I planned to spend 3 months near my parents’ winter mobile home assessing their needs and setting up Elder care support for them. I took a shotgun approach — moving in several directions at once. I wrote about calling the local County Agency on Aging in a previous post. At the same time I decided to pursue a private case manager to help me assess my parent’s needs and refer me to the needed resources. I did a web search and came up with a list of Geriatric Care Managers at “The Homecare Directory”.
I used the information I found on this and other websites to come up with a list of questions. I obtained a list of Care Management Agencies from the local county office on Aging. I chose a home health agency and had several telephone conversations with the agency manager.
After our initial conversations, the Private Care Management Agency sent me some forms to complete with information about mom and dad needs and financial resources. They also included a financial contract in which I would sign to allow them to charge my credit card monthly for their work. I had discussed contracting them for an initial assessment only, not for ongoing care, so I was concerned about this open-ended contract. During another phone conversation we agreed that I would amend the form to state there would be a maximum charge of $500 total for their work. They had estimated it would take 3 to 4 hours at $95 per hour, so the $500 looked to be more than sufficient.
The assigned Case Manager called me the day before her interview with mom and dad to gather background information on their health and financial status. That would help shorten the time she had to take with mom and dad. The case manager, “Judy” was young and pleasant and didn’t come with a clipboard and papers. She just talked like she was having a conversation and would say things like “I’m not being nosy, but what would you do if…” She made suggestions for things that would make things easier right during the conversation. Afterwards she wrote up the entire assessment and her suggestions for further follow-up.
Judy asked about plans for the future if something were to happen to either of them. She asked about long-term insurance, burial plans, dental health, etc. I was pleased to have her ask about plans but frustrated with mom’s response that she doesn’t “make plans” or “borrow trouble” and she would just wait and see what to do when the time comes.
One thing Judy mentioned right away was her concern that dad was getting his monthly shots from Essie who had no medical credentials (but saved them a trip to the doctor). She suggested it was a liability issue for Essie as well as a health concern for dad. Judy said they could ask the doctor to refer them to a Home Health Agency and Medicare would pay for this service. She also suggested that the Home Health nurse could assist mom in counting pills as mom had made potential serious errors there too.
Mom was upset that I “made her look stupid” when I noted how she counted out double doses of dad’s blood pressure medications for 4 days last week. I reminded mom that she had vision problems and no one thought she was “stupid”.
About 2 weeks after the assessment was done, I received a written copy from Judy and her agency. The bill came to $500 for Judy’s time (and would have been more if I hadn’t put an upper limit on it), but mom didn’t know I was paying for it. I had told her the assessment was free or else mom wouldn’t have allowed me to schedule it.
The assumptions in the agency report were not all valid—specifically that mom and dad would not qualify for low-cost county provided services such as the homemaker, home emergency system, etc. The report noted: (1) cognitive impairment and memory problems with both mom and dad (based on the interview); (2) Dad’s lack of dental care in recent years could man problems in the future (he needed an emergency extraction less than 2 months after that assessment), (3) mom responded to most questions that her friend, Essie, would “take care of that” a response which was a red flag to Judy that mom and dad were open to manipulation by their friend, Essie, as they depended too heavily upon her.
The agency’s report contained many valuable suggestions, though some overlapped with the (free) information I had gotten from the county Agency on Aging. Recommendations included (1) obtaining legal documents such as wills and powers of attorney from an attorney in that state where they spent winters only to replace the ones they already had from the northern state where their permanent home was; (2) obtaining a document from their physician stating that neither were capable of making financial or legal decisions (to protect them from Essie or another manipulative “friend” who might come along (3) engaging the services of a companion for cooking, grocery shopping, etc.; (4) obtaining a home emergency system; (5) hiring a home health nurse to fill the medication boxes; (6) having mom visit several assisted living facilities to see if any of them interested her ; and planning to have a companion accompany mom and dad to the airport to help them since dad got lost on the flight down in the fall.
It also suggested that instead of getting transportation to all her medical appointments, mom should arrange to have some services brought to her at home. For instance, some labs would come out to draw blood; there was a podiatrist who made house calls; etc. and Medicare paid for these services. In addition, she suggested we hire a home health companion but there was a charge for this type of service.
Some of the suggestions were identical to the ones suggested (and supplied at no or little cost) from the Area Agency on Aging, such as the home security system and the homemaker/companion. I considered the suggestion about the lawyer to be unreasonable because they spent every summer in their home state where their current legal documents were created at great expense. One cannot have 2 wills at the same time. The southern will would be more recent and thus override the northern one written by their Elder law attorney a few years before.
Overall, I considered the entire process worthwhile if a little expensive. Some of Judy’s suggestions, such as having their physician refer them to the home health nurse, were worth that price alone. Starting almost immediately, a home health nurse began making regular visits. The home health nurse was able to oversee mom on medication management for only two weeks since Medicare wouldn’t pay for that unless she was doing something else during the same visit. Instead, on the days when the nurse gave dad his shots, she also checked their medications, took blood pressures on both mom and dad and interviewed them both on how their health that week. She was one of the few professionals who observed mom and dad on a regular basis and was able to detect when a serious change was occurring.
In fact, that one service may have been the most important thing to have come out of this assessment! I will write more about that in a future post.