• Nearly one in four adults in the U.S. is caring for an aging family member.
• Of adult family members who are caregivers and adults who are concerned about caring for an aging loved one in the future, more than three-quarters agree that they could use help from a geriatric care manager (GCM).

That’s according to a recent survey by Harris Interactive for the National Association of Professional Geriatric Care Managers (NAPGCM), marking May as Geriatric Care Managers Month.

GCMs help plan and coordinate care for the elderly and disabled to improve their quality of life and maintain their independence for as long as possible. NAPGCM members commit to rigorous standards of practice regarding issues such as the client’s right to privacy, promoting a client’s right to self-determination, conflicts of interest and continuing education.

Debbie recently joined NAPGCM’s Standards Committee to help review existing professional standards and develop new ones to complement the organization’s Code of Ethics.

Last month, Debbie also joined about 300 other GCMs from around the U.S. at the NAPGCM annual conference, April 18-21, in Seattle. This year’s conference theme was Reaching New Heights: The Power of Compassion.

In addition to attending sessions such as Who Is My Client: Ethical Lessons from the Field and Unlocking Generational Codes, Debbie met with GCMs to build her extensive contact network around the country. These connections are invaluable when DFA is asked to find GCMs for family members who live far from Massachusetts. The conference was also a great opportunity to learn and share best practices.

Debbie is committed to maintaining the highest standards of professional practice at DFA and serves as Vice President of NAPGCM’s New England chapter.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified geriatric care manager. Drawing on more than 30 years of professional experience in geriatric care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

The result: a growing trend toward families who are considering compensating family caregivers for their time and effort.

Massachusetts Provides Funding for Family Caregivers
Massachusetts is among several states that recognize and support so-called consumer directed care. Two Massachusetts programs, the Personal Care Attendant (PCA) program and Caregiver Homes, provide state funds for recipients to either hire their own caregivers or to pay family caregivers for care they are providing. The care recipients must be eligible for MassHealth, a state subsidy program.

Care providers can be family members other than spouses or persons legally responsible to provide care, such as parents of minor children or legal guardians. Adult children can be paid caregivers as long as they are not the legal guardians of the care recipient.

State compensation for family caregivers is one alternative. For those with means, another option is for the elder to enter into a private-pay contract with a family member. If your family chooses to go this route, here are some guidelines:

Family Care Contracts Make Expectations and Agreements Explicit
What is a family care contract? It’s an agreement between two people, the family member who is providing service and the elder recipient, which defines what services will be provided and exact compensation. We recommend family care contracts because they clarify both parties’ expectations about specific care to be provided—the caregiver’s responsibilities and what the recipient will pay for those services.

A family care contract also provides documentation for other family members. This helps to avoid misunderstandings, especially when estates are settled after the elder’s death. These contracts may also be used to document that payments to caregivers are wages, not gifts, if there is a Medicaid application in the future.

Contracts may be initiated by your family’s elder law attorney, your elder’s care manager, the caregiver, the caregiver’s family or the care recipient.

Contracts Should be Based on a GCM’s Professional Assessment
Geriatric care managers (GCMs) play an important role in developing a family care contract; because the contract must describe the services to be provided and compensation, it should be based on a professional needs assessment. The assessment should include the following elements:

• A narrative description of your elder’s situation and background, family response, need for services and how they have been provided to date. This is the place for the GCM to tell the care recipient’s and caregiver’s story.
• A detailed assessment of your elder’s functional capacity to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).
• How services are provided, by whom, including the time involved to perform services and whether tasks are shared with others.
• Costs to the caregiver for providing services, including financial, time, health and lifestyle changes.
• Valuation of services based on local cost comparisons. Assessments may include several different models to consider, such as hourly, daily and weekly costs; live-in versus awake/overnight; agency versus private rates. This is probably the most important piece of the assessment, as it is used to set the compensation in the contract.

