Geriatric Care Managers: Geriatric Care Managers: Know When to Call Them Know When to Call Them Presenter: Moderators: January 29, 2010 Vanessa R. Bishop, MSW, LICSW, CMC Robert Bullock E. Ayn Welleford, PhD This webinar presentation, including the slides, is not designed or intended as legal advice or counsel nor is it intended to create an attorney-client relationship. 1
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Geriatric Care Managers:Geriatric Care Managers:Know When to Call ThemKnow When to Call Them
Presenter:
Moderators:
January 29, 2010
Vanessa R. Bishop, MSW, LICSW, CMC
Robert Bullock E. Ayn Welleford, PhD
This webinar presentation, including the slides, is not designed or intended as legal advice or counselnor is it intended to create an attorney-client relationship.
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HOWHOW--TO and QUESTIONSTO and QUESTIONS2
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DefinitionDefinition
A professional Geriatric Care Manager(GCM) is a health and human services specialistwho helps families who are caring for older relatives.The GCM is trained and experienced in any ofseveral fields related to care management, includingnursing, gerontology, social work, or psychology,with a specialized focus on aging and elder care(NAPGCM - www.caremanager.org).
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Need and Selection ProcessNeed and Selection Process
Elder care has become so complex, that amultidisciplinary team of experts is necessary tosuccessfully manage the total spectrum of needs ofelder clients. One of the essential players of this teamis the Care Manager.
The proper selection of each member of the careteam becomes critical. This is particularly true of theCare Manager.
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QualificationsQualifications
True or False:
Anyone regardless of their level of education andoccupational background can call themselves acare manager.
• How will the componentseffectively and professionallybe managed if the caremanager does not have anappropriate level ofeducation?
Degree ConcentrationDegree Concentration
• What area is their degreeconcentration?
• Care managers with a background inpsychology, nursing, social work,public health administration andother fields related to human servicespecialization will be the mosteffective.
• Medical and mental healthbackgrounds are crucial whenhaving to prepare for guardianship,power of attorney, emergencyplacement and crisis management.
• Care Managers must know thetechniques and skills in determiningan individual’s capacity whenpetitioning for legal guardianship.
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Qualifications (cont.)Qualifications (cont.)
LicensureLicensure
• Determines the ability toassess and determine anindividual’s mental,medical health andgeneral welfare
• A Licensed Clinical SocialWorker is particularlysuited to do this
• Legally authorize toassess and determine thecognition, mood andbehavior of the client.
• Diagnose and treatmental illness withpsychotherapy
• Assist in guardianshipcases by assessing theindividual’s mentalcapacity using standardassessment tools.
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Qualifications (cont.)Qualifications (cont.)
Registered Nurse (RN)Registered Nurse (RN)
• Have an extensive knowledge oftherapeutic interventions,medication therapy and medicaldiagnosis and are able to conducttreatments at the home site versusneeding to enter into a hospitalsetting.
• Can take treatment orders over thephone versus in the medical office.
• Are able to monitor a client’sphysical status and medicalmanagement, which is animportant component ofmanaging the total client/patientrelationship.
Work HistoryWork History
• Duration of experience in a relatedfield: months versus years.
• Service model: social workers,nurses, psychologist.
• Continuing education to maintainand expand ones knowledge base.
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Qualifications (cont.)Qualifications (cont.)
Certification
• There is no specific license or degree forGeriatric Care Management.
• Certification exists for a Certified CareManager or Case Manager and can beused as indicators for competence.
• Eligibility requirements must be met.• College or advanced degree in a medical
or mental health related field.• Number of clinical supervision hours.• Number of years in the field.• Passing a certifying exam.
• Remember, certification is much differentthan a certificate.
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National Association ofNational Association ofProfessional GeriatricProfessional Geriatric
Care ManagersCare Managers
• No exam, howevereligibility requirementsmust be met
• Largely consists ofrequirements for care orcase managercertification.
• Has an extensive andgrowing directorythroughout the US.Directory also includestheir degrees, licensuresand areas ofspecialization.
The NationalThe NationalAssociationof SocialAssociationof SocialWorkers: AdvancedWorkers: AdvancedSocial Worker CareSocial Worker Care
ManagerManager
• No exam is required,however eligibilityrequirements mustbe met anddeterminedappropriate by thereview board.
National Academy ofNational Academy ofCertified CareCertified Care
ManagersManagers
• Conducts an examtwice year. Eligibilityrequirements mustfirst be met.
www.NACCM.netTel: 800-962-2260
www.caremanager.orgTel: 520-881-8008
www.socialworker.orgTel: 800-742-4089
SERVICESSERVICES
Care management iscomprised of manydifferent componentsand services.
