When Life Gets Complicated: Professional Care Managers

Whether in personal or professional life there are times when “you alone can do it, but you can’t do it alone.” Attorneys are seen as trusted advisers and counselors. They may be called upon to provide answers to complicated life issues and events that are outside the scope of their expertise. Reputable professionals know their limits and know the professionals to call upon to create a “community of care” on behalf of valued clients.

Professional care managers are an important part of the team when complex care issues arise as individuals age or face chronic physical or mental illness. Unlike “case managers” who typically work for institutions and face institutional constraints, care managers are beholden to no one but the client being served.

Care managers are typically licensed professionals, such as nurses or social workers, who are able to oversee and protect the ecosystem of care that older adults and those with chronic illness face. As the population has aged, an increasing array of services and providers has been created. Some are of high quality and some are not. Without proper information and guidance, it is far too easy to make decisions that lead to regret. “If only I had known” is a statement we hear all too often. As health care becomes more fragmented, the narrow focus of specialists ignores the question, “How we can best serve and care for the person?” Care managers insist that decisions are based on a broad range of issues relevant to the individual situation, whether housing, health care or finances.

Ray and Loretta lived at home and did well, despite Loretta’s mild dementia, until Ray was diagnosed with a brain tumor. Their attorney recommended a care manager to help their family sort out a myriad of issues. A request was made to visit the couple: “I want you to visit my parents, but my dad won’t let you in the house.” In fact, Ray did let the nurse care manager into the house. Often professionals, who are both compassionate and dispassionate, can be more effective than family members. A relationship that lasted 15 months was easily established once he was assured that he would be given the truth. Ray was initially not able to accept his terminal prognosis. In time, with support, he was able to discuss how he wanted to spend his final days and plan his funeral.

Beyond assisting in ensuring the best care for Ray and Loretta, the care manager helped the family recognize that they were facing the “stuff of life” that is better handled with discernment, wisdom and grace rather than with a narrow focus on a “fix.”

Ray and Loretta’s attorney and financial planner were key to safeguarding care and ensuring their wishes were respected. They appreciated that there were aspects of their care that were beyond their scope of practice that a case manager could handle, such as:

1. Counseling the sons that moving the couple from their home would be disruptive and eventually lead to their separation. Families need help in understanding what care facilities can and can’t do. They need help in considering long-term consequences of decisions that are made in a crisis.
2. Vetting and hiring home care candidates, developing and overseeing a plan of care to manage the household and provide for both Ray and Loretta’s care needs. Care giving is about relationships, not just tasks. Finding the right caregiver can be likened to finding the right marriage partner. There needs to be a sense of simpatico and open communication.
3. Communicating with medical providers and coordinating medical care for both Ray and Loretta. Informed advocacy ensures that as treatment decisions are made, providers see the person, not simply the diagnosis.
4. Involving their neighborhood and church community to support the couple. Recognizing individual resources, internal and external, and preserving autonomy and well-being, even in the face of loss.
5. Helping the family understand both Ray and Loretta’s strengths and needs. In the face of illness and decline, it’s tempting to globalize deficits and overlook strengths and abilities.
6. Bringing in and coordinating with a quality hospice organization when Ray’s illness progressed. Not all services are created equal. Knowledge of quality providers and indicators is essential to good care.
7. Accompanying Ray to a critical oncology appointment during which he was able to understand that he was dying and make plans for his final days with Loretta. Care management is about helping individuals live well and, in the end, die well.

Throughout the relationship with Ray and Loretta, the care manager created and coordinated a “community of care” that included their professional advisors, their family and their friends.

As in every service, it is important to be able to separate the wheat from the chaff. A “buyer beware” stance is protective and can avoid regrets.

Some of the questions to consider in choosing a care manager:

1. Does the agency have potential conflicts of interest? Some care managers are associated with larger companies that provide and profit from other services, such as caregivers, home improvement, and or transportation. Likewise, some agencies receive a “finder’s fee” when a client chooses a service or facility at their recommendation.
2. Is the care manager a professional, such as a nurse or social worker held to standards of practice regulated by a licensing body?
3. What in the care manager’s educational or experiential background affords expertise to do their work?
4. What is the care manager’s length of time practicing in their current location?
5. Can the care manager provide personal and professional references?
6. Does the care manager have 24-hour call coverage for emergencies?

As professionals, we hold ourselves to a high standard of practice and a commitment to providing the very best for our clients. Knowledge of resources and how to discern quality is integral to offering the best in your legal practice.

About the Author

Signe Gleeson is the founder of ElderCare Solutions, a geriatric Care Management company in Naperville, Illinois, that helps families gain a comprehensive understanding of their elders’ needs and find the care situations that best meet those needs. Ms. Gleeson has written and spoken extensively on elder care issues to professional groups including the Chicago Bar Association and the Illinois Institute for Continuing Legal Education. Signe has been caring for older adults throughout her nursing career.

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This article originally appeared in the March 2018 issue of Trusts & Estates, the newsletter of the Illinois State Bar Association’s Section on Trusts & Estates.