This assessment process also offers the opportunity for your family and GCM to discuss other possible services that could benefit your loved one. Be sure to consider all of your options and to weigh carefully the benefits of keeping it “within the family” versus the costs of stress, as well as physical and emotional endurance that are intrinsic to the caregiver role.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified geriatric care manager. Drawing on more than 30 years of professional experience in geriatric care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

The first step, of course, is selecting a provider who makes you feel comfortable and confident that you’ll receive proper care. If you’re seeing a physician for the first time, here are some tips to help you develop and sustain a positive working relationship:

• Get to know the support staff. They can be great conduits to the provider and may be able to answer some of your questions.
• Write down your questions and concerns. Review the list with your provider at the beginning of the appointment and, together, determine which are most important, to be answered first.
• Create a system to remember your provider’s answers. It’s best not to rely solely on recall. You can do this in a few ways:

1. Take notes.
2. Ask if you can record the conversation for later review. Hand-held digital recorders retail for under $100.
3. Bring a family member or friend with you to your appointment. Your companion can help you remember what you wanted to discuss as well as the answers. Be careful, however, that your companion doesn’t become the focus of the conversation. You’re the patient, and you should take center stage.

• Ask questions about any proposed treatment or solution. Don’t feel rushed to accept any recommendations.
• Be sure you understand any follow-up that’s necessary and make the appointments before you leave the office.

You also have responsibilities in this relationship:

• Share any changes in your health or medication with your provider.
• Follow up on agreed-upon treatment recommendations or report to your provider why you are not proceeding.

It’s also a good idea to find out how your physician prefers to communicate with you. Some practices are now using email, which can be a great time-saver for routine questions. If you’re not always available to take a phone call, let your provider and office staff know if you’ll receive detailed messages. Providers are very concerned about privacy, but playing phone tag all day is frustrating for everyone.

What if, after all that effort, you don’t feel the professional relationship is working? Before moving on, try speaking with your provider to see if you can work out your concerns. You may need a special appointment to make time for this discussion. If the practice has a manager, he or she may be able to mediate any issues.

But if the situation doesn’t improve, it may be time to find a new physician. Given the limitations on openings in medical practices, it’s wise to have a new provider in place before giving notice to an old one.

A version of this article originally appeared on jewishcentralvoice.com

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified geriatric care manager. Drawing on more than 30 years of professional experience in geriatric care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting.

• The New England Chapter of the National Association of Professional Geriatric Care Managers (NAPGCM) has elected Debbie as Vice President, a position that leads to President by ascension. A professional group of care managers in six New England states, the organization has about 250 members.
• Debbie has also been recently admitted as a Fellow of NAPGCM’s Leadership Academy. Fellows are certified GCMs who have demonstrated that they are advanced practitioners and experts in the field of geriatric care management, and who are committed to the mission, leadership, programs and activities of NAPGCM.
• With Emily B. Saltz, Debbie co-authored “Avoiding Nursing Home Placement: Community Long Term Care Options,” for Estate Planning for the Aging or Incapacitated Client, 3rd edition (2001), edited by Emily S. Starr and Donald Freedman.

In addition, Debbie was just re-certified as a care manager through the National Association of Certified Care Managers. This process, which occurs every three years, requires verification of her work and peer consultation, as well as fulfillment of required annual continuing education credits.

Short-term Home Care Services
There are several different types of home care services. Skilled nursing and therapeutic care, such as physical, occupational and/or speech therapies, are provided by visiting nurse agencies and are generally paid for by insurance (Medicare and other supplemental policies).

But these services are usually very brief in nature. It’s common for someone to be released from a hospital or rehabilitation center and receive visiting nurse services for only a few weeks.

State-Subsidized Home Care
Care can be supplemented by private home health aides and personal care assistants or through services under some of the state-subsidized programs. For general information about the state programs, visit www.800ageinfo.com or call 1-800-243-4636. Note that there are limits to the amount and type of home care services provided through the subsidy programs.

Some specialized, subsidized home care programs do provide more intensive services. However, the rules for qualifying for these services can be complicated, as your loved one must meet both clinical and financial guidelines. If you chose to go this route, it’s best to get professional guidance to help you work through the qualification process.

Long-term Private Home Care
Private home care, while it provides the most comprehensive and personalized support, is not covered by most health insurance programs. Some long term care insurance may cover the services if your loved one meets the care “triggers.”

Private home care can be scheduled from 1-24 hours per day; the cost averages $23 per hour. There are often price breaks when the caregiver lives in the home (and can sleep there at night). Under a private home care arrangement, your loved one and family retain the most control over schedules, tasks to be completed and choice of home care aide.

