Healthcare Career As a Geriatric Care Manager

HEALTHCARE CAREER AS A

GERIATRIC CARE MANAGER

Institute Research Number 317, ISBN 1-48411-317-4 DOT Number 195.107-030, O*Net SOC Code 21-1022.00

HEALTHCARE CAREER AS A

GERIATRIC CARE MANAGER PUBLIC HEALTH SOCIAL WORK Professionals Helping the Growing Population of Elderly and Their Concerned Relatives

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THANKS TO ADVANCES IN MEDICINE, HYGIENE, AND HEALTHIER LIFESTYLES,

people are living longer than ever. Today, those who reach their sixties are no longer considered old, and many work well into their seventies. After retiring, many people are able to continue leading active and healthy lives. Nevertheless, people who live long enough invariably encounter the transitions associated with the normal processes of aging. These changes may include chronic illnesses and unexpected health concerns that require a variety of services. For many elderly individuals, the day will come when they are unable to take care of all the day-to-day matters necessary for keeping themselves healthy and functioning. Traditionally, helping the elderly as they grow older and frailer has been the duty of family members. But in the United States today many families live in different cities and states. Even if they are living nearby, family members are likely to be juggling demanding careers and families of their own, leaving little time to navigate the myriad avenues of resources and assistance available for their elderly parents or other family members. Taking all of these factors into consideration, you have the foundation for one of the potentially fastest growing careers in healthcare and social work – the geriatric care manager (GCM). In a sense, GCMs are like professional family members who help make sure that the elderly have what they need to remain comfortable, safe, and healthy. In this role, they can become the extra eyes, ears, and hands that help provide the relief families need as they deal with the stress and conflicts that can arise as they try to determine the right thing to do with elderly relatives. GCMs can also be a direct resource for the elderly themselves, who may not want to burden their family members with worries about caring for them. Because it is a relatively new profession, many people have never heard of geriatric care managers. But the ranks of these professionals are growing as more people learn about the invaluable services they offer. Numerous statistics support the field’s vast potential. For example, the percentage of Americans over 65 has more than tripled since 1900 and will continue to increase with the baby boom generation. In addition, 3.5 million people in the United States are 85 years old and up, and this number will double by the year 2025. The American Association of Retired People has found that one in four of the elderly who live alone do not have any living children.

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In essence, a GCM assesses the needs of the elderly and helps implement all the aspects of a long-term care plan for them, including immediate support needs. Working on an individual case-by-case basis, the GCM considers the highly individual aspects of each person and strives to make sure that the elderly have the most independence and autonomy possible, whether it means helping them to remain living at home, coordinating healthcare services, or recommending a good nursing home to fit the individual’s needs. In the process, GCMs not only work with the elderly and family members, but often with a wide range of professionals in the fields of health, social services, law, banking, and government. Helping to improve the lives and dignity of the elderly can be both exciting and extremely gratifying on a personal level. You can also impact the entire family by identifying the best solutions to the problems family members face in seeking help for their elderly parents and relatives. Although old age is often associated with a time of decline and loss, the geriatric care manager is dedicated to making an older individual’s later years a time of growth and development as well. If you like people and want to experience the rewards of helping others, a career as a geriatric care manager may be right for you. This report provides an in-depth overview of what being a GCM is all about. This information can help current high school and college students, as well as those already working in the healthcare arena who are thinking of changing or furthering their careers.

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HOW YOU CAN START LEARNING NOW IF THIS CAREER IS FOR YOU ALTHOUGH LIKING OLDER PEOPLE AND WANTING TO HELP ARE A NECESSITY FOR

becoming a geriatric care manager, there is much more to becoming a successful GCM. Although the field is currently not regulated, most companies hiring GCMs require that they have at the minimum a college degree and, in most cases, a graduate degree in a social services field, such as social work, nursing, or counseling. As a result, you should consider whether you are willing to put in the time and effort required to earn such a degree, which usually takes six years or more after high school graduation. If you’re not sure how you will interact with the elderly, gaining experience in this aspect of the work can be done at any age by volunteering at a senior center, nursing home, church group, or other organization that deals directly with the elderly. Talk to people working in the field of aging. If possible, talk with a GCM. A good place to find them is through the Geriatric Care Managers Resource Guide and Directory offered by the National Association of Professional Geriatric Care Managers. Another resource are people who work with the elderly in other areas, such as medicine, nursing, home healthcare, and so on. Ask them what it’s like working with older people, what they do, why they do it. Find out what they like about it, and what they don’t like. Your goal is to answer this question: Is working with the elderly for you? You can also learn more about working with the elderly by reading a variety of publications, such as Networks, published by the National Council on Aging, and Generations, published by the American Society on Aging. If you’re a college student, you may want to take an introductory course in gerontology (the comprehensive study of aging and the problems of aging). High school and college students and those already working in a health-related field can also seek out meetings of regional, state, or national professional organizations where professionals talk about the care of the aged. Although these meetings often cost money and are open only to members, they often need student volunteers to pass out pamphlets and do other work. A good source for finding out about such meetings is your local state or area agency on aging.

