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Aging Wisely July 2013 - Aging Wisely

A Day in the Life of a Geriatric Care Manager


Geriatric care managers do a wide array of tasks for their elder clients and families.  It is almost hard to say there is a “typical day” for a geriatric care manager due to the varied nature of the job.  However, here we will share with you some of the common tasks handled by care managers and the ways these benefit clients.  You will get a good picture of the role and skills involved in quality care management. 

Aging Wisely geriatric care managers

A good care manager is an excellent planner and must manage time carefully…while at the same time having the flexibility to change courses quickly and adeptly.  A care management job by nature revolves around the particular clients the care manager is serving.  One of the unique aspects of care management is that while practices are standardized, the services aren’t “one size fits all”.  The care manager is a problem solver, which is often a bit like solving a puzzle.  The pieces may be very different, but the care manager knows common patterns and techniques to solve the puzzle.

Geriatric care managers don’t spend most days behind a desk.  You’re more likely to find them behind the wheel of the car and in and out of care facilities, doctors’ offices, hospitals and clients’ homes.  Care management has benefited from technology advances that enable the communication and research involved to be done more efficiently for a mobile workforce.

Some of the major tasks carried out by geriatric care managers (and why these are so important) include:

  • Coordinating and attending medical appointments: A big piece of quality care management is helping clients achieve better consistency and thus results from medical treatment and care, i.e. bringing a holistic picture to medical treatment that includes other aspects as well (nutrition, how the person is managing/safety at home, emotional issues, medication management and more).  The care manager helps coordinate and advocate for the individual and can help all providers achieve better results for the patient through this continuity (and communication).
  • Assessing and re-evaluating concerns/needs: Care managers not only do initial geriatric assessments in which many areas are evaluated for customized recommendations, they also evaluate on an ongoing basis.  These “routine” visits are checkups to spot things that could become a problem.  They keep things on track and also provide peace of mind to family members and others involved.
  • Coordinating providers, services, benefits:  A care manager typically makes initial recommendations and helps set up services which then evolve as needs change. This is a broad category, as a care manager could help with anything from setting up in-home care to ascertaining an appointment with a highly sought after specialist to assisting with benefits eligibility.  This is where geriatric care managers are really “resource experts”.  Because this category can cover any aspect of clients’ lives, this is also where clients benefit from a team approach like that at Aging Wisely.  The Aging Wisely client has access to the knowledge of a whole team of resource experts.
  • Communicating to involved parties: It is well documented that some of the biggest problems that arise, for example at hospital discharge or other transitions, come from communication gaps.  The care manager takes the time to: make sure parties are informed with the necessary information, ensure understanding of instructions, procedures, risks etc., ask key questions (often the most common “unasked” questions that produce misunderstandings) and provide feedback.

This “day in the life of a geriatric care manager” just highlights some of the big categories of tasks involved in the role.  The reality is that because geriatric care management is so customized, each day for each care manager can look very different.  The care manager must also be “crisis manager”, helping when a client goes to the emergency room or other immediate concerns arise. It is also for these reasons that a team approach can provide the best results for clients.  You can read more about Aging Wisely’s team approach to geriatric care management here.

Need a quality geriatric care manager in Tampa Bay, Florida?  Give us a call at 727-447-5845 for a free needs analysis and help with any and all of the above tasks!

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Evaluating Senior Housing Options: A Checklist for CCRCs


Retirement considerations and senior living

There are a dizzying array of options for senior living.  At Aging Wisely, we help many families with the decision process and transition to a senior living community.  In this article, we will share some of our wisdom about CCRCs as a senior housing option.  

What is a CCRC?  A Continuing Care Retirement Community (CCRC) offers various levels of care within one campus.  There are all types of set-ups for these communities and a wide array of price ranges, available services and styles.  A typical CCRC offers independent living (some may even have villas/homes), assisted living and skilled nursing.  Some may offer memory care as well.  

CCRCs have traditionally been set up as “buy-ins”, where you pay an up-front entry fee to the community along with a monthly fee (plus possibly some a la carte fees).  While this is most common, there are also CCRC style communities which offer all levels of care in a straight rental arrangement.  This is fairly common in our area in Florida (Tampa Bay/Pinellas County) and can offer extra flexibility for “snowbird” residents who may not wish to commit long-term. The more traditional arrangement, however, is that one pays a large entry fee up front in order to have long-term access to the various levels of care as needed.