Choosing the Best Home Care Solution for Your Loved One
Bringing someone into the home to care for your loved one is an important step, and there are several issues to keep in mind:

• First, determine what your loved one needs and best care options. (Please see Part 1.)
• Determine if you are going to hire someone on your own and become an “employer,” or if you are going to go through an agency.
• If you are going to hire someone independently, be sure to check the worker’s certificates, licenses, references and criminal background. Consider the legal status of the worker.
• Explore how the aides are to be paid and whether or not they are insured. While privately hired aides may be less expensive (at least at the outset), they are often not insured against injury or bonded for damages. Homeowner’s insurance policies generally exclude coverage for in-home workers.
• There are responsibilities as an employer that your loved one, as the care recipient, must consider if hiring aides from outside of an agency. Be sure to consult first with your attorney and accountant.

You can avoid some of these issues by working with a professional home care agency. Agencies are responsible for background checks, taxes and insurance liabilities. Ask around to get references on the agency. Meet with representatives from several agencies to get a sense of how each works.

With a well-researched care plan and the right professional support from your care team, including an elder law attorney, financial adviser, elder care manager and care provider, you can rest assured that your loved one will remain safe and independent for as long as possible.

A version of this article originally appeared on jewishcentralvoice.com

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified geriatric care manager. Drawing on more than 30 years of professional experience in geriatric care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting.

Developing a workable solution begins with understanding your loved one’s unique circumstances. Among the many factors to be considered:

• Extent of disability and care need
• Structure of the home
• Available funds and other types of support

As you work through these questions and develop a care plan, it’s most helpful to build a care team—attorney, financial advisor, care provider, care manager and others who can provide expert guidance.

Get a Professional Functional Assessment
To determine what services are necessary, you’ll need a functional assessment that identifies your loved one’s  strengths and deficits and how to support her needs. Assessments can be performed by nurses, therapists, social workers, private care managers and case managers.  The depth and focus of the assessment depends on the assessor.

This step includes an assessment of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). ADLs are bathing, dressing, transferring/mobility within the home, toileting and feeding oneself.  IADLs include meal preparation, grocery shopping, housework, laundry, medication management, using the telephone, financial management and transportation.

Identify Home Adaptations
The assessor should also determine what home adaptations can be made and what equipment can improve safety. Some simple adaptations can make a significant difference:

• Remove any clutter from the home
• Rearrange furniture to maximize mobility
• Set up living space on one floor and minimize the need to use any stairs.

The next step is finding the right equipment.

Get a Personal Emergency Response System
The most popular type of aid is the PERS (personal emergency response system).  This is the “I’ve fallen and I can’t get up” button. Many people resist getting one, telling me that they’ll know when they need one.  Sadly, this is when they are on the floor. Accidents happen. I recommend the PERS to virtually every elder living alone (no matter how healthy) and also to couples where one person is relatively healthy but the other may not be able to make an emergency phone call if needed.  Because the PERS can work for a good range, even outside of the house, it is a handy item to wear when taking out the trash.

There are several companies that offer these types of systems and even some systems that will automatically dial the emergency number if there is a fall. In addition to the PERS, there are other systems that assist with managing medications and even track movement in the home.

Make Necessary Structural Modifications
Homes can also be adapted with permanent or temporary ramps, hand- and grab-rails, stair lifts, walk-in tubs, major additions or renovations.  There are architects and contractors who specialize in home adaptation and companies that specialize in specific changes (such as stair lifts or tubs).  As you work through these options, it’ s important to have a professional such as an occupational therapist conduct a thorough assessment to determine the most appropriate adaptations. I also recommend that you work with a licensed contractor to enact them.

Several companies offer temporary home modules, fully handicapped accessible, that can be linked to an existing home.  Be sure to research zoning requirements before embarking on any major renovation or addition.

In Part II, we’ll  explore the range of home care services, including visiting nurses and private home health aide, and some of the issues to consider when hiring.

A version of this article originally appeared on jewishcentralvoice.com.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified geriatric care manager. Drawing on more than 30 years of professional experience in geriatric care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting.

This year’s walk brought in more than $172,000 to help the Alzheimer’s Association advance important research into better treatments and a possible cure. The Association also offers care, education, support and resources for the millions of Americans afflicted with this devastating disease.

As a geriatric care manager working with many families who wrestle with Alzheimer’s, as co-chair of the Worcester Alzheimer’s Partnership, and as one who has experienced the pain of this fatal disease in my own family, I am determined to do my part to help find a cure.