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HISTORY OF THIS CAREER ALTHOUGH THE SPECIFIC CAREER OF GERIATRIC CARE MANAGEMENT HAS EVOLVED

over only the last two decades, its roots are tied to the field of social work and its focus on helping those in need. Social work as a recognized profession grew out of the age-old concepts of charity and philanthropy to assist the downtrodden. Even prior to the American Revolution, programs existed in America to help the poor, improve child welfare, and even provide mental health services. By the beginning of the 19th century, the government began to take a greater role in providing these services, primarily on the state level. These services broadened during the Civil War, when volunteers working with the Sanitation Commission developed many of the programs that are currently associated with the field of public health and the Red Cross. The Freedman’s Bureau, which was established to help the emancipated slaves following the Civil War, provided a wide range of social services designed to aid former slaves in finding work, new homes, and generally becoming accustomed to a new life and fitting into society. The rapid industrialization of America following the Civil War laid the groundwork for modern social work. As more people moved to the cities leading to rapid urbanization, and more immigrants arrived for the opportunities available in the United States, both individual and community needs associated with issues of poverty and child welfare increased. For the most part, these needs were addressed through the formation of charitable organizations that attempted to help people during a series of economic depressions. The Settlement Movement focused on providing relief and assistance due to the impact of industrialization and immigration. They sought to address the environmental causes of poverty and to improve working opportunities and conditions for the poor. By 1910 there were more than four hundred settlements, and virtually every urban area of America had not one but a network of settlement houses. Jane Addams and Ellen Gates Starr founded Hull House in Chicago in 1889, which would become one of the most renowned settlement houses in the United States. The many charitable and settlement organizations that proliferated throughout the country eventually gave rise to formal social work educational programs. In 1898, the New York Charity Organization Society offered a summer course in social work that 6

included field excursions. This program would eventually evolve into the New York School of Social Work in 1917. The Chicago Commons Settlement provided a complete social work curriculum in 1908 through the Chicago School of Civics and Philanthropy, which would eventually become the University of Chicago’s School of Social Service Administration. By 1919, seventeen schools of social work were affiliated through the Association of Training Schools of Professional Schools of Social Work. By the beginning of the 20th century, specialties also began to take form in the social work arena. Although New York’s Elizabeth Blackwell created the concept of visitors going to the homes of sick people, medical social work was largely established when Dr. Richard Cabot introduced a medical social services department at Boston’s Massachusetts General Hospital in 1905. Cabot realized that many of the hospital’s patients were not receiving proper care after they left the hospital. With his colleague Ida Cannon, he began advocating the idea of social service departments becoming an integral part of hospital administration programs. The Boston School of Social Work offered a specialty in medical social work seven years after Dr. Cabot founded the program in Boston. Soon many other hospitals followed and began establishing medical social work programs. By this time a number of social work organizations had been established, including the National Conference on Charities and Corrections (NCCC), which was regarded as the primary social work organization in the early 20th century. In 1912, the Intercollegiate Bureau of Occupations developed a section for social worker applicants. In 1918, hospital social workers formed the American Association of Hospital Social Workers. Two years later, leading psychiatric social workers formed the Psychiatric Social Workers Club. In 1921, the American Association of Social Workers was established. World War I also led to an expansion of government programs focusing on social work or with a social work component. As a result, social workers focused more on the individual, and the concept of individual casework became firmly established. Caseworkers began to work along with physicians and psychiatrists to help soldiers adjust to civilian life after the war, opening new areas of opportunities for the profession, which had traditionally focused on the poor and indigent. The stock market crash of 1929 and the Great Depression led to a growing recognition that poverty and the need for assistance could stem from a person’s environment or circumstances as much as a 7

result from personal traits or failure. President Franklin D. Roosevelt’s New Deal led to the development of a complex national social welfare program. The Social Security Act of 1935 helped establish a new comprehensive role for the federal government in social welfare issues, including problems associated with housing and child welfare. Various forms of social insurance were introduced, to help the sick, the unemployed, the elderly, and others. As a result of this growing role, the social work profession grew, both in visibility and in numbers, as the number of professional social workers doubled from 40,000 to 80,000 in one decade. By the time the United States entered World War II in 1941, social workers had become an essential part of modern government and American society. In 1953, the Department of Health, Education and Welfare was established. In the 1960s many social welfare programs were created, including Medicare and Medicaid and the Department of Housing and Urban Development. Throughout its history, social workers have been involved with the elderly, who are often vulnerable and in need of social services because of problems such as ill health, frailty, and poverty. In the 1960s and 1970s, demographic changes that included a growing elderly population increased awareness that the long-term care system in the United States needed improvement. The Social Security Amendments of 1972 centralized and standardized government aid to the low-income elderly. Although poverty among the elderly declined in the 1970s, the percentage of the overall population that was elderly continued to grow. By the late 1970s, older people were facing higher costs for long-term care services. Not only were they suffering a budget crisis but so were their families and the government programs created to help them. The geriatric care manager profession evolved as a an approach to solving many of the problems in long-term care needs, services, and costs. Just as the elderly population and the number of services and programs available to them grew, so did the complicated bureaucracy associated with providing these services and, as a result, a greater need for professionals to help identify and obtain appropriate help. The 1980s and 1990s saw an impressive growth in geriatric care management. Several well-known care management projects, such as Project Open, were conducted to validate the need for these services. In addition to the traditional social services providers, entrepreneurs 8

began to create private companies offering comprehensive services beyond those that many public and government agencies were able to offer. As a result, the first association for the profession, the National Association of Professional Geriatric Care Managers, was established in 1985 with 30 members. Today, membership is more than 1,500 and growing.

