Tuesday, June 15, 2010

Professional geriatric care managers may be an important resource for some families (especially long distance); behave with care!

An important resource for adult children facing eldercare situations can be a geriatric care manager. The National Association of Professional Geriatric Care Managers (NAPGCM) has a useful and informative website here

Geriatric care managers assist clients in exploring care options for appropriateness, and in screening in-home caregivers. They also can assist clients in a paralegal sense, in advising clients of behaviors that should be expected of everyone affected.

NAPGCM says that the profession is particularly useful for long-distance caregiving situations, where the adult child(ren) live(s) in another state or at some distance and does not want to face moving back, extensive travel, or is unable to move the parent in to the other state. It is apparently particularly useful when families choose to hire caregivers directly and have to do with a number of legal workplace requirements, which agencies will handle (although perhaps charging more); a GCM also may recommend particular agencies in a particular city. The website(in an essay by Linda Fodrini-Johnson) says that “geriatric care management” is “a viable career option for (the) private duty home care industry.” That comports with the general observation that, during the next economic recovery, the job market is likely to become much more “people centered” than it was in the past, with emphasis on labor intensive jobs that cannot be automated easily or outsourced . GCM can also help with “downsizing” into independent senior living, assisted living, or nursing homes. The sentiment in the eldercare world in the past two years has turned sharply toward more political and social support for in-home care, including discussions about improving wages and benefits for workers, in view of some legal cases (such as, in New York State in a 2007 Supreme Court decision, Long Island Care Care At Home, v. Evelyn Coke, Cornell Law School link to opinion here). I’ve covered some of this debate in previous postings and would add that eldercare needs to be a much large piece of the entire health care debate, both legislatively and within the Obama administration.

NAPGCM’s website offers a sobering (and rather detailed) discussion of elder financial abuse (in an essay by Cathy Jo Cress and Ann Bunni Dybnis), and especially as to how it can monitor families of clients for certain long-term patterns of abuse. It mentions scam artists like Bernie Madoff, but goes on to say that adult children are responsible for 33% of investigated cases of elder financial abuse according to a survey of state departments of Adult Protective Services. (She leads into this with mention of the Brooke Astor case with abuse of son Anthony in New York City a couple years ago.) Such cases increase during economic downturns and may be more likely as adult children experience their own workplace difficulties or debt burdens. The finding puts adult children caregivers on the “hot seat” a bit (or as I called it in kindergarten, “the red chair”). GCM’s are required by law in most states to report suspected financial abuse, so clients should be keeping good financial records and be careful that they are not comingling improperly before contacting GCMs. Clients might well contact attorneys first and have the proper powers of attorney documents drawn up, but powers of attorney can be abused. Clients should be careful on how they behave with respect to changes in wills, also. In some cases GCM’s may want to become more active in managing an elder’s business matters if they take on a client and perceive a conflict of interest.

The financial abuse page leads to another page (link on the left) “family caregiver agreements": when a family member is ‘paid’ to be a personal caregiver” which could probably include financial management (if risky) and medication. In such cases it’s wise to have a different person write the checks, it says, and estimate income taxes and FICA taxes must be paid (and reported to the IRS and SSA at the end of the year on tax returns). Sometimes, in “reverse live in” situations, board might be included and a tax adviser is needed to handle the situation correctly, or the caregiver might pay rent (if moving back in) and charge for services, in which case both are taxable – but the caregiver may have more independence this way. To avoid the appearance of comingling, renumeration should be reasonable, compared to what individually hired people would be paid.

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