Who Knows? Who to Ask When Help Is Needed?
by Carol S. Heape, MSW, CMC
March 12, 2020
My mother is quickly spending her savings and will not be able to afford her assisted living community. What do we do?
My husband requires so much care due to his health that I am exhausted. I want to be able to do it all, but I have my own health issues. What is there that can tell us if there’s a solution for us?
I live alone and am finding it harder to get through the day. Chores around the house are piling up and I know I should look for an affordable solution as I grow older. Who can I talk with about where to start?
My husband is a veteran and we’ve heard there are resources that veteran families can access. How can we find out what those are and if he qualifies? We are needing help badly.
My parents live thousands of miles away from me. They want to remain in their home, but I worry that with no help or local contact, something awful will happen. What can I do to help them and give me a sense they are taken care of?
My father is in his 90s, lives alone in a rural area and is very stubborn. He relies on a neighbor for a trip to the grocery store and refuses any more help. He wants to stay in his home and not move closer to me. How can I do the right thing and still respect his decision?
All of the above scenarios are real with older adults and their adult children having to address difficult situations. It’s hard to know where to turn for the answers and sometimes a decision has to be made quickly. As we’ve all been taught or learned from experience, we look to the person or profession that will address the issue. The types of situations above do not clearly direct how to discuss and find the solution to the particular problem. For example:
If it’s a legal issue, common sense says to contact an attorney and one that has expertise in the area of law you need. If it’s a banking problem, you call your bank. The post office helps with mail and of course, when you need food, there’s a choice of grocery stores and specials. Medical problems are addressed with your doctor. You get the picture.
Why is it that when there’s an issue with your parents, your spouse or yourself that knowing where to go, who to talk to and get knowledgeable help with the problem. There are probably several things going on such as increasing age, declining health, inability to drive, cook meals, balance the check book, etc. Fortunately, there are professionals who are educated and trained to help – care managers.
Credentialed care managers are social workers, RNs, gerontologists and other human service professionals who are experts in their own community, their region and their state. Families, who understand they don’t have the answers, contact these experts and detail the stories as described above.
So you may ask, how are these care managers qualified to help families resolve these complicated issues? Care managers, many of whom have graduate degrees, have specialized in issues around moving, housing choices, public programs such as Medi-Cal waiver programs, veterans’ assistance, public programs funded through federal funds such as the Older Americans Act. Their skills include:
- Knowing how much things cost, such as board and care homes, assisted living communities, skilled nursing facilities or remaining at home with care can help families sort out what they can afford.
- Talking about how to honor the wishes of the elder while addressing security, medical or daily care issues.
- Learning the client has a long-term care insurance policy but unsure how to file a claim, be approved for benefits, understand the benefits and understand the complexities of documentation and billing roadblocks that many insurance companies put in place to discourage valid claims.
- Understanding a veteran’s service and needs in light of particular programs such as Aide & Attendance, transportation to out of county healthcare appointments.
- Working individually with clients and families to develop a specific plan during the present crisis and planning on how to proceed in the future with the care manager expert at their sides to assure safety and client expectations
- Interacting with blended families, same-sex couples, estranged families or no family is an expertise you can expect with one of these credentialed experts. Receiving bad information from someone you believe should have good information can be particularly damaging.
This is particularly true if the family is working against a deadline. Assuming a conservatorship is necessary and realizing it can be a time-consuming, expensive, legal process, when, in fact, a valid Durable Power of Attorney (DPOA) and a Advance Directive for Health (DPOAH) make a conservatorship unnecessary. How disappointing to find out the information given while given in the best interests was incorrect and completely unhelpful. The best information anyone can receive while seeking help is honest information. If an attorney, a healthcare professional or a Medi-Cal worker is honest when giving out information, at least it can set the person on the right path to find out more.
Unfortunately, the term “care manager” is not legally protected and thus, it’s critical that families looking for a knowledgeable expert care manager verify their education, certification and training. Some businesses or franchises advertise the use of a “care manager,” but in actuality, it may be a long-term employee, one of the owners of the franchise that falsely claims the title but no one in the company has the important National Certification i.e., CMC after their name and credentials. A four year degree, RN licensure and a master’s degree plus additional classes and training are vital to this profession. As you read the credentials in your physician’s office or the attorney who is helping with estate planning, so too verify a care manager.
Some companies or organizations advertise “free” care management, but be careful of what you get for “free.” Plan on paying for the advice and knowledge of a credentialed care manager who works in the community, is familiar with older entitlements such as Medicare, Medi-Cal, Social Security, SSI, Medicaid waiver programs through home and community-based services (HCBS) along with special programs such as FCSP, MSSP, senior day care, IHSS and others. True care management companies are willing to talk to client/families on the phone or do a short meeting in person at no charge. This short time allows both the client/family and the care manager to understand the issues at stake and decide if working together for a solution is a way forward.
Regardless of where you live or where the older adult lives, there are resources available that may help and be applicable to the exact situation. It’s well worth looking for an expert to help you understand what those resources are, establishing eligibility or getting the person on a wait list for a good waiver program. Pieces of information may come your way from the hospital discharge planner, your family physician, the estate planning attorney or the person delivering home-delivered meals. It isn’t the whole picture though. Look for and talk to a credentialed, knowledgeable expert – a care manager. Credentialed care managers may belong to the Aging Life Care Association (ALCA) or Case Management Society of America (CMSA). Online directories can help you find one of these experts throughout the United States.
Carol S. Heape, MSW, CMC is Founder/CEO of Elder Options, Inc. assisting older adults in the Sacramento 
Region “to live life fully” since 1988. As an older adult living in El Dorado County, she experienced multiple power shut offs during October 2019.