WHERE YOU WILL WORK MANY DIFFERENT TYPES OF INSTITUTIONS AND COMPANIES EMPLOY GERIATRIC

care managers. Among the more obvious employers are nursing homes, geriatric centers, and home care agencies, as well as hospitals and managed care facilities. Because the field is rapidly growing, many entrepreneurs have started private businesses offering geriatric care management services. GCMs working for private geriatric care management firms may provide a variety of services for the elderly and their families. As the field continues to develop, more and more institutions that currently employ social workers, such as hospitals and other healthcare facilities, will be employing GCMs. You may also work for government agencies, such as the Veterans Health Administration, which has an inpatient and outpatient Geriatric Evaluation Management Program. Other sectors that may employ a professional geriatric care manager include law offices that handle wills, trusts, and estates. In the future, some of the larger accounting firms, hospitals and insurance companies will be offering GCM services. Because many people in today’s work force provide some type of assistance to their elderly parents or other relatives, many of the larger corporations are hiring GCMs to help their employees with this duty and, in the process, reduce turnover, increased absenteeism, and requests for a lighter workload. Geriatric care managers are needed throughout the United States, from large cities to small rural communities. Nevertheless, since most people, including the elderly, live in larger metropolitan areas, the majority of GCMs work in or near these locales. Other factors that may affect where you work include the specific demographics of an area. For example, areas with larger elderly populations, like Florida and

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Arizona may have more opportunities and a wider variety of work choices than other cities or rural areas. As for the day-to-day working environment, GCMs spend a lot of time in an office. However, you will often have to travel and meet with clients in their homes or, in the case of children and relatives, in their offices. The wide variety of employment settings for GCMs may include: Adult protective agencies Area agencies on aging Banks & investment firms Corporations Elder abuse programs Employee assistance programs Group medical and dental practices Home healthcare companies or agencies Hospitals and medical centers Information and referral agencies Insurance companies Legal services Nursing homes Planning agencies Private geriatric care management firms Public social service agencies Rehabilitation centers Religious organizations Senior centers and housing facilities Veteran’s services agencies

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YOUR WORK DUTIES ALTHOUGH GERIATRIC CARE MANAGERS DO NOT PROVIDE HANDS-ON CARE FOR

the elderly, their efforts are integral to the client’s well being. The GCM strives to establish and implement a dynamic plan of care that evolves to meet the ever-changing needs of the elderly and their families. Skills and knowledge are needed in social, psychological, and healthcare issues and needs. The GCM is a planner, as well as an advocate and negotiator. As a reliable and dedicated professional support system for the elderly and their families, the GCM often has to help the elderly and their families deal with such important issues as: Cost of care Quality of care Control over care Impact of care on the elderly Impact of care on the caregiver Overall, the duties are wide ranging and will vary according to an individual client’s needs. First, the GCM evaluates every aspect of the elderly person’s life, from health status and the ability for self-care, to a wide variety of matters that may encompass nutritional, legal, medical, financial, and home safety issues. In the process the GCM coordinates information from many sources, including doctors and nurses, family counselors, lawyers, accountants, bankers, and housing and other care agencies. After gathering the information, the GCM sets out to develop a customized and comprehensive long-term care plan encompassing the type and extent of services and care needed while simultaneously addressing such issues as independence, security, and safety. Integral to this process is a balanced evaluation of the elderly person’s physical, emotional, financial, and psychological and social well being. Once a plan is developed, the family may take over. But, in most cases, the GCM assists the client in meeting the goals that have been established. In the area of healthcare management, the GCM may coordinate all necessary services, as well as arranging and negotiating for medical insurance benefits. Selection, screening, and supervision of in-home healthcare providers may also be necessary. The GCM may have to develop a way for monitoring an elderly person’s medication 11

compliance and interaction, develop and organize a healthcare power of attorney, and sometimes even accompany an elderly person to medical appointments as necessary. In terms of fiscal and property management, geriatric care managers work to preserve the elderly person’s assets and avoid financial problems. They may review the elderly person’s financial and legal concerns and, if needed, make referrals to the appropriate financial professional or lawyer, who may also be a specialist in working with the elderly. The financial manager may help review insurance claims and file for reimbursement and help the elderly during tax time in gathering documentation to give to a professional tax advisor and then follow up on the process. Developing a monthly budget may also fall under the GCMs purview, or the GCM may recommend a different professional in this area. Property management and administration services may also be provided including arranging and monitoring home maintenance and repairs for the elderly who are still able to live independently. The GCM may work with physicians and other healthcare professionals to help prevent a health crisis and avoid unnecessary hospitalizations. Attorneys and GCMs often collaborate to assess a complex health situation that may affect the elderly person’s legal rights, financial situation, or competency to manage affairs independently. Banks, accountants, and other financial professionals may also use a geriatric care manager to provide a professional assessment to assure that essential services are provided in a cost-effective manner. The GCM may also work closely with a private company’s employee assistance program to help employees who are dealing with stress and diminished work performance associated with their obligations to care for an older parent, spouse, or relative. Often, the GCM works as a long-distance liaison with families who live far away from their relatives. In this role they not only educate and inform the family caregivers about their relatives’ needs, but also assure them that the process is moving forward, alert families when new problems or needs arise, and offer recommendations on necessary adjustments to care. The GCM may track down and recommend an appropriate nursing home if needed and then help fill out the application. They may then help the older person move to or from a nursing home, retirement community, or other long-term care facility. 12

