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Got parents? Then read this

Sep 30, 2009 | | Comments (4)

I've made that promise...
Creative Commons License photo credit: heureuy

One of my friends mentioned the other day that we’ve reached the age where we worry as much about our parents as they used to about us.

Aging isn’t for sissies, as Bette Davis aptly noted, and our parents face a fleet of health, housing and cognitive issues as they grow older. Sometimes, dealing with those issues is too much for them—and for us, whether we live next door or 3,000 miles away.

Enter the geriatric care manager, a kind of case worker for the elderly who can assess virtually every kind of problem and offer solutions.

The New York Times had an excellent piece about these professionals in its Patient Money section: “When elder care problems escalate, you can hire an expert.”

The article offers this good advice:

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.

A geriatric care manager, who I found via CareManager.org, was a godsend for us when my father suffered a massive stroke while visiting his sister in Florida. Her background in nursing was invaluable as she translated what the doctors were saying into layperson’s terms and then gave us a clear idea of Dad’s likely prognosis. She helped us find a rehab facility for him and monitored his progress. It was her sad duty to let us know that he was failing, and she even helped with the funeral arrangements.

She was worth every penny—but her services didn’t come cheap, and this is one bill for the elderly that Medicare and insurance typically won’t pay. A one-time assessment can cost a few hundred dollars, while ongoing services can quickly run into the thousands. We paid $90 an hour for many, many hours, although the cost can range from $50 to $200, according to the NYT.

Some families make the cost more manageable by splitting the bill among the siblings or using the parents’ savings, if available.

If you really can’t swing the cost, the Times article mentioned other options, including the Alzheimer’s Association, which offers free care consultations for people with dementia, and the Eldercare Locator, a service of the Department of Health and Human Services, which can link you to local agencies on aging.

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I think it is becoming increasily difficult for people to know when they need help with their parents and when they can help them themselves. You mention that this service isn’t covered by insurance, wouldn’t that be covered by a Long-Term Care policy? I guess as long as the LTC policy covered in-home care as most do. That’s probably the biggest reason to get a LTC policy is to stay in your home as long as possible and/or have the option of where to go after that. What is your take on this type of insurance?


Costs for geriatric care managers isn’t automatically included in LTC insurance–as with most aspects of this coverage, you have to check the policy. I think LTC coverage could be a smart choice for people who can afford it and who aren’t rich enough to self-insure, but it’s one of those issues that’s not do-it-yourself. I’d consult with a fee-only planner who’s familiar with this area and get a referral to a competent agent.


self-insure? I guess I never understand that goal? concept? whatever it is. I wrote about it: http://evolutionofwealth.com/2009/09/14/self-insured-or-is-it-no-insurance/

What is your take?


It’s a viable risk-management approach but it’s not for everyone. Some people will never self-insure; in their eyes, the certain expense of a premium is better than the potential of having to spend their own wealth. And I would argue that few should self-insure for health care, since the expenses can be so catastrophic. But if you have a reasonable estimate of the costs you’re likely to face and the wealth to cover them, then self-insurance can work. For example, most people spend a couple of years in a nursing home, max. But the possibility exists that you could spend 20 years there. If you had the wealth (20 years times $120,000, plus an inflation factor) and didn’t care about leaving inheritances, self-insuring would be an option.