Tips for Choosing A Geriatric Care Manager

As the number of Geriatric Care Managers across the country continues to grow, we at AZA Care Management and Home Care are thrilled to be part of such a thriving profession. Because we have been in business for almost 20 years, we have witnessed many changes and trends in the industry. Recently, we have noticed that our consumers are more informed about the field of Geriatric Care Management and are asking better questions. As a result, we have put together some tips for family members and fellow professionals about how to be savvy consumers when shopping for a high quality care manager.

The following are areas we suggest considering:

Credentials

Check the credentials of the care manager you are considering hiring. Care managers have diverse experience, education and backgrounds. Often a good care manager has both an advanced degree and several years of experience in care management.

Many care managers are licensed in their state in specific fields such as nursing or social work. If appropriate, make sure they are members of their basic professional organizations.

Experience

Care managers should be full (not associate) members of the National Association of Professional Geriatric Care Managers in good standing. As of 2010, as full members of the National Association, care managers are required to carry one of the following certifications: CMC, CCM, C-ASWCM or C-SWCM.

Availability

The care manager should be available 24 hours a day, seven days a week, and you should have access to his or her cell phone or answering service number. You should also be aware of other members of the care manager’s team — nurses or support staff — in case you have a question and can’t wait for the care manager to return your call.

Transparency

Make sure you know all the ins and outs of the care manager’s billing policy. Some care managers bill more for phone calls or visits on weekends and holidays or after normal business hours. Make sure you are aware of how and for what you will be billed.

Chemistry

An important part of working with clients and their families is chemistry. Be sure you get along with and like the individual you are considering hiring.

Areas of Expertise

You should find out if the care manager has a particular area of expertise. You will want to hire someone who regularly handles clients with similar needs and issues.

Continuing Education / Supervision

Care managers should be engaging in continuing education on issues of aging as well as in their areas of expertise. Each care manager is required to complete a certain number of hours each year in which he/she is being supervised by another care manager.

Conflicts of Interest

You want to hire a care manager who is not receiving incentives to place clients in certain facilities or with particular providers. The advice you get from a care manager should be related to the care needs of the client, not to the care manager’s relationship with third party providers. Receiving this kind of kickback is not only a conflict of interest, but also a violation of our National Association’s standards of practice.

Quality Assurance

When evaluating the potential working relationship with a care manager, you should make sure that the care manager has methods to get feedback from customers and ask what this system is. Also ask if such feedback has had an influence on his or her practice.

Type of Practice

Care managers generally fall into two categories: sole practitioners who work for themselves or those who work for a practice with two or more care managers. There are advantages to working with both types of practitioners. A sole practitioner may have fewer formal legal contracts and paperwork to be signed. When you contact a sole practitioner, your communication from the start is with the person you will be working with. Care managers who work for a larger practice, on the other hand, will often have the opportunity to work as part of a team and will have the benefit of other team members’ experience as well as their own. Additionally, you may have the ability to find a care manager that suits your personality from a more diverse practice. Regardless of the type of practice the care manager works in, experience with and knowledge of the specific issues the family is dealing with are of utmost importance.

In summary, as with any important decision you make in life that affects you or a loved-one, due diligence is essential. You should feel free to ask for references, the extent of geriatric experience the care manager has and the other policies of the practice that may have an affect upon a positive working relationship and the best possible outcome.

Helpful Links:

The Elderly: Finding a Good Geriatric Care Manager, August 6^th, 2009

http://www.businessweek.com/magazine/content/09_33/b4143056857265.htm

Questions to Ask – National Association of Professional Geriatric Care Managers

http://www.caremanager.org/displaycommon.cfm?an=1&subarticlenbr=82

Emergencies and Natural Disasters: Are we prepared?

The recent water emergency in the Greater Boston Area has raised some questions for us as eldercare professionals and members of seniors’ families about our readiness to deal with an emergency or natural disaster. We made it our goal this month to research what issues had been identified for older and disabled adults and how we can better prepare our clients and families to cope with disaster.

Several types of emergencies could threaten the safety of older and disabled adults such as a terrorist attack, flood, hurricane, earthquake, tornado, blizzard, or water crisis. According to an AARP survey, roughly 13 million people aged 50 and older say they will need help to evacuate in a natural disaster. About half of these individuals will require help from someone outside of their household. As an example, in Louisiana during Hurricane Katrina, roughly 71% of the victims were older than 60 and 47% were over the age of 75 (AARP Press Center, 2006).

Issues Raised by Former Disasters / Emergencies

Both Hurricane Katrina and the 9/11 terrorist attack have brought to light issues and concerns for older and disabled adults that may have not been previously considered or planned for.For example:

* Essential services such as meals for the homebound and home health care were not delivered because staff had no official authorization to carry out their responsibilities.

