South Florida Hospital News
Wednesday June 20, 2018

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October 2005 - Volume 2 - Issue 4




Working with Qualified Care Managers

Care management as an integrated component of services to older adults is booming and becoming a more typical component of the team of professionals who help families through the health care maze.

Care management has evolved from a social model of care to meet the social, functional and medical needs of an aging population. Often these are chronic-care concerns resulting from changes in the social environment (i.e. loss of a spouse); the need to cope with a chronic illness (i.e., Alzheimerís disease, developmental disability, etc.); a change in functional status caused by physical or emotional impairment (i.e. Parkinsonís disease or depression); environmental changes caused by deteriorating living arrangements; or cultural changes that leave the individual unsafe and /or socially isolated. Financial or legal concerns might also trigger the care management process Ė for example, the need to preserve private resources to prevent impoverishment of a well spouse when someone is faced with a chronic care need and a long life expectancy. Assistance for decision making about end-of-life issues, care alternatives and surrogate caregivers may also trigger care management. Care management, when used proactively, can lead to better compliance with the physicianís plan of care, stabilization before a crisis and a quality, individualized plan of care. The care manager often focuses on empowering the client and the support system to maintain a level of functioning, good relationships with caregivers and a quality of life. The care management process includes the following components:

  • Intake
  • Assessment
  • Care Planning
  • Care Implementation
  • Monitoring and reassessment
  • Quality assurance and advocacy
  • Termination when appropriate
In the last 15 to 20 years, the care management field has emerged to assist families coping with problems of later life. Private care management practices have developed around the country to supplement public and non-profit agencies. In addition, care managers are creating care teams across disciplines to address the complexity of care needs that older adults and persons with chronic illnesses face. Companies like Rona Bartelstone work closely with physicians, attorneys and financial advisors to assure a comprehensive approach to meeting the needs of the care recipient and the family.

Furthermore, in families we donít think of ourselves as "caregivers", rather we define our role by the relationship that we have to the care recipient. I am my motherís daughter, my husbandís wife, and not their caregivers! This makes it challenging to reach out to families when they are facing all of the difficult decisions and choices around the care being provided. This is why it is important for physicians and discharge planners to inform patients about care management services.

The goal of care management is the advancement of dignified care. Care managers are committed to maximizing the independence of the elder, while striving to ensure that the highest quality and most cost-effective health and human services are used.

Questions to ask when looking for a qualified care manager:

1. What is the care managerís professional training that prepares her to work with elders, those with chronic illnesses, and their families?
2. How long has the care manager been in practice? Is this a full-time or part-time endeavor?
3. What licenses or certifications does the care manager hold that permit functioning at the independent level of practice?
4. What are the care managerís hours and how can she be contacted in a crisis? Does she have an on-call system for after hours, weekends and holidays?
5. In a solo practice, how does the care manager provide backup or coverage during illness or vacation? Does the solo practitioner have someone they consult when they have a clinical or ethical dilemma? 6. In a larger practice, what are the staffís professions and qualifications? Do they work under supervision? Are they employees or independent contractors?
7. Does the care manager or the company carry professional liability insurance?
8. What are the fees for service? Are they provided in a written agreement? How often will you be billed? How can you control your expenditures?
9. Which services does the manager provide directly? Which are arranged through outside provider? What is the care managerís role in relation to other providers, especially after the referral is made?
10. Does the care manager have a financial interest in any referrals being made?
11. How does the manager keep the family informed? How often?
12. Does the care manager or the practice have references that you can contact if you have not been referred through a personal recommendation?

Care managers also can assist in implementing and monitoring long-term care plans. The goal of this process is to provide an individualized service that maximizes the eldersí independence and dignity. This allows involvement of the family, without the burdens of guilt and helplessness. The customizing of care plans is becoming increasingly important as managed care and social services move toward the use of protocols and clinical pathways that can result in one-size-fits-all solutions.

Care management services can be as extensive or as limited as a family may desire. One family may feel the need for only limited assistance with an assessment and care plan, while another may require a professional to monitor the on-going quality of service and well-being of their loved one.

Care management is a consumer-centered service that helps clients navigate the health care and social services systems, assisting elders in meeting their own unique goals. It is rooted in a trusting, caring relationship between the care manager, the family members, and of course, the person receiving care. Elders and their families remain in charge of all decisions, including who provides the care, where it is provided, the amount of out-of-pocket expenditures, and the duration of care. Since care management currently is an unlicensed discipline in most states, families need to make certain that care managers have the education and experience to effectively perform their duties. They must be able to understand the social and emotional needs of older adults and their families. Thatís why most care managers in private practice come from a licensed human service fields like social work, nursing, psychology, mental health, gerontology or family therapy.

Private care managers typically charge between $90 and $250 per hour for their services. While the price may be prohibitive for some, those who donít qualify for public services and those who would flatly refuse to use non-profit agencies do have another option.

Rona S. Bartelstone, LCSW, BCD, CMC, CEO of Rona Bartelstone Associates, Inc., can be reached at (954) 967-8999 or or visit their website at
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