When Elder Care Problems Escalate, You Can Hire an Expert

By LESLEY ALDERMAN – New York Times
CARING for an elderly parent is emotionally and mentally draining. There are diagnoses to decipher, housing issues to consider, health aides to vet and a raft of legal documents to complete. It can seem overwhelming, even when families are in complete agreement on how to care for an elderly relative. And often they are not.

Last week, my colleague Walecia Konrad offered advice on how to find “respite care” — someone to temporarily help you tend to an elderly parent or loved one so you can have some time for your own life. This week, I am writing about what to do when you feel the situation calls for the equivalent of a case worker.

Happily, such case workers can be found. They are called geriatric care managers.

Yes, you must pay these professionals out of your own pocket. Regular insurance does not cover them, although some long-term care policies do. But a good care manager can buy you time and some peace of mind so you can concentrate on your job, your family and your own health.

A typical case might be Howie Gray and his two brothers. For years, they had cared very well for their widowed mother, Delle Gray. Ms. Gray lived alone in a ground-floor condominium in Brookline, Mass., two streets away from her son Stephen. But after Ms. Gray passed out in the bathroom one night, the sons suspected that their mother, then 90, needed more help.

“We wanted her quality of life to be as good as it could be,” Howie Gray said.

But the men, busy with their own lives, did not have the time or expertise to figure out what was missing. So about five years ago, they hired Audrey Zabin, a care manager in Boston.

Ms. Zabin did a thorough assessment and found that Ms. Gray had low blood pressure, which is why she passed out, as well as poor vision and balance. She determined that it was time for Ms. Gray to have home care. Ms. Zabin also persuaded Ms. Gray to change her sleep habits — something her sons had been trying to do for years. Instead of staying up until 2 a.m. and sleeping until afternoon, Ms. Gray shifted to a more normal rhythm — asleep by 10 p.m., up by 9 a.m. — which would make it easier for her to get to doctor’s appointments and see her family.

“My mom doesn’t listen to us, but she listens to Audrey,” Howie Gray said.

That is another great reason to use a care manager: they can play the bad cop, persuading the older person to stop driving or insisting that an aide move in, so you don’t have to.

That person can also be the voice of reason when a family is not seeing eye to eye. Reesa Tansey and her siblings agreed that their mother, Ruth Tansey Goldberg, should age at her home in Los Angeles. But their mother’s husband — their stepfather — did not think that was a good option for him or for her.

Mrs. Goldberg, 85, was suffering from Alzheimer’s, but her husband, 84, was going to work each day and still able to golf with his friends.

Bunni Dybnis, a care manager based in Los Angeles, helped the children navigate the complicated terrain. At first, Ms. Dybnis arranged for 24-hour home care for Mrs. Goldberg. When Mr. Goldberg concluded that his wife would be better off living elsewhere with more stimulation, Ms. Dybnis helped the family find a reliable and intimate residential home for Mrs. Goldberg to move to.

“This wasn’t our first choice,” Ms. Tansey, who lives in Berkeley, said. “But Bunni helped make it all work out. We never felt like we were drowning.”

A geriatric manager can swoop in, figure out what needs fixing and move on to the next case. Or the manager can provide continuing support for situations that cannot be resolved quickly. Because care managers charge by the hour — typically $50 to $200 — what you pay will be based on how long you choose to keep them on the case.

If you want to hire a geriatric care manager, you can start by asking for names from everyone you know with elderly parents.

“The majority of new clients come from referrals,” notes Phyllis Mensh Brostoff, a geriatric care manager and president of the board of the National Association of Professional Geriatric Care Managers. “This is a personal business. It’s akin to hiring a babysitter.”

If that does not work, you can go to the association’s Web site, www.caremanager.org, and click on Find a Care Manager to locate one in your area.

Be sure to ask about backgrounds and credentials. If your parent has complicated medical issues, a care manager with a nursing background might be best. If the parent has cognitive problems or is just plain ornery, someone with a master’s in social work might be better.

Find out whether the person is a member of the national care managers’ association, which has strict requirements: members must have a master’s degree in a field related to care management, like nursing or social work, two years of supervised experience and certification by one of three accrediting agencies. Ask for a brochure and a fee schedule. Learn whether the care manager works alone or in a group practice and if they will be available to you 24 hours a day or just on weekdays.

Once you have found someone you like and trust, there are three ways you can use their expertise.

CONSULTATION If you want straightforward advice — like, “Is it time to move my mother to a nursing home?” — set up a consultation. This is generally done in person and typically takes one to two hours. “The care manager can help you figure out what you need to concentrate on and what solutions may exist, ” Ms. Mensh Brostoff said.

Cost: $100 to $200

ASSESSMENT When your parent is living far away or has multiple problems, you can ask for an in-depth assessment. The care manager will spend an hour or so with your parent, speak with family members and doctors, and assess the living arrangement in order to paint a complete picture of the client’s situation and challenges. The manager will send you a 5- to 10-page written report with specific recommendations.

Cost: $500 to $1,200

CONTINUING CARE If the recommendations are extensive, you might want the care manager to carry them out for you (like upgrading a home or locating an assisted-living facility). Ms. Mensh Brostoff has one client she has been seeing for more than 20 years, although she says her average case lasts about three.

In Brookline, Mr. Gray and his family rely on Ms. Zabin to make sure their mother, now 96, has everything she needs. Ms. Zabin checks in with Ms. Gray periodically and makes recommendations. “She owns the case,” says Mr. Gray. “And that is tremendously comforting to all of us.”

Cost: Hourly fee

Finally, when money is tight, consider free options. If your elderly person has Alzheimer’s, the Alzheimer’s Association (800-272-3900; www.alz.org) can set up a free care consultation with a social worker, who can provide advice and connect you with useful services in the community.

Also, you can try the Eldercare Locator (800-677-1116; www.eldercare.gov), a service of the Department of Health and Human Services, which can connect you with local agencies on aging. Sometimes just attending a free seminar can give you enough information to make tough decisions on your own.