friends nearby who can pop in and out it's a really good idea. My mother-in-law has an individual caregiver because the assisted living place she currently lives in doesn't provide some of the things she needs. Her caregiver emails us regular updates about their activities and M-I-L's status. Meanwhile my brother-in-law checks the residence's website regularly and contacts them to do simple things like request an alternative meal for her when he sees that the posted menu is something she doesn't like because she is both inassertive and so deaf and blind that reading a menu is impossible. So contact - with individuals, with what should be a detailed website if it's a residence and with someone on the scene is essential to my mind.

I think it's hard to choose sensibly long distance - if you know anyone who works in related services locally you may be able to find out essential things. We are planning to move my M-I-L near us as soon as a spot becomes available in our place of choice. While researching we ruled out one because of its utter lack of intellectually stimulating activities. Later a friend told us that her father had discovered massive embezzlement of residents' assets at the place we had rejected (he was a resident, very blind and deaf but cognitively intact and with great computer skills). The manager in question was quietly let go but no charges were ever filed. We never would have heard about this if we hadn't known someone. Key takeaway is also to not be quick to turn over financial assets you don't have to - keep control and keep track.

And good luck - dealing with dementia is very difficult and depressing.
posted by leslies at 7:32 PM on September 24, 2009

When my Dad had to be moved into a board-and-care home due to dementia, the hospital social worker at his health-plan hospital was able to help - she had a list of care managers, care homes and so on.

You also might want to check out the Alzheimer's Association - they have local chapters, a message board, and helpful links.

Best of luck to you - this is a sad and energy-sapping situation that so many adult children find themselves in.
posted by Rosie M. Banks at 10:28 PM on September 24, 2009

My grandparents had some bad physical problems right toward the ends of their lives. Their insurance helped cover the cost of having a nurse come over daily, cook meals, clean up a bit and hang out with them. After things got too rough and they had to go to a home, we sold the house and helped pay for a really nice assisted living facility. My advice to you (I strongly encourage this) is to go and visit any and all prospective homes before you make your decision. My grandmother was in three homes for various periods of time, and I can tell you now that a bad nursing home is like Hell on Earth. Seriously.
posted by wild like kudzu at 12:00 AM on September 25, 2009

posted by Carol Anne at 5:27 AM on September 25, 2009

Hi All:

As a follow-up to my original post, I thought I would share my subsequent experience with a geriatric care manager. Overall, the experience has been a disappointing one. It has been a little over two months and about $1,400 in fees since my sister and I engaged the geriatric care management firm, and thus far we have learned nothing we had not already known or otherwise figured out on our own long. There were frequent time delays with family interviews and feedback as well as inaccuracies and significant omissions in the care assessment report. The experience was, in short, a waste of time.

The firm in question was recommended to us by a well regarded elder care attorney who helps us with our mother and her brother, our uncle (i.e., our other elder care project). The geriatric care firm is also well regarded by local personnel with A Place for Mom, an organization that provides referrals to nursing homes and assisted living facilities. Although I interviewed several geriatric care managers I found through a variety of channels, I settled on this firm because (a) it, or at least the owner / manager, is well regarded; (b) it has infrastructure with two offices (in New York and Florida), two care managers with social services backgrounds, an on-staff nurse and an office assistant in contrast to the many geriatric care managers who are free agents operating out of their homes; and (c) the owner seemed very astute in the two or three conversations we had before I engaged her firm.

What isn't clear to me is whether our experience is reflective of the management style and / or workload of the geriatric care practice as a whole or primarily the result of the disorganization or competence of the individual care manager assigned to our case, who is not the owner / manager. Regardless of the underlying causes, the time lags between interviews and other delays seemed to contribute to the care manager's errors in factual understanding as well as her ultimate and critical failure to interview our brother and consider him in her assessment despite routine requests and reminders from me to do so. As to overall management style, I can at least attest that the owner / manager’s client relationship management skills were sorely lacking in our discussion of the problems with our care manager’s assessment.

It is possible that our expectations of the capacities of a geriatric care manager were unrealistic notwithstanding the fact that expectations like ours are those around which such firms market themselves. My sister and I had a thorough and accurate understanding of our mother’s limitations and their potential consequences, and expected the care manager to help us strategize practical ways to deal with them given our mother’s personality and the facts of our own lives. We didn’t need someone to come in and reassure us that, yes, our perceptions were correct; we needed someone to help us figure out workable solutions – and this is quite possibly where we misjudged the utility of a care manager. In a conversation on Friday, our lawyer shared with me his view that care managers are much better equipped to deal with crisis situations requiring immediate intervention and less effective with situation like ours in which there are chronic problems for which there are no clear cut, formulaic conclusions. In such non-crisis situations, he believes that the only real value of a care manager is to be available to check up on the disabled person when caregivers are unavailable; he did emphasize, however, that even this value is limited as no one can attend a disabled person 24 / 7. I only wish he had shared these insights with me before we embarked on this adventure.

At this point, I think it would be a waste of time to try to force some assistance out of the current care manager or her firm or to start over with another firm. There are, however, two things I should have done differently and would recommend to anyone contemplating the engagement of a geriatric care manager: (i) investigate the capacities and reputation of the individual care manager to be assigned to the case separately from those of his or her employer, and (ii) insist that the service agreement or contract include a specific timetable for the conduct of the care assessment as well as financial penalties for the failure to meet deadlines that do not occur due to reasonable unforeseen circumstances or delays imposed by the client.

Alas, forewarned is forearmed.

Thank you for all your responses!
posted by SuzB at 3:02 PM on December 6, 2009 [1 favorite]

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