Written by Dorothy Tagarelli, Geriatric Care Manager, LCSW, A-CSWGCM
As a Geriatric Care Manager (GCM), I am often asked what services I provide. My response is always, “Tell me what the needs are, and I’ll let you know if and how I can help”. The multitude of tasks I perform, and the complexity of those tasks vary greatly, as individual needs do.
GCM’s, formally referred to as Aging Life Care Professionals (ALCP) are human services specialist who offer guidance and support for older adults facing challenges. Whether that guidance is needed during a crisis or for ongoing care and support, these professionals assist families in creating and implementing care plans to ensure the best quality of life for the older adult, while providing the necessary support to the families.
As a member of the National Aging Life Care Association (ALCA), we are a group of about 1,675 professionals trained in fields related to long term care. These include social work, nursing, gerontology, physical and occupational therapy, psychology, counseling, mental health, and other allied health professionals who focus on the health and well being of the older adult.
To become a member of Aging Life Care Association, one must meet strict requirements in their professional experience, education, and certification as well as adherence to ALCA’s strict code of ethics and standards of practice. These requirements ensure the ALCA Professional has the knowledge of available resources in their communities, and the expertise to offer guidance and support while creating a safe and feasible plan of care.
To give you an idea of what I do, the following is an example of two recent cases I had:
Mr. B is an 85-year-old man with high blood pressure and high cholesterol, living in a home he owns with his wife, who is recovering from hip surgery. One day, his mental status was altered, and his son brought him to the Emergency Room. He was combative, noncompliant and required 24/7 supervision in the hospital. When the call came through to my office, I was told that this was not typical behavior and although he exhibited some mild problems with his memory, he was still able to perform his activities of daily living up until a few days before which meant he was driving, shopping, paying bills, and taking care of his own personal needs.
He was combative toward the hospital staff and would not agree to give them a urine sample or allow a blood draw. The psychiatrist was called in and gave him Haldol to keep him calm.
When I met Mr. B, he was irritable and confused. On top of it, he did not know why he was in the hospital and was agitated that the staff were continually coming in shouting commands at him (even though their goal was to provide a good level of care). I spoke to the social worker and the nurse and asked that they try to refrain from commanding and ask Mr. B instead. Instead of telling him, “I am going to take your temperature”, try “Mr. B, would it be ok if I took your temperature. The doctor is concerned and wants to know if you have a fever.”
Once he was given this control of being able to answer for himself, we could see his irritation lessen.
I sat with him and repeated many times why he was in the hospital and let him know I was on his side. Once we formulated a plan together – “Let’s just get the urine and blood tests and get out of here,” he calmed down. He now had an ally; I was on his side.
It was determined, in working with his family and the doctors that a complete panel of blood work was warranted as we were unsure of his adherence to his medication at home.
When the urine came back positive for a Urinary Tract Infection (UTI), they were able to start antibiotics and we started to see an improvement in his overall status.
Once he was released from the hospital, I worked with the family to create a plan where Mr. and Mrs. B had aides in the home for the time being. The family was given referrals to elder care attorneys to get their legal documents updated and local resources to aide in paying bills. My organization (acting as Aging Life Care Professionals) has taken over managing their medical care and they are escorted to all medical appointments. We’ve arranged for prepackaged medication, home food delivery, and they both have Physical Therapy in the home, so they do not have to drive to those appointments.
As Mr. and Mrs. B both recognize they have some health issues, we are exploring assisted living options that can provide the level of care they require. In working collaboratively with the hospital staff, family, and other local resources, we all feel confident that Mr. B is in a safe and healthy environment and we will continue to provide oversight. Ultimately, our goal is to provide a level of care that ensures safety for the client and stress relief for the family.
The family of Mrs. F contracted with me over four years ago. At the time, Mrs. F was diagnosed with vascular dementia and both her daughters recognized her needs would increase over time. Mrs. F was, at that time, an independent 81-year-old woman well educated and capable woman who lived in the city and enjoyed a variety of cultural and social events and had many friends to share them with.
Unfortunately, Mrs. F’s local daughter passed away last year leaving her other daughter to manage things from afar and me to manage things day to day.
Mrs. F’s cognitive impairment increased and her mobility and ability to manage her independent activities of daily living decreased. She has little insight about her deficits and tends to prove combative at times. About a year ago, I hired a companion who spends five days a week with Mrs. F (10 am – 5 pm). Mrs. F was resistant as she “didn’t need any help,” but, it followed a hospital stay and the doctors “mandated” she have help in the home. She is still alone on weekends with a cleaning woman on Saturday morning and a neighbor who pops in to check on her. Mrs. F, her daughter, and I have spoken about increasing help to seven days a week as she is exhibiting cognitive decline.
As it happens, Mrs. F was alone recently when the blackout in New York City occurred. After calling the building, Mrs. F, her neighbor, her son-in-law (to which there were no answers), and finally Con Ed, I was sure she lost power. So, at 9:30pm, I packed a bag complete with flashlights and a charged cell phone and headed to New York City. I parked my car as close as possible (there were lots of police barricades), walked the ten blocks to her apartment in the eerily dark streets of NYC. When I arrived, I found the building did not have a land line and the switch board was down. The doorman knows my client and they aware of my role and told me they hadn’t seen her.
I walked up the eight flights, quite thankful she wasn’t on the 24th floor. She did not answer the doorbell, so I let myself in. As I approached her apartment, power was restored. Every light was on, the a/c was blasting, and Mrs. F was sound asleep and never heard me enter her apartment.
I made sure the cat had water, left a note and flashlights. I contacted her daughter, neighbor and son-in-law with an update and after a glass of water and sitting to catch my breath for ten minutes, I made the return trip home.
If power were not restored, Mrs. F and I would have spent the night in a hotel in Westchester. Luckily, there was no need to disturb her. As it turned out, her son-in-law and neighbor were both out of town. Her daughter was not yet aware. I waited until I could assess the situation before contacting her.
Going forward, we are adjusting the care plan. Weekend help will be in the home by next weekend!
In the end, I was able to respond to the emergency and her daughter has the peace of mind knowing that. It’s never a problem, just a day in the life of a Geriatric Care Manager!
After note: Mrs. F called today and asked why she was alone. I told her I was at the apartment last night and she said, “Well, I wasn’t. I was hanging out with all the lovely people on the street. You shouldn’t have bothered!” 😊