* Home Health Aides were unable to check on whether or not their patients had been rescued. They were denied access because they lacked proper identification showing they were service professionals.

* Disabled people who were unable to leave their apartments were left behind with no electricity, no running water, and no information about what was happening and what they should do.

* There was no way to identify vulnerable people who were not connected to a community service agency.

* People did not know whom to call for assistance and there was much confusion over identifying and accessing phone numbers of organizations that could help.

* Local pharmacies were closed, doctors’ offices were difficult to reach, and older people could not physically get to pharmacies to pick up medications.

Planning Ahead

Having identified these issues, many state and federal agencies have now developed recommendations for how older and disabled adults and their families can cope with a disaster. These agencies insist planning ahead for a disaster with family and care attendants will minimize the potential neglect that can result in trauma or death. Every family should have an emergency plan that includes safety precautions for older or disabled family members, whether they are residing in assisted living or skilled nursing facilities or living independently.

Based on these recommendations we compiled the following list of ways you can help an elder or disabled adult prepare for a disaster.

Get Informed

Ask about specific hazards that threaten the community and your risks, community response plans, evacuation plans, designated emergency shelters, warning plans, special assistance programs available in the event of an emergency, service providers, emergency plans, and facility based emergency plans.

Complete a Personal Assessment

Consider how a disaster might affect the elder or disabled adult’s individual needs. Identify what resources are used on a daily basis and what might be done if they are limited or not available. Make a list of personal needs and the resources available for meeting them in a disaster environment.

Create a Personal Support Network

Establish a group of people that can help in an emergency. Make an emergency plan. Make sure everyone in the network knows the plan and where the elder or disabled adult will go in case of a disaster.

Document / Stockpile Medications

Document and store all prescription medication information, including dosages and treatment and allergy information.

Prepare Emergency Documents

Make copies of important documents such as health insurance cards, Medicare cards, and Health Care Proxy agreements, and store them in a waterproof container.

Compile an Emergency Survival Kit

Create an emergency box that contains essential items a person would need to survive in an emergency, such as battery operated radio, flashlight, batteries, first-aid kit, non-perishable food, cell phone with extra battery, etc.

Plan for Pets

If someone is evacuated, pets may not be allowed in emergency shelters. Contact local animal shelter or emergency management office or talk to a veterinarian to find out what options there are for pets if they must be left behind.

Other Important Ideas

Phones for Life: Senior Cell Phones

Provides free cell phones so that seniors can dial 911 in an emergency. www.phones4life.org

Vial of Life

Provides free vial of life kits to all seniors that include a form indicating their demographic information, current and past medical conditions, blood type, medications and allergies, doctor’s contact information, special instructions and emergency contact information. This form is placed in a seal-able plastic bag on the refrigerator and a decal is placed on the front door.

http://www.vialoflife.com/

Financial Planning: Electronic Payments for Federal Benefits

One simple, significant way people can protect themselves financially before disaster strikes is to sign up for electronic payments for federal benefits.

Go Direct (800) 333-1795, www.GoDirect.org

Direct Express® (877) 212-9991, www.USDirectExpress.com

Identification for Service Providers

Contact service providers such as home health agencies to ask about what identification is available to home health and transportation providers should they need to reach an older or disabled adult during a disaster.

For this e-blast, we have included only a basic list of how to prepare for a disaster. If you would like more detail about disaster planning, please call or email us for a detailed list of ideas. Our Care Management department also offers emergency planning for our clients. Please contact us if this service would be helpful to you or an older or disabled person that you know.

Other Resources / Printed Material

Ready America Older Americans Emergency Preparedness Brochure

http://www.ready.gov/america/getakit/seniors.html

Disaster Preparation by Seniors for Seniors

http://www.redcrosstbc.org/pdf/DisasterPreparednessSeniors.pdf

Emergency Preparedness for Older People
http://www.ilcusa.org/media/pdfs/epopib.pdf

Topics of Interest: The Debate Over Senior Drivers

From the desk of Audrey Zabin, M.Ed., CMC, LSW

A series of recent accidents involving senior drivers has sparked efforts by the Massachusetts state legislature to impose tougher rules on older drivers. On March 2nd, the Massachusetts Senate passed a driving safety bill that would impose new mental and physical fitness screening on older drivers who seek to renew their licenses. The House passed a similar bill last month. However, the two bills are quite different in terms of their recommendations for older drivers. Currently, Massachusetts drivers are required to renew their licenses every 5 years, regardless of age, but must do so in person every 10, when they are required to take a vision test. The House bill requires older drivers to renew their licenses in person every 5 years and pass a vision test. The Senate version goes much further, requiring mental and physical acuity screening for those 75 and older in addition to the 5-year in-person renewal with vision test. Before the Governor can sign either bill into law, however, the two chambers have to resolve the differences in their approaches.