The primary duty of the geriatric care manager is to be an advocate for the elderly person, whether it is at home, in the hospital, with a social services agency, or nursing home facility. As the advocate, the GCM must earn trust and may need to encourage the elderly person to accept the help that is needed. They may make regularly scheduled visits to evaluate the elderly person’s progress and adaptation to new situations and needs. A GCM may also be needed for crisis intervention, whether the crisis involves a medical issue, the family, or a service provider. In rare instances, the geriatric care manager may even be called upon as an expert witness. In some cases, personalized services may also be offered. These services may include ensuring that the elderly person maintains social contacts and a sense of belonging in the community, or scheduling and arranging for shopping for groceries, prescription pickups, and various appointments.

PROFESSIONALS TELL THEIR OWN STORIES I Am a Geriatric Care Manager “Many people think that working with older people is depressing and just like working with people who are sick and dying. Nothing could be further from the truth. I have a master’s degree in social work and am nationally certified as a geriatric care manager. For the past six years, I have worked for a geriatric care management company. In my experience, many of our elderly clients are intelligent and vibrant people who still have a lot to offer this world. Often, they are just a little confused and overwhelmed when they are suddenly faced with a wide spectrum of healthcare decisions and the possibility of losing their independence. In many cases, it isn’t much easier for their family members. Even when they are living nearby and have the time to devote to their parents, aunts, or uncles, families are literally starting from scratch in trying to find out about the many options available to them and the services that they need. It is my duty to help them through my expertise and working knowledge of the public and 13

private services and funding sources available to them. Like the elderly and their families, I sometimes get frustrated in working with other individuals, agencies and facilities that can help my clients. I know I can’t guarantee their services, but I work hard to use my knowledge and discretion in screening these resources. Although I have extensive training in human development and family dynamics, there is no exact recipe for dealing with my elderly or family clients. Everyone is different in how they handle these situations, especially when they reach the crisis stage when highly charged emotions can be involved. It is often part of my job to help allay my clients’ fears about the future. I recently worked with a mother, a concerned daughter, and her husband, who were trying to decide whether the mother should go to a nursing home or continue living on her own with a live-in caregiver. We discussed issues like cost, quality of care, control over care, and impact on their mother’s lifestyle. It was also important to explore the emotional impact that going to a nursing home would have on the mother and the family. It took a great deal of time and energy to explore all the options. In the end, we found an affordable home care service that allowed the mother to remain relatively independent. There are times, however, when I have to help the family make very difficult decisions. In one case, a son and daughter found themselves helpless in dealing with their mother. They were friends of another client of mine, who assured them I could help. Their mother had dementia and refused assistance of any kind. She would not go to the doctor or take her medication. When her children came to visit, they found spoiled food in her refrigerator that she was apparently eating. She rarely went out, and when she did she was still driving her car, even though she often couldn’t remember where she was going and got lost on the way home. After visiting with the children and their mother, I knew that their mom could no longer live on her own and that we had to work together to defuse a potentially dangerous situation. We tried to convince the mother that she needed to go into a specialized nursing home, but she would hear nothing of it.

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Eventually, I helped the children get legal counsel and have their mother declared incompetent. It was a difficult and traumatic decision for the children, and I helped them deal with their sense of guilt in taking over their mother’s life, and recommended professional counseling to help them cope. As for their mother, I willingly took the blame and brunt of her anger for the decision. The son eventually became her legal guardian and I went on to help him find a good nursing home in a well-respected unit that dealt with residents suffering from dementia. I can honestly say that I can’t imagine another job that could be as rewarding as the one I’m doing now. On the other hand, it can be hectic and overwhelming at times. It can also be emotionally difficult. I think good geriatric care managers are passionate about the work and cannot really do a good job if they don’t like people and bond with them in many ways. But we are constantly dealing with difficult issues and older people, who become sick and often die. It can be like losing a close friend or a relative. As a geriatric care manager I carry a lot of responsibility in helping the elderly and their families make the best possible choices, usually among a confusing maize of alternatives. In many cases, the answers don’t come easy and often not quickly either. As a result, it is my duty to keep up on the latest advances or changes in healthcare for the elderly, social services available to them, and government regulations that affect their everyday lives. In a society that often focuses on youth and discards the elderly, I find immense personal satisfaction in offering a proactive service that helps the elderly remain independent and strong if possible. My top priority is to find the services and care the elderly need to remain independent. I love making their older years golden.”

