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James Sullivan
James Sullivan
Geriatric Care Managers and Superior Client Service

How geriatric care managers complement CPAs serving aging clients.

November 19, 2009
by James Sullivan, CPA, PFS

This article was previously published in the AICPA CPA Insider™.

Sitting across from you is Sarah, a long-time tax and financial planning client. Her husband, David, no longer attends these meetings. David is 68-years-old and is suffering from dementia of the Alzheimer’s type. Increasingly, Sarah is finding it hard to take care of David by herself. They have two adult daughters both of whom live in another state. Her sister will occasionally stay with David so Sarah can run errands. Both daughters have been pressuring Sarah to sell the family home and move nearer them so they can help take care of their father. Sarah is not sure that’s the right thing to do. Taking care of David and arguing with her daughters about his care has taken its toll on her health. Exasperated, she asks for your advice.

As their client base ages, CPAs will see scenarios similar to the one above play out in their office with increasing frequency. Many of these issues are well outside the scope of the CPA’s expertise. The key to providing exceptional client service, however, will be in knowing when and to whom to make a referral. Geriatric Care Managers (GCMs) specialize in working with the elderly in need of care. Their services include performing a comprehensive assessment; developing a plan of care; overseeing the delivery of care and working with the family to educate and ease the tension between family members that often accompanies the need for long-term-care (LTC) of an elderly parent or relative.

Geriatric Care Managers (GCMs) work with the elderly and their families to coordinate the provision of care and help them remain as independent as possible for as long as possible. Unfortunately, says Luise Warren, a GCM in suburban Chicago, adult children often back their parents into a corner. Concerned over their mom’s or dad’s safety, they will force the issue of moving from their home to a safer environment. The parent will become defensive and may eventually tell their children to “mind their own business.” A GCM is not emotionally involved and brings a balanced perspective to the situation.

“Care managers,” says Audrey Zabin, a GCM in Boston, “must always answer to the issues of safety and care.” There is often a fine line between placing a senior in a too restrictive environment in which they may languish and actually decline both physically and cognitively, and placing the senior in a less restrictive environment that may endanger them. Here is where the knowledge and experience of a GCM can be most valuable.

GCMs come from a variety of professional backgrounds including nursing, gerontology, social work or psychology. Many have done their masters-level work. Zabin holds a M.Ed. in counseling from Harvard University. Warren also holds a masters degree and is a Licensed Clinical Professional Counselor. While their backgrounds are diverse, GCMs have a common focus on aging and elder care.

Many GCMs are members of the National Association of Professional Geriatric Care Managers. Beginning in 2010 the NAPGCM will clearly identify which members are certified care managers. In order to be recognized as such, the member must hold at least one of four certifications granted by three different organizations. All certifications require the passing of an examination and a required number of hours of practice in the field.

Planting the Seeds for Change

GCMs offer a variety of services all focused on the need of the elderly person for some level of care. Each client will react differently to the loss of autonomy — some will resist the introduction of care insisting that it is not needed. According to Warren, a GCM must be sensitive to how the care is introduced. If possible, it may be better to gradually introduce the care in stages rather than all at once.

Obtaining the trust of the elderly client is the first step. If possible, Warren begins by focusing on those issues most important to the client — even if there are more pressing problems. It is important not to overwhelm the client and not to push them. When possible, says Warren, “I first plant the seeds, I show patience and let the client mull over the possibility of change.” Ideally, the senior will eventually initiate the needed change. In the meantime, she builds in the necessary safety features.

A Broad Range of Services

Engagements with a GCM can range from a short consultation of one or two hours to a long-term engagement that may last the remainder of the client’s life. Both Zabin and Warren have met with seniors and their families to review the services available in the local community and discuss state and federal entitlement programs for seniors. A GCM’s familiarity with the local community and the various entitlement programs saves the family time and money as they begin their search for resources.

As their name implies, GCMs do not actually provide the care, rather they coordinate and monitor the care provided by others. Examples of more comprehensive services offered by GCMs include:

  • Comprehensive assessments of the client’s functional, physical, social, emotional and financial needs as well as their capabilities.
  • Develop an individualized plan of care.
  • Linking the senior to community services.
  • Guardianship services; signing a power of attorney for healthcare and financial responsibilities.
  • Counseling services.
  • Support for caregivers.
  • Providing advice and guidance on family caregiver arrangements.
  • Acting as a client advocate with health care professionals, hospitals, insurance companies.
  • Supporting, monitoring and maintaining services for clients living at home.
  • Evaluating, selecting and coordinating new living arrangements when needed.
  • Basic money management including bill payment, bookkeeping, organizing tax related documents.
  • Monitoring client care to ensure quality and effectiveness.
  • Serving as a liaison between the elderly client and his or her out of town family.
  • Filing supplemental insurance claim forms.
  • Provide referrals to caregivers or geriatric specialists.
  • At the center of all of this care is the client. While care givers see only a part of the person they care for; the GCMs see the whole person.

Fees

GCMs typically charge an hourly fee for their services. Medicare does not pay for the services although some LTC insurance policies do. Clients or their families typically pay out-of-pocket. But the value GCMs can bring to your client is clear. Helping a client stay in their home longer and avoid a nursing facility can save thousands of dollars each month. Their knowledge of the local community service providers can help families avoid mistakes and save hours of research. Finally, they can provide families peace of mind.

You recommend that Sarah hire a GCM to do a comprehensive assessment. You explain to her what a GCM does. You encourage Sarah to tell the GCM about her daughters’ concerns. The GCM will recommend ways to alleviate the tension that has developed between her daughters and herself. You tell Sarah that you would be happy to work with the GCM once the assessment and plan of care is completed. You can work the estimated additional costs of care into their overall financial plan to determine what changes may be needed.


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James Sullivan, CPA, PFS, MAS, is an investment counselor at Core Capital Solutions LLC. He has almost 25 years of experience in individual tax, investing and personal financial planning. Before joining Core Capital Solutions, Sullivan spent 20 years at Arthur Andersen LLP. He is a member of the AICPA PrimePlus/ElderCare Task Force.