There are good arguments both for and against the more rigorous bill the Senate is proposing.

Advocates for this more stringent regulation might argue that:

· As the population ages, there will be more older drivers on the road. The number of licensed drivers over 65 is projected to double to nearly 57 million by 2030. Older people now keep their licenses longer and drive more miles than prior generations. This rapid increase in the older driver population has led to concerns about the potential effects on traffic safety associated with the trend.
· Older drivers are more likely to be involved in crashes that are fatal. In 2008, nearly 8% of the 451 fatal crashes in Massachusetts involved drivers age 75 or older, compared with less than 4 % of the more than 57,000 nonfatal crashes and the 142,000 crashes that resulted in property damage.
· Compared with younger drivers, senior drivers are over-involved in certain types of collisions such as angle crashes, overtaking and merging crashes, and especially intersection crashes. Seniors are also more likely than younger drivers to be cited for failing to yield the right of way.
· Physical, cognitive, and visual abilities decline with advancing age. Many older drivers take medications that can impair driving ability at any age, but that can be especially impairing for an older person.
· It is very likely that this type of legislation can reduce fatal crash rates for older drivers. Several studies also show that vision testing and in-person renewals among seniors are associated with lower fatal crash rates per population and per licensed driver.

Opponents of the proposed rules might argue:

· Senior drivers are being unfairly discriminated against. Although some abilities may decline with advancing age, there are large individual differences in the onset and degree of functional impairments. Therefore, age alone is not sufficient information to judge driving ability.
· Statistics on older drivers need to be taken in context. A review of state and national data showed that elderly drivers account for a smaller percentage of accidents than other age groups. In 2008, while Massachusetts drivers age 75 or older constituted more than 7% of those holding licenses, they accounted for 3.6% of all crashes.
· Although fatal crash rates are high for drivers age 75 and older, they are not as high as those for drivers 16-19 years old. Additionally, the higher likelihood of fatal crashes in older drivers may have more to do with increased frailty rather than driving ability.
· Despite growing numbers of drivers on the road, fewer older drivers died in crashes and fewer were involved in fatal collisions during 1997-2008 than in prior years.
· Infrastructure and other roadway changes could be made to reduce the probability of crashes in intersections. Improvements such as better visibility of road signs and pavement markings and dedicated left-turn lanes and signals could be made to improve roadway safety for seniors who may have visual impairments due to macular degeneration, glaucoma, cataracts or other health factors. Another approach might be to reconfigure existing or new intersections or rotaries, which could reduce vehicle speed and eliminate some of the most complicated aspects of traditional intersections.
· Older drivers may have safer driving habits. The Massachusetts Institute of Technology AgeLab reports that most older drivers have some safer habits, including more constant use of seat belts and fewer instances of speeding, reckless driving, and alcohol-related incidents. The AgeLab also found that seniors tend to be more cautious about when they drive, foregoing outings in bad weather or at night.
· This type of legislation has not proven universally effective in reducing fatal crash rates. Several studies have shown that vision testing among seniors was associated with lower fatal crash rates. However, other studies have shown that fatality rates did not differ for states with and without laws for vision testing, road testing, or shortened renewal periods.

Folks on both sides are likely to agree that every person will face a decline in functional ability with age. However, correctly identifying at-risk drivers and providing remediation are important. The goal of driver screening is to identify people at high risk of crash involvement without falsely identifying drivers who are not at risk. So far, there are no tests that accomplish this goal with sufficient accuracy. Until there are, it is likely that this debate will remain a hot topic for those of us in the eldercare industry as well as for those on Beacon Hill.

In our practice, we frequently deal with the issue of when to stop driving. This is a sensitive issue for many seniors and one that requires compassion and understanding. If you or a senior you know needs help making this difficult decision, there are several “Shifting Gears” programs listed below that might be helpful. The programs focus on how age affects one’s driving ability, how to avoid collisions, how to assess your own driving skills, when or/if an elder should surrender his/her license, and the benefits of not driving a vehicle.