There are three basic types of contracts for buy-in CCRCs:

  • Life Care or Extended Contract: This typically requires the largest up-front fee, but offers unlimited assisted living and skilled nursing care.
  • Modified Contract: This contract offers a set of services provided for a period of time. When that time expires, other services can be obtained, but for higher monthly fees.
  • Fee-for-Service Contract: This comes with a lower initial fee but residents pay for assisted living and nursing services at market value at the time needed.
Many continuing care communities offer variations on these contracts and have different specifications and limitations.

Here is a checklist for evaluating Continuing Care Retirement Communities:

  1. Know your budget and compare true costs.  Read the fine print of the contract and consider your risk tolerance (i.e. someone with little risk tolerance who can afford it may feel more comfortable having the guarantee of a life care contract).
  2. Find out about the stability of the ownership.  Be prudent with your investment as financial issues or other problems could leave you in the lurch.  Also, find out about your rights and protections if you choose to buy in to a community.  Here is a great article on the Wall Street Journal about Assessing the Financial Stability of a CCRC.
  3. Review all facilities and available services.  When you tour, you will likely look at the independent living where you will probably start your stay.  However, don’t neglect to see the assisted living, skilled nursing and any special care units.  Find out, in particular, about the quality of care at the skilled nursing unit which you may need at some point at least for rehabilitative care.  If that facility is poorly rated, some of the security you are paying for may not be worth it.
  4. Think about the long-term.  Will you be willing to move from what will become your home in to another apartment/section of the facility?  While having options on one campus sounds great, it will still feel like a move to you.  If you don’t take advantage of the additional care levels, will it be worth the money for a CCRC?  What if you enter as a couple and one person needs a higher level of care before the other?
  5. Involve key people in the discussion.  Talk to your financial advisor when looking at your budget and what might be most logical for you.  Consider how long-term care insurance plays in to this decision (if you have it).  Consider having your attorney review any contract before you sign.  Talk about the decision with trusted family members.  Consider bringing in a professional advisor such as a geriatric care manager, who can give you access to the whole array of eldercare options that might fit your needs.
Of course, assessing the quality of any senior care facility is important and we at Aging Wisely are here to help.  Our care managers assist Tampa Bay/Pinellas County elders and families with the senior care search and transition, with services from assessment and recommendations for facilities and financial assistance through the whole move process.  You might also be interested in our Guide to Choosing the Best Senior Facility which offers steps to organize your search and considerations in locating quality options that make sense for you.

As eldercare professionals, we often share the advice that people typically wait too long to consider senior living options and could benefit from more proactive thinking.  As I recently spoke to my 90-year old grandfather and friends from his CCRC, they echoed this sentiment. Most of their cohort only consider a retirement facility after health and care (or household management) needs have become problematic, when they could benefit from some of the positive aspects of retirement living sooner. It might be worth considering senior living options as a part of your overall retirement and healthcare planning, rather than thinking of it as a last resort.  

Give us a call at 727-447-5845 if we can help with your search for assisted living or retirement communities in the Tampa Bay, Florida area.
 We’re here to help you determine what eldercare options are best, with expert input and solutions for YOU.

This list offers some top considerations about a CCRC.  There are many additional details to consider and we will have additional articles on this and related topics.  You can sign up to receive our latest blog posts via email.  Leave us a comment if you have a question or topic you’d like to see us cover.

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Family Eldercare Issues: How Not to Have “The Talk”


eldercare conversation with daughter and aging parentSome of the most common questions our care managers get revolve around how to approach concerns with aging parents. Talking to friends recently reinforced how many of us worry about this.  We see a growing concern, such as a parent losing their hearing or having more difficulty managing the household, and we wonder how to bring it up and how they will react.  This also relates to “the talk” about future planning (i.e. will it be reasonable to stay in your large home if Dad dies, do you have long-term care insurance/what can you afford, contingencies for handling affairs).

The good news is that those who are thinking about this issue have avoided a big mistake, which is not to think about the approach at all.  Here are a few of the top mistakes you can make in “having the talk” about eldercare issues or planning with aging parents (and tips for making things go more smoothly):