I Started My Own Geriatric Care Manager Consulting Business “As a geriatric care manager, I not only view myself as an advocate for the elderly and their families, but also as their friend. I began my career as a nurse and, over the years, found that I really enjoyed working with my elderly patients. Admittedly, the elderly needed more attention 15

than many of our younger patients. They could be cantankerous, like anybody, but they were also the patients who seemed to most appreciate personal attention. I returned to school and got a graduate degree in healthcare management and then worked for several years as an administrator in hospitals and medical centers. But I missed working directly with patients and especially the elderly. One day a close friend asked if I knew of anyone that could help her find a good nursing home for her mother. At the time, geriatric care management was a relatively new field. I volunteered to help my friend and really enjoyed working with her and her mother. The experience was so gratifying that, about a year later, I took the leap and started my own geriatric care management consulting business. I decided against developing a large agency with many employees because I wanted to keep my services affordable and cost effective for my clients. Over the past 10 years, my experiences in helping older people and their families have convinced me that there is a need for my services and that I make a tremendous difference in people’s lives. I remember one case when a family member from out of state contacted me and said she was concerned about her father and his health status. Although her dad was still independent and living alone, she wanted me to keep an eye out for him, especially in matters concerning his medical problems. The daughter felt guilty and apprehensive about asking a total stranger to help with matters that she considered to be a part of her family duties. But, as a mother who also held a full-time job, she couldn’t leave her home for an extended period of time. I assured her that she was being a good daughter in seeking assistance to help with her father’s needs. I also told her I was formerly a nurse and would meet with her father on her behalf to assess the situation. Over the next two years I worked closely with the daughter and developed a special relationship with her father. He was fiercely independent but he came to rely on me more and more as his health deteriorated. Soon I was making all his doctors appointments and helping him get to their offices. Eventually, the daughter and I decided that he had to be hospitalized. I went to 16

the hospital with him and made sure that the physicians were aware of his medical history. I kept the daughter abreast of what was going on. Several months after he returned home, the situation took a turn for the worse, and I told his daughter that she should come to see her father. Although it was the first time we met face-to-face, it was like we were life-long friends. She told me how grateful she was that I was there to help her make important decisions about her dad’s care and ensure that her dad’s final years were as comfortable and enjoyable as possible. When I started my business, I did it all, serving not only in my professional capacity as a geriatric care manager but also as the receptionist, secretary, accountant, business manager, and even as janitor cleaning my office to save expenses. However, over the years my business has grown. I eventually hired a secretary and two other geriatric care managers who share my own philosophies about caring for the elderly. I believe that it is our duty as geriatric care managers to maximize the elder person’s independence and quality of life, no matter what the setting. Even though I make a comfortable living in my field, I believe that I owe it to my clients to be cost-effective and work within the boundaries of what the family can afford. At the same time, I always keep the elderly family member’s needs and wants at the forefront. The field of geriatric care management is becoming better known and sometimes young people ask me if they should consider a career in the field. Before answering them, I ask if they like older people and why? If they do, I tell them that, by all means, they should look into a career as a geriatric care manager. The field is growing and more and more geriatric care managers will be needed in the future. I also tell them that it can be a lot of hard work and emotionally demanding. But the rewards are much more than financial. Being a geriatric care manager has changed my entire outlook on life.”

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PERSONAL QUALIFICATIONS NEARLY EVERY ASPECT OF A GERIATRIC CARE MANAGER’S DUTIES IS FOCUSED ON

making life easier and better, both for the elderly clients and their families. As a result, successful GCMs should have a strong desire to help others. GCMs must also appreciate and respect older people as diverse individuals each with unique qualities and traits. They should be adaptable and patient. Geriatric care managers must be able to work with and develop the trust of a variety of people and personalities. They are able to develop a rapport with people, from the elderly and their family members to various professionals who they may work with in creating and carrying out a care plan. GCMs must be able to work in a team environment. They must also be highly energized self-starters who are able to work independently as they manage and prioritize the many tasks that may be required of them. Successful geriatric care managers are willing to take all the time that is necessary to get to know the individuals they are helping and their family members. They are understanding of their clients’ unique situations, concerns, needs, and wants. They also realize that the personal nature of their business requires strict adherence to cooperation and confidentiality. GCMs are client-oriented and focus on achieving their satisfaction through attention to detail and by following up to ensure that the plan they have helped create is effective. Although GCMs may work for any number of businesses, agencies, and programs, managers always remember that the client comes first. They maintain objectivity and freedom from affiliations, remembering that the number one priority is always doing what is best for the client. Anyone wishing to become a GCM must also be willing to complete college and, in most cases, achieve a master’s degree in an area such as social work, nursing, or counseling. The job duties require strong written and spoken presentation and communications skills. GCMs spend a lot of time on the telephone and are comfortable with and excel at communicating. The best geriatric care managers are reliable and knowledgeable about the issues, agencies, and health problems associated with the elderly. They must also be willing to keep up with changing issues, regulations, legislation, and services that may affect their elderly 18

clients. Since each situation is different, GCMs are flexible in their approach. They can remain cool in a crisis and are able to assure their clients while communicating clearly the issues and problems involved, so that everyone understands and can move forward together. Although the work geriatric care managers do is highly personal, they must also be able to maintain their professional conduct and not take things personally. For example, it is often the geriatric care manager’s role to take the brunt of an elderly person’s or family member’s dismay, resentment, and sometimes even anger. These emotions often arise when people are faced with difficult issues and crisis.