3/24/10 8:00am 1340 Centre Street, Newton (617) 244-4373 x 10
3/30/10 10:00am Holliston Council on Aging 150 Goulding Street, Holliston (508) 429-2624
3/31/10 7:30am 1340 Centre Street, Newton (617) 244-4373 x 10

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Sources and Resources:
Schworm, P.; Elderly Drivers don’t live test-free in N.H.: Mass. studies program’s results. The Boston Globe. August 4, 2009.
Bierman, N.; Senate approves testing for elderly drivers, ban on texting while driving, The Boston Globe, March 2, 2010.
Shishkin, P. ; Crashes Fuel Debate on Rules for Older Drivers. The Wall Street Journal, July 14, 2009.
“Q&As: Older People.” Insurance Institute for Highway Safety. April 2009. http://www.iihs.org/research/qanda/older_people.html
Elderly Driving Statistics and Motor Vehicle Operation Laws: A comparison between age groups and the effectiveness of age-based laws. http://www.senatormoore.com/issues/indepth/seniors/resources/Elderly%20Drivers%20Research.pdf
Abel, D.; Elderly drivers in fewer accidents than others: Statistics don’t discourage push to change law. Boston Globe, July 19, 2009.
Levy, D.T.; Vernick. J.S.; and Howard, K.A. 1995. Relationship between driver’s license renewal and fatal crashes involving drivers 70 years or older. Journal of the America Medical Associates 274: 1026-30.
Nelson, D.E.; Sacks, J.J.; and Chorba, T.L. 1992. Required vision testing for older drivers. New England Journal of Medicine 326: 1784-85.
Grabowski, D.C.; Campbell, C.M.; and Morrisey, M.A. 2004. Elderly licensure laws and motor vehicle fatalities. Journal of the American Medical Association 291: 2840-46.
Colarossi, A.; Seniors’ low car-accident rates dispel myths about age and driving. Orlando Sentinel, 2010.

No Surprise: Baby Boomers Struggle More with Caring for Aging Parents

AZA Care Management and Home Care recently completed a study with some graduate students at Bentley University, and wanted to share with you some of the interesting results. The goal of the study was to ascertain what challenges baby boomers are facing in caring for their aging parents and how a care manager might help adult children deal with these challenges.

The students conducted a survey of 60 baby boomers representing a variety of demographics. The survey results indicate that parental caregiving may be more challenging for this group of adult children than it was for the prior generation. The majority of respondents were between ages 45 and 64, representing the baby boomer generation born between 1946 and 1964. Our study supported data published by the Economic and Social Research Council in 2008 that showed family responsibilities among boomers have increased rather than decreased. [1] For example, a majority of the sample (58%) reported having a minor child for whom they were responsible, and a majority of the same sample (64%) reported having an aging parent for whom they were providing care. Furthermore, improvements in life expectancy mean that a greater number of baby boomers, even in their late 50s, will have a parent still living. Our survey supports the suggestion that more baby boomers will be members of the “Sandwich Generation,” i.e., middle-aged adults providing care to both their minor children and their aging parents at the same time. [2]

Because middle-aged baby boomers are likely to still be employed, caregiving for their parents
(as well as for their children, if they have them) will also present a time constraint. In our study, almost all the
respondents were employed (93%) and most (78%) were working 40 hours or more per week.
Of those who had cared for or were currently caring for an aging parent, more than half the respondents
(66%) reported spending 10 or more hours per week and a quarter (26%) reported spending 20 or more hours
per week caring for the parent. 

Adding to the challenge of caregiving for aging parents, baby boomers are finding themselves responsible
for relatives who may live some distance away from them. More so now than in the past, baby boomers
have moved away from their hometowns to take jobs, while their retired parents have headed to
warmer climates. [3] In our study, although most respondents lived within an hour’s travel time from their
parent(s), more than a third (36%) lived farther away. 

The challenges of dual caregiving burdens, time limitations, and lack of convenient proximity to
aging parents are not new for middle-aged adults. However, our results do support the premise that
baby boomers are having and will continue to have greater difficulty grappling with these issues
than their predecessors did. 

At AZA Care Management and Home Care, our skilled professionals are well aware of these
issues as we work on a daily basis with adult children who are struggling with
similar challenges. We look forward to hearing your feedback on our study, as
well as continuing the very important work of supporting this unique generation
of caregivers. 

[1] Joseph F. Coughlin. “Creating Products to Relieve ‘Sandwiched Boomers’.” National Underwriter. Life & Health
3 Oct. 2005: ABI/INFORM Global, ProQuest. Web 9 Nov. 2009.

[2] The Boston Globe 16 Nov. 2009, Health and Fitness section. Boston.com Web.
.
[3] Susan B. Garland. “Faraway Relatives Turning to Geriatric Experts.” The New York Times
19 Jan. 2003,Late Edition (East Coast): Banking Information Source, ProQuest. Web. 9 Nov. 2009.