Thanks to your support, I am grateful to be among the top five fundraisers in Central Massachusetts and a member of the Elite Feet category statewide. We beat our goal of $4,000 this year. With your continued support, I hope we will do even better next year and in the years to come, until this disease is defeated.

—Debbie

You know how it goes—Mom or Dad seems to be doing okay, even with moments of forgetfulness or trouble getting around as easily as before. You have your concerns. Is she taking all of her medication? Is he remembering to turn off the stove? Should she still be driving? Does he need a cane or other support to walk outside?

But then again, you don’t want to push too hard or insult Dad’s sense of independence or hurt Mom’s feelings. Or maybe one of your siblings disagrees and tells you that you worry too much.

Then Mom falls and breaks her hip, or Dad leaves food cooking on the stove and starts a kitchen fire, or . . . fill in the blank.

How to Talk about Elder Care Needs Before a Crisis Hits

How do you break the subject of getting help before a crisis, while still respecting your parent’s need to feel capable and self-sufficient?

In this Senior Moment Spotlight, broadcast February 21, 2011, on WCRN-830AM Worcester, Debbie joins Angela Rocheleau, CEO of HomeStaff, and radio host Hank Stolz for a candid conversation about how to have that conversation. (Please click link below for podcast.)

WCRN Senior Moment Spotlight with Deborah Fins and Angela Rocheleau of Home Staff 2-21-11

Key Points to Remember

• Begin from a loving place. Reassure Mom that you love her and want her to remain independent as long as possible, but that you want to take steps now to ensure that she can do so.
• Explain that accepting a little help now may well enable Dad to stay on his own longer. Speak in terms of a range of care options, to help him understand that this is not about invading his privacy with round-the-clock help, but rather, a way for him to have assistance with select aspects of his daily routine, as needed.
• Enlist the help of an independent geriatric care manager or other elder care professional, as necessary, to explain the issues and possible options. Often it’s easier for Mom or Dad to get advice from someone with experience, who can remain objective and not get caught up in family power struggles.

Join Team DFA on the Move
There are some changes in the Walk this year beyond just the name. The Central Massachusetts and Northern Worcester County walks are now combined. We have outgrown our old space and will be headquartered at Quinsigamond Community College, walking in the Burncoat Street neighborhood. I am starting a team this year—DFA on the Move—and I invite you to join me in walking and raising funds from your own contacts.  I welcome your company and support.

As a geriatric care manager, I work with families every day who are confronting Alzheimer’s Disease and related disorders and their devastating effects. I walk in honor and in memory of all of my clients who are or were affected by these terrible diseases. I would be happy to have less work if it meant that all of these diseases had been defeated. I co-chair the Worcester Alzheimer’s Partnership, a coalition of professionals working with and serving families dealing with these diseases. So, I am working on many levels to fight Alzheimer’s and related disorders.

Help Us Walk to Find Better Treatments and a Cure for Alzheimer’s
In addition to my professional work, I have confronted these diseases within my own families of origin and marriage—first with my grandmother, then my aunt and finally my father-in-law, who passed away last year. I am determined to make a difference.

I want to do my part to fight this fatal disease, but I can’t do it without your help. All the funds we raise help the Alzheimer’s Association advance important research into better treatments and a possible cure. And, for the millions already affected by these diseases, the Association offers care, education, support and resources in communities nationwide.

Please Help Me Raise $4,000 for the Alzheimer’s Association
My personal goal this year is $4,000. Your support in any amount is very important and very much appreciated.  To make a donation, please follow my personal link at http://alzwalk.kintera.org/worcestercounty/dlfins. To join my team or make a general team donation, please follow the team link at: http://alzwalk.kintera.org/worcestercounty/dfaonthemove. If you work for a company that matches donations, please let me know.

On behalf of the millions of Americans who are living with Alzheimer’s Disease, thank you for supporting my efforts.

—Debbie

To help you understand the different stages of this complex, progressive disease and learn ways to cope, Debbie is facilitating a three-part support group for families and caregivers of people with Alzheimer’s Disease.

The group meets at 4:30 p.m., April 14, May 19 and June 16, at Tatnuck Park at Worcester, 340 May Street.

Please join us for the next monthly educational discussion. RSVP to Reception at 508-755-7277 or email reception-tpw@benchmarkquality.com.

Complimentary care and programs are provided for your loved one during each session. The program is free and open to the public.

President of Deborah Fins Associates, P.C., Debbie is a licensed independent clinical social worker and certified geriatric care manager.