Some care managersmight specialize in acertain area of caremanagement, e.g.Alzheimer’s andother memory relatedimpairments,consultation, acutemedical caremanagement andmuch more.
When is Placement Appropriate? Inability to independently conduct their activities of daily living
Safety and quality of life is in jeopardy
Comprehensive assessment is a key component indetermining placement.
A key component in determining placement is the informationgathered in a comprehensive assessment. Key assessment tools aredemographics, psychosocial history, medical history, nutritionalstatus, cognitive and mental health status, functional abilities/statusand home safety.
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IndependentLiving:
One, two bedroom or studio
Amenities, full kitchen,transportation, housekeeping,
recreational outings or programs
Mild level of care, i.e.,administration of medication or
reminders
No 24 hour nursing care.
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AssistedAssistedLiving:Living:
One, two bedroom and studio. No full kitchen because at that point it isof question if the individual has to the ability to safely conduct meal
preparation.
Amenities, higher amount care, some medical services providedin house, i.e., dental, audiology some visiting doctors,
transportation, social and recreational programs.
Higher number of nursing staff and for longer periods duringthe day. M-Sun. Medical staff available in the event of an
emergency.
Some specialize in memory impairment and provide a specialcare unit.
Levels of care 1-4. 1= assisted with administration ofmedication, reminders, bathing lower body. 4= extensiveassistance with their activities of daily living, i.e., bathing,
dressing, feeding, meal preparation, transfers.
Important to look at long-term care nursing when this starts.
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Long-term carenursing:
When one requires 24-hour nursing care andcan no longer live safely in the community such
as AL with just custodial care. Requiresassistance from licensed nursing and medical
staff.
Many services provided, i.e., nursing, socialwork, dietitian, rehabilitation, visiting MDs,
podiatrist, audiologist, dental, ophthomology,and some specializing doctors, i.e, wound care.
Continuing CareRetirement
Communities:
Consists of Independent Living, Assisted Livingand long-term care nursing. Various entryrequirements and payer sources for each
residential setting.
A lifetime package is offered for those enteringinto IL, but there is no long-term care Medicaidfor those entering straight into long-term care.Alternative placement would have to be sought
after.
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ASSESSMENTASSESSMENTTOOLSTOOLS
DemographicsDemographics
Health StatusHealth Status
Mini Mental State ExaminationMini Mental State Examination(MMSE)(MMSE)
Key component in determining eligibility andaffordability.
Medicaid, Medicare, private pay, HMOs and long-term care insurance
Subsidies
Independent Living: subsidies, private pay
Assisted Living: subsidies, grants, private pay andsome long-term care insurance
Long-term care nursing: Medicare, Medicaid, HMOs,long-term care and private pay
Will determine coverage under health insurance andout of pocket expenses
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LongLong--termtermcare Medicaidcare Medicaid
Misconception of long-term careMedicaid
Must medically and financiallyqualify
Assuming one fully qualifies can bedangerous. At first glance you mightthink they will qualify but Delmarva,
KePRO or DMAS could determineappropriate for assisted living.
Have a care manager conduct amedical assessment to assist in
determining qualification.
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EligibilityEligibilityandand
admissionadmissionprocessprocess
Bed availability. An extensive waitlist can impact theadmission process. Census will determine if someone will
be accepted straight Medicaid or does a number ofmonths of private pay need to be considered.
Acuity level is also a factor. If nursing is already strainedbecause of the acuity level will they want to take another
patient placing the quality of care at risk?
Each residential facility, i.e., independent, assisted andnursing conducts a medical screen to determine
placement.
Financial applications are to be completed by the residentor responsible party member.
Decision making lies in the hands of the facility
Why I encourage that all of the eggs are not placed in onebasket. Have 2-3 facilities of interest determined.
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ConclusionConclusion
There are 26 million peopleworldwide with Alzheimer’sdisease (AD).
There are 5.2 million in theUnited States with AD and50% are undiagnosed.
The estimated direct andindirect US annual costs aremore then 148 billion.
Mil
lio
nP
eop
le
The United States has a significant problem now and it willintensify significantly in the future.
ConclusionConclusion (cont.)
To cover the total spectrum of needs in elder care,various disciplines will need to be involved. Moreimportantly, in depth expertise in each of thedisciplines, in particular that of geriatric caremanagement is required to assure a successful andsatisfactory outcome for those in or entering intotheir “golden years.”