• Health – Geriatric Care Managers like one of the family by Bob Moos
    Dallas Morning News
    August 2, 2008, Albuquerque Journal
  • Adult children get assistance in making crucial decisions regarding parents

Kay Paggi says her job title could be less confusing if she just called herself “a surrogate daughter”. She’s a geriatric care manager, who steps in to help overwhelmed sons and daughters with their elderly parents’ needs.

“I’m the person you call when you have more questions than answers about your mother’s or father’s care,” Paggi said. About 44 million Americans look after adult family members, an especially daunting task for adult children who live in another state or who have demanding jobs or their own children according to the Family Caregiver Alliance. And that number is expected to double by 2050.

That’s where geriatric care managers such as Paggi come in. While they don’t typically provide hands-on care, they help families hire and supervise in-home caregivers or shop for a senior-living community.

Mike Tankersley has called on Paggi twice in six years, first to evaluate nursing homes for his mother-in-law and more recently to help his mother move from Austin to a senior community in Dallas. “There are so many communities, we couldn’t have done it on our own,” he said.

A crisis often prompts the initial call to a care manager. A parent falls and breaks a hip, or the children notice that their mother doesn’t remember a conversation from just minutes ago. In those cases, Dallas care manager Molly Shomer said, she usually starts by sitting down with the family and determining the older person’s physical, mental and social needs. She drafts a plan for care and, if the family agrees, coordinates it.

“Some families may think Mom is ready for a nursing home, but maybe all she needs is a daytime companion.” Shomer said. “Other times, her continuing to live at home may be isolating or dangerous. It all depends on the person.”

Kitty Snelling of University Park, Texas, who is recovering from a hip injury, values the encyclopedic knowledge of her care manager, Carol Franzen. The 74-year-old former businesswoman views Franzen as her personal consultant. “Carol knows everything there is to know about senior care,” Snelling said. “My children are so busy, so I hate to lean on them. Besides, I want to be independent. Carol has spared me a lot of headaches.”

Franzen accompanies Snelling on medical visits, asking questions and taking notes. Like many care managers, she is in private practice and manages about 20 cases at a time. Some clients she sees once a month; others she visits three times a week, she said. Families find her through word of mouth or referrals from doctors or nurses.

If there’s a drawback to care managers, said Donna Schempp, program director of the Family Caregiver Alliance, it’s that some families can’t afford them. Their fees range from $75 too $125 per hour. Medicare and most long-term care insurance plans don’t cover these fees, but many families who hire care managers say they’re worth the money. Charles Dale said Shomer is helping his family apply for veterans’ benefits to defray the cost of caring for his father, who has Parkinson’s disease.

Kim Warwick, an only child who lives in Los Angeles, said she sought professional advice when her mother in Dallas began showing more signs of Alzheimer’s a year ago. Her care manager, Carole Larkin, specializes in the care of people with dementia and helped persuade Warwick’s mother to give up her car keys. When the older woman could no longer remain at home, Larkin recommended several assisted-living communities. Now Warwick flies to Dallas to visit her mother every other month, and Larkin regularly stops by the dementia-care community.

Most of the nation’s 7,000 geriatric care managers come from nursing or social work, said Monika White, president of the National Association of Professional Geriatric Care Managers. But because others may have no experience besides looking after their own parents, the group recently began requiring its members to become certified. That means passing a test and meeting educational and work standards. Paggi, who’s been in private practice in Dallas for 12 years, says she tries to put some emotional distance between herself and her clients because most come to her in the final years or months of their lives.

But she often breaks her own rule. “All my clients eventually die. It’s an occupational hazard,” she said. “But at least I know I made a difference in their lives. That’s what keeps me going.”