ATTRACTIVE FEATURES FOR MOST GERIATRIC CARE MANAGERS, THE MOST ATTRACTIVE FEATURE OF THEIR

work is the potential to make a difference in the lives of the elderly and their families. In fact, geriatric care managers have almost endless possibilities to positively impact and influence peoples’ lives, from concerns about health and home care to the financial and legal arenas. Geriatric care managers invariably enjoy an immense amount of both professional and personal satisfaction as they help address the challenges of those who are growing older. Whether it’s helping an older person maintain an independent and vital life or aiding family members in charting the future course for their older family members, geriatric care managers often go home at the end of the day knowing that they have accomplished something important. Geriatric care managers also get to work with a diversity of people. Their older clients and family members come from a variety of racial, ethnic, and economic backgrounds. The lives of professional geriatric care managers are often enriched because of the depth and breath of the experiences they encounter while helping this diverse population. They also get to experience what many people today ignore – the wit, wisdom and creativity of the elderly population. GCMs also have the opportunity to work with many different kinds of agencies and professionals, from doctors and lawyers to social workers and financial advisers.

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Not only is the field of geriatric care management diverse, challenging and exciting, it also offers numerous opportunities. As a relatively new career field, geriatric care management provides its practitioners with numerous opportunities to devise and implement innovative ideas, programs, and products. If geriatric care managers have the entrepreneurial spirit, they can start their own business, offering the entire gamut of GCM services or specializing in areas such as home healthcare and assistance in finding nursing homes. They may also become independent consultants with business and corporations, helping them develop either employee programs or marketable services and products. Another rewarding aspect is that geriatric care managers can positively influence how both the local community and society in general view the elderly. Depending on where they work and their level of commitment, GCMs can have a dramatic impact in the long term on how agencies and organizations serve older people. The future looks good for geriatric care managers. The post-World War II Baby Boom population is reaching retirement age and has a higher disposable income than perhaps any previous elderly population. As a result, there is a great potential for job security and a lucrative salary. Geriatric care managers have a wide range of choices of where they can work, from hospitals and medical centers to private agencies, and from large metropolitan cities to smaller rural communities.

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UNATTRACTIVE FEATURES WORKING AS A GERIATRIC CARE MANAGER HAS ITS OWN UNIQUE STRESSES AND

bad points. While geriatric care managers often become like family members, they are essentially outsiders who must step in and help solve what is often a difficult family dilemma or crisis. Family members may not always agree on the best course of action for their older loved ones, and the elderly themselves can often resent an outsider coming in and suggesting how they should live their lives or helping make decisions about their future. In such cases, the GCM must often function as a skilled diplomat in getting all the parties involved to agree on a course of action. For the most part, geriatric care managers work normal eight-hour schedules. However, depending on who the employer is, GCMs may be required to work evenings and weekends. They are often on call for a crisis that can happen at any time of the day or night. Although GCMs can do a thorough evaluation and come up with a care plan that they know is best for the elderly person, the ultimate decision on whether or not that plan is carried out is seldom up to them. As a result, there can be a sense of frustration when the elderly or family members don’t follow through on specific recommendations. Although geriatric care managers are essentially part of the healthcare team and environment, many physicians are not aware of or do not understand the role of geriatric care management. As a result, many physicians do not inform patients about the benefits of hiring a geriatric care manager. Many social workers and nurses have been discouraged from entering the field because GCM services are not now covered by Medicare, Medicaid, or most insurance policies. Some long-term care insurance policies may provide benefits, but these instances vary widely depending on the insurance policy and the specifics of the individual case. Public funding for many community and social work agencies where a geriatric care manager may work has also decreased over the years. As a result, people employed in these areas may encounter increased work loads and the potential for the quality of their services to become compromised.

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EDUCATION AND TRAINING UNLIKE MANY OTHER CAREERS ASSOCIATED WITH HEALTHCARE AND SOCIAL WORK,

there are no set educational and training requirements or licensing credentials to become a geriatric care manager. Nevertheless, to work as a geriatric care manager you will most likely require a bachelor’s degree in gerontology (the study of aging), social work, nursing, counseling and psychology, or health and human services. Although entry-level positions can be found with a bachelor’s degree, most geriatric care managers working in the field today have a master’s degree in one of these areas. The graduate degree is usually required for individuals seeking work in a clinical practice setting and for most policy, planning, and supervisory positions.

Licensing As the field becomes more established, more and more geriatric care managers are seeking a license from the National Academy of Certified Care Managers (NACCM). A license validates a person’s competence through a standardized exam that tests skills, knowledge, and practice ethics in the field of geriatric care.