  1. Waiting too long to have the talk/doing it in a crisis.  “The talk” should almost always be a series of talks, allowing time for your loved one to voice concerns and not feel pressured.  There may be times when this is difficult due to an unexpected crisis, but even then it may be helpful to take a step back and give your loved one some time to process the changes.  There may be ways to “buy time” or make a more temporary decision to deal with the crisis, while allowing time for permanent decisions.  But, most eldercare issues build up over time, with various opportunities for starting the discussion.
  2. Not thinking about the person’s perspective/personality and what approach might work best for him/her.  As mentioned above, the fact that my friends were thinking about how best to bring up an issues shows they were taking a positive step.  A difficult conversation in some families may be a non-issue in others.  Some older adults bring up driving with their children and tell them they have decided it is best to stop.  Others fight tooth and nail about giving up the car keys.  Family relationships, personalities and various factors affect how these conversations will go…and how they should be approached.  Think about what matters to the person, motivations and how the person is likely to react (fears/concerns that may arise).
  3. Not bringing the right people to the table.  It is likely that you should discuss the issues first with siblings to get on the same page (or find out if you’re not).  The same holds true for spouses and other important people in your loved one’s life.  If you don’t have their involvement, all the conversation may be fruitless.  You can also do a lot of future damage by not including your siblings or other key people.  If you know this is going to be problematic, consider having a care manager serve as a liaison in the process.  Additionally, think about any key figures of respect in your aging parent’s life.  Is there a pastor, doctor, or friend who might be helpful in the discussion?
  4. Treating an aging parent like a child.  The words we use can either frame the conversation in a way that treats the person respectfully or makes him/her feel defensive and disrespected.  Check our “Recommended Reading for Caregivers” for great books on this topic.  A geriatric care manager can also be an excellent resource about how to approach the conversation and ways to make sure choices and dignity are inherent in the process.
  5. Coming unprepared/not doing your homework.  While the first conversation may not immediately be about choosing a solution, you should come prepared with ideas and information.  If you are going to discuss getting some help around the house or giving up driving, you should know what resources are available.  Your aging parent is likely to raise practical concerns such as costs.  You don’t have to know all the answers, but it helps to have some ideas.  You may want to meet with a care manager beforehand to get some information, or suggest that as a next step to discuss options with an expert.

Need help “having the talk” or doing your homework to know the eldercare options available for your aging parent in Florida?  Aging Wisely’s geriatric care managers serve Pinellas, Pasco and Hillsborough counties in Florida.  We offer a range of services from eldercare consultations to geriatric assessments and ongoing care coordination.  Contact us at 727-447-5845 for help today!

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Eldercare Planning Assumptions that Can Derail Your Golden Years


long term care and eldercare derailmentWorking with so many families with different situations at Aging Wisely, you might be surprised that we see some common mistakes.  Or, more accurately, some common assumptions that people tend to make that lead to misguided eldercare planning or unanticipated problems later.  Whether you are in your golden years, helping an aging parent or just want to be wise about planning ahead, knowing these eldercare pitfalls can help you.

What are the top mistakes or assumptions people make in eldercare planning?

  1. Assuming that loved ones will be able to provide any and all care that is needed.  Family members do provide 80% of the long-term care assistance in the U.S. and you likely have family members that will be willing to pitch in to help.  However, there are many reasons that may not be enough.  First, your family’s circumstances may not allow for a family member to take on primary caregiving (for example,you may live hundreds of miles apart with neither party able to relocate, your children may be raising their own children and unable to quit jobs).  Second, your loved one may not physically be able to provide the care you need (can your daughter or son lift you, bathe you, and transfer you if you’re unable to help at all?).  There are many additional reasons you shouldn’t assume your loved ones can provide all your care.
  2. Assuming Medicare will cover what you need.  Medicare is not intended to cover long-term care needs.  It is really an acute care health insurance and therefore does not cover the types of custodial care that people often need at some point as they age.  You can read more in our articles on Medicare and long term care and Florida Medicaid.
  3. Assuming you have enough money based on a steady rate of spending ( i.e. neglecting to count healthcare and other care costs in retirement planning/budgets).  Acute healthcare costs alone average over $250,000 from age 65 to death, without factoring in long-term care.  This is why planning and professional help are so vital…from understanding appropriate options to choosing insurance coverage and matching care planning to a budget.
  4. Assuming your loved ones know what you would want.  Your loved ones may have to take over decision making for you at some point, or at the very least will likely be involved in helping you.  It is important to equip them to understand your perspective, especially the appointed decision makers (healthcare surrogate, power of attorney).  Families rarely talk about end-of-life wishes or even preferences for the time when care might be necessary.  While it may not seem like a pleasant topic of conversation, it is a lot worse to leave your family members in the position of guessing what you would want during a crisis.  Make sure you not only take care of the legal planning, but have the conversations to go along with it.
  5. And, of course, the biggest mistake is in not planning at all, or assuming it is not something you’ll need to think about because you are healthy.  The biggest problem with this assumption is that by not planning, you potentially lose choices and put yourself and your loved ones in the position of making decisions in a crisis.

There are a lot of little assumptions people make in retirement and eldercare planning, as well.  Sometimes people assume certain decisions or processes will be straightforward (e.g. choosing a Medicare plan, picking an assisted living facility, getting financial help for eldercare).  This can lead to ill-informed choices and regrets later.

Assuming you can do it all on your own, while it may be possible, might not be the wisest use of your resources.  Getting professional help can make all the difference in your outcomes. 

Another common issue is not sharing sufficient information with the professionals helping you.  To be able to give you the right advice, professional advisors need to know your circumstances.  Don’t neglect to tell your estate planning attorney about that estranged family member or deep-seated conflict, for example.  Don’t leave out major financial information when talking to your financial advisor, elder law attorney or geriatric care manager.

The best place to start for eldercare planning, or to deal with a current question or concern is an eldercare consultation.  Get help with everything from care options to navigating Medicare and long-term care to choosing the best assisted care.  You can call us at 727-447-5845 or click below to request a consultation:

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Celebrating Interdependence: Reframing the Eldercare Conversation


interdependence quote from Ghandi

Maintaining independence seems to be one of the more commonly stated desires (or worries) people have as they age.  Elders often express the desire to remain in their own homes, be able to continue driving and operate as usual with no outside help.  What this really boils down to is the natural desire to maintain choices and control over one’s life.  In our years of working with elders and families, we have begun to see this issue more clearly and think that it might make sense to change some of the terminology and reframe the conversation.

As social animals, we are all in some sense connected to others, and reliant on each other for various needs.  It is widely acknowledged that isolation is not healthy for the human psyche.  As we age (or have health problems or mobility issues), the type of dependence we have on others may change.  Some of the things we once did ourselves, we may now need others to do (or help with).  The nature of relationships sometimes change.

Interdependence is the type of mutual give and take that shapes most human relationships.  We think it might make sense to start valuing this interdependence more (or at least changing the language to more accurately reflect what we value). As we age and need help with certain tasks, this does not negate the value we bring to others. 

This is not to underestimate the emotions of having to rely on someone else for something (especially something physical/intimate or something you have done for yourself since you’ve been an adult), but isn’t relying upon each other a part of us being human?

We wrote about changing relationships in senior care recently and explored the language of “parenting my parent” or “role reversal” in caregiving.  While this all may seem like semantics, the words we use have strong emotional ties.  They frame the conversation and the way we approach things.

In our experience, many of the things most feared (or stated) by people as they grow old, turn out much more positively than portrayed.  Of course, dealing with illness and loss is not easy…but people don’t actually talk much about those fears.  It seems to be more the ideas of “giving up independence”, getting help or moving to an assisted living people that get people talking about the negatives of getting older. 

Time and time again we see that what is really scary is the isolation and fear of someone living alone and refusing help.  The dangers that some people expose themselves to in the name of remaining independent often take away just that choice.  On the other hand, many elders we work with grow to enjoy their home caregivers…for both the relief of having help and the company.  Similarly, after some adjustment, many elders find a lot to like about living in a care community.  If someone has been isolated at home and maybe even fearful about safety, the group setting brings a lot of positive change.  Not only are basic needs such as nutrition and safety covered, but socialization and activity do a lot for health and well-being also.

Our mission at Aging Wisely is to enable every individual we work with to live the most fulfilling life possible, with utmost dignity, focusing on their physical, mental, spiritual, family and financial wellbeing.  The essence of what we do as care managers is to help find solutions that work for the person, holistically.  A big part of that work is in the approach we take.  Families often comment about how something they expected to be negative (“giving up the car keys”, bringing help in to the home, moving to assisted living) turned out to be a totally different experience with the guidance of their care manager.

If we can help (or if you just want to talk about how we might be able to)…give us a call at 727-447-5845.  When you are approaching some of these issues and concerns, thinking about things from a different perspective can help.  Taking time to consider the approach and wording you use in talking to your loved one can make all the difference.  Working with someone who can not only help with the approach, but maximize the options available, can make it a whole different experience.

For further reading, we offer some book suggestions in our “Recommended Reading for Caregivers” and the David Solie and Mary Pipher books are especially good on this topic. 

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Mission Statement

Our goal is to enable every individual we work with to live the most fulfilling life possible, with utmost dignity, focusing on their physical, mental, spiritual, family and financial wellbeing.