Preparation in High School and College If you are still in high school and are planning on a career in geriatric care management, you can start your education now by taking as many science and social studies courses as possible. When it is time for college you will have several avenues of study open to you, including majors in social work, nursing, gerontology, and psychology. Many of these programs include a component that focuses on aging. Fortunately, because of the growing need for people to work with the elderly, many colleges and university have dramatically increased the number of educational programs in these areas with an emphasis on aging. For example, many colleges and universities offer a certificate or bachelor’s degree in gerontology. Some students choose to minor in the field as a supplement to one of the more traditional academic majors such as nursing and social work. During your four-year undergraduate education you should also consider taking a wide range of courses in areas such as economics and finance, ethics, and other courses that can help you learn about such issues as disability, community services, and chronic disease management. As you continue with your education, you may want to look for programs that offer clinical or field experience, including experience in dealing with families in crises. 22

Preparing as a Nurse If you choose a career path in geriatric care management through nursing, your options are a little broader. Some three-year programs in nursing are still available through hospital programs, and a two-year associate degree in basic nursing skills obtained at a community college is also an option. However, for the most part, nurses today are earning a four-year bachelor’s degree to become a registered nurse (RN).

Graduate School Most professional geriatric care managers go on to earn a graduate degree. Many in the field consider graduate education to be essential to become thoroughly trained in all aspects of an older person’s life. To attend graduate school you will first need to have completed your undergraduate training and received your BA or BS degree. It is important to do well early in your college training because many graduate programs require a 3.0 undergraduate grade point average or better. If you are in college and are considering graduate school you will have to take a Graduate Record Exam (GRE), usually in the fall prior to admission to a program. The career counseling center or your advisor can guide you on the best route to take and on studying for the exam. The specifics of your graduate training will vary widely depending on the type of program you decide to pursue. Nearly all graduate programs require students to write a thesis in their area of study under the supervision of a faculty member. Some programs may waive the thesis requirement and instead offer the option of taking additional credits ending with a comprehensive written examination. A graduate master’s degree usually requires two additional years beyond college.

Getting Experience If you are already working in a related field, you should try to gain the experience required to become certified as a geriatric care manager. Most successful applicants taking the certification exam have full-time direct experience working with elderly people with chronic disabilities. They also have supervised care management experience that includes assessment, care planning, problem solving, and fact-to-face interviewing experience. These requirements will vary, but to take the certification examination expect to have at least a minimum of two years working in a full-time care management setting, or four years of working full time with the

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elderly in such settings as social work, nursing, mental health, counseling or care management.

Continuing Education As in any career in social work and healthcare, the process of education and training never ends because of new advances and ongoing changes in social services and government regulations. As a result, many geriatric care managers take continuing education courses to keep up-to-date in their field. These courses are typically offered by colleges, professional organizations, and hospitals.

EARNINGS IT IS SOMEWHAT DIFFICULT TO PROVIDE A DEFINITIVE RANGE FOR SALARIES IN

geriatric care management because of the variety of positions and many different employers within the field. As with most careers that straddle both the private and public sectors, salaries can vary widely. In general, geriatric care managers typically earn more working for a private company such as a large care management business, law office, or nursing home, as opposed to publicly funded or government organizations such as a community agency on aging or other public agency. Based on national averages, an employee can expect to earn a minimum of $30,000 to $35,000 in an entry level position, around $40,000 to $50,000 at a mid-level position, and $50,000 and up in a top position. Many positions with private companies not only pay good salaries, but also offer potential for commissions and quarterly bonuses. Of course, as with most careers, the opportunity to make a higher salary is possible depending on an individual’s ambition and willingness to work hard. Many geriatric care managers are entrepreneurs who have started their own businesses. Working alone in a private practice, a geriatric care manager bills privately on a fee-for-service basis and typically charges anywhere from $50 to $100 per hour. Initial assessment fees can range from $100 to $500. If the business is successful and grows, the earnings potential is far higher than the upper end salary of a geriatric care manager working as an employee.

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OPPORTUNITIES IF YOU WANT TO TAKE A LOOK AT FUTURE OPPORTUNITIES FOR GERIATRIC CARE

managers, put on your sunglasses because it’s bright. A result of an aging population that is living longer, each year sees a growing need for GCMs. And the field’s growth is expected to continue far into the future. Statistics abound to support this outlook. The Council on Social Work Education points out that in 1987 less than 30,000 social workers work dealt with the elderly either on a full- or part-time basis. The council estimates that by the year 2020, as the Baby Boomers begin turning 65, approximately 50,000 to 70,000 social workers will be needed to work with the elderly. According to the National Association of Social Workers, by the year 2030, the percentage of people over the age of 65 is expected to double, to approximately 70 million people. Looking further down the line, one in five Americans will be over 65 by the middle of the 21st century, and 25 to 28 million people will be over the age of 85. In terms of the elderly population’s personal needs, most are living at home. According to recent statistics, only about five percent of elderly Americans live in nursing homes. Approximately 30 percent of all older households are composed of elderly people living alone. Of the elderly living alone, many rely on their children who live nearby to help them. Nevertheless, according to a study by the American Association of Retired People’s Public Policy Institute, one in four elderly people who live alone do not have any living children. According to the National Alliance for Caregiving, almost two in three family caregivers are employed full or part time, and their jobs suffer because of their caregiving duties. One study found that half of all employed caregivers have taken off work, come in later, or worked fewer hours because of their caregiving duties. The results of a survey by the MetLife Insurance Company revealed that businesses in the United States suffer over $11 billion annually in lost productivity resulting from employees providing hands-on care for their elderly family members. Other estimates indicate that companies may lose anywhere from $17 to $24 billion a year.

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Employees with elderly caregiving duties face numerous emotional, physical, and financial burdens that can affect job performance and attendance. It has been estimated that about 10 percent of all workers currently have some responsibility in helping an elderly relative. This is expected to increase to approximately over one third by the year 2020. Because of these statistics, many companies are recognizing the benefit of providing their employees with supportive services and information about caregiving demands. As a result, opportunities for geriatric care management are expected to increase as companies look to support their valued employees through education, referrals, and in-house or contracted adult care counseling programs. According to a survey of geriatric care managers, many also see new roles on the horizons for GCMs. Some areas of suggested growth include working as life coaches who team up with trust officers and financial planners, as well as a growing role as consultants to various other organizations and companies. As physicians continue to deal more and more with elderly patients, opportunities will grow for liaison services between physicians and homebound patients. Other growing areas of opportunity include working for church groups and other charitable organizations to provide or oversee the care of parishioners or members. Although supply and demand in the job market fluctuates over the years, experts in the health and social work fields generally agree that the future will see a long-term need for professionals trained to serve the specific needs of older Americans. Considering the rising cost of healthcare and other services, more and more people are recognizing the value of GCM services that can reduce hospitalizations, critical illness, accidents, and associated costs through planning that promotes safety, wellness, and crisis prevention. Overall, geriatric care managers will be gaining increased visibility and new opportunities as they broaden their horizons and work across the continuum of care for the elderly.

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GETTING STARTED HELPING THE ELDERLY AND THEIR FAMILIES CAN BE AN EXCITING, CHALLENGING,

and rewarding career. If you are considering a career in this field you can start planning and preparing now. Planning ahead allows you to: Begin researching the field and your career goals early Gain experience and make contacts Do a self-assessment Plan a strategy To find out more about geriatric care managers, a good place to start is at the source. People working as geriatric care managers or in other areas of elderly care can give you an insider’s view. Volunteering in a senior center or a nursing home will also give you insights into what working with the elderly is really like. You can seek out opportunities to work shadow geriatric care managers or social workers to gain first-hand insights into working practices. The National Association of Social Workers and the American Geriatrics Society can provide information on social work with older people and geriatrics as a career choice. The contacts and experience that you also gain from these endeavors will ultimately contribute to your successful career. You can also assess your career goals. What are you looking for in a career? Money? Status? Respect? A challenge? The opportunity to contribute to society? Ask yourself if geriatric care management can help you fulfill these goals. You can start finding out right now what you need to do to accomplish your objectives. You can begin enhancing your personal qualities through life experiences such as dealing with people and interaction with your own older family members. These life skills are readily transferable to your new career. The Internet can also be a valuable resource for learning more about geriatric care management and how to break into the field. Many of the primary websites are listed at the end of this report.

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Because there are several avenues to becoming a geriatric care manager, you need to decide which one you want to try for. Social work and nursing are the primary routes to a career in geriatric care management, but you may also want to explore counseling and psychology. For a minimal charge, the Association for Gerontology’s National Directory of Educational Programs in Gerontology and Geriatrics will conduct a computerized search for a list of schools that offer programs in aging. The list includes descriptions of the programs and whom to contact for more information. Geriatric care management is becoming recognized as an effective holistic approach to dealing with the needs of elderly people and their families, addressing not only medical needs but financial, psychological and social needs, family dynamics, environmental needs, and more. Whether you are a student or a professional currently working in a related area, you can start developing your strategy now to enter this exciting and rewarding field.

ASSOCIATIONS n American Society on Aging n Association for Gerontology Education in Social Work n Association for Gerontology in Higher Education (AGHE) n Care Management Society of America n Council on Social Work Education n Gerontological Society of America n National Academy of Certified Care Managers n National Association of Social Workers n National Association of Professional Geriatric Care Managers n National Council on Aging

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PERIODICALS n Journal of Social Work Education (published by the Council on Social Work Education) n Generations (published by the American Society on Aging) n Innovations: The Journal of The National Council on the Aging n The Gerontologist (published by the Gerontological Society of America) n Networks (published by the National Council on Aging)

WEBSITES n Administration on Aging http://www.aoa.dhhs.gov/ n Council on Social Work Education http://www.cswe.org n National Academy of Certified Care Managers http://www.naccm.net/ n National Association of Social Workers http://www.naswdc.org/ n Council on Social Work Education http://www.cswe.org/home/start.htm n National Association of Professional Geriatric Care Managers http://www.caremanager.org/ n National Council on Aging http://www.ncoa.org/

COPYRIGHT 2007 Institute For Career Research CHICAGO CAREERS INTENET DATABASE www.careers-internet.org

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