By: Paula Tchirkow, MSW, LSW, ACSW

Eight years ago, on New Year’s Eve, I visited a 97-year-old client at 2:00 p.m., giving me more than enough time to check in on her, and still get ready to ring in 1996. I finished that call at 3:00 a.m., in a hospital emergency room. My client’s heart was failing, and I spent most of the night calming her fears, holding her hand, and putting cold wash clothes on her head. She died that night, her heart giving out after a long life.

I spent several hours on New Year’s Day arranging for her funeral. She didn’t have any family, and outlived all of her friends. But as a long-time client, I knew she wanted a formal funeral — with lots of flowers. So her priest and I made sure her final wish was granted.

Indeed, to be a successful geriatric care manager (GCM), you have to be tremendously flexible in terms of scheduling and temperament. It’s a hard way to make a living, and on the toughest days, the hours are long and the challenges take a physical and emotional toll. It helps to have a good sense of humor, a lot of patience, and a thick skin — that is, you can’t take things personally. That includes being hit on the head with a skillet, cursed at, or having a client smother you with a sweater. All in a days work? Yes, some days are like that.

In truth though, most days aren’t too wild. But you still have to love the work and thrive on the intangible rewards that come with helping elderly adults and their families cope with aging and illnesses. It’s a holistic job, that encompasses a client’s mind, body and spirit, and one that requires a great deal of creativity and resolve when a crisis erupts.

Are you still thinking about becoming a geriatric care manager? If so, there are a few things you’ll need to know before you hang up your shingle.

Easier Said Than Done?

To start, anyone can call himself/herself a GCM. It’s an unregulated field, and the GCM designation does not require a special degree, license, or a certain amount of experience. However, “Buyer Beware” is my advice to adult children and family members who want to retain a GCM. 

There are many individuals who do not have the proper education or background and market themselves as GCMs. For example, there is a Pittsburgh real estate broker who advertises that he is a GCM, based on the idea that he specializes in selling the homes of older adults and helping them relocate into condominiums or senior facilities. Adult children…look out!

GCMs should have degrees in social work, nursing or psychology. Many also have education at the Master’s level in these fields or gerontology and have experience in family work, client advocacy, long-term care and/or psychotherapy. Some are even certified such as through the Academy of Certified Social Workers (ACSW). It is imperative, in my opinion, that all GCMs, at minimum, be licensed in their state. 

Successful GCMs also keep current on changing Medicaid and Medicare laws, and follow changes made in county Department of Aging rules, which, among other things, set income and asset limits for individuals that qualify for Medicaid assistance to help pay for long-term care facilities.  

Open for Business

It takes more than a listing in the NAPGCM directory and professional credentials to start a GCM practice. This is not a business that draws clients via advertising, but rather through referrals and “word-of-mouth” endorsements. I market heavily to attorneys and financial planners, yet any referrals I receive from those professionals are predicated on long-term, trusted relationships.

I made the leap to full time practitioner when I obtained five steady clients. These were client relationships that I established while working in a local bank’s trust department, essentially assisting bank customers with financial options related to long-term care.

Using referrals from attorneys, financial planners, clergy and physicians, I built my business into a steady practice that even includes two clients who are younger than 50 years old, but still requiring long-term care assistance. 

These clients need varying degrees of care, which creates a good natural balance to the ebb and flow of my business. For example, some clients require weekly or monthly visits after the initial assessment, while others only need me on a spot basis, for crisis intervention or during hospital stays.

Depending on the region of the country you set up your practice, GCMs charge between $85 and $125 an hour for services, with successful single-manager practices generating about $50,000 annually. GCMs are usually paid by the client’s adult children, the trust department of a bank, or a lawyer that holds the power of attorney. Clients don’t have to be wealthy to afford a GCM, but they –or their families – need to have some money set aside that can be designated for this purpose.

Unfortunately, you will encounter resistance about paying for GCM services, as there is a negative connotation associated with asking clients to pay for social work. They just don’t expect to pay.

That’s because as a relatively new profession – about 10 years old – geriatric care management is viewed as an entitlement. In other words, many people believe that GCM services should be covered by Medicaid or insurance. The reality, however, is that the government does not provide aid for care management services, and only newer insurance policies carry long-term care riders.

In other situations, paying a GCM seems natural, especially in emergency situations, or when a GCM is called in as a last resort. That is, when a parent is deteriorating to the point that a family is being pulled apart by the prospects of caring for, or arranging for care, for the elderly person.

Also consider that many good client relationships tend to be a long-term endeavor. The initial assessment only takes two to six hours, over one or two visits, depending on the complexity of the situation. That assessment phase can be the only service a client uses. However, most clients and their families work out a more comprehensive care plan that includes repeat visits by a GCM. In fact, many clients stay with a GCM for the remainder of their lives, as physical and mental changes are quite common during the later years of a person’s life, and therefore call for a continuous reassessment of needs.

Furthermore, the longer a GCM retains a client, the easier it becomes for the practitioner to recognize and address problems and changes in a timely fashion. In addition, the client builds up trust in a GCM, which is immensely important when anyone is facing a health crisis. “Everything is going to be alright, Paula is here,” announced one client to the hospital staff, when I arrived in the emergency room.

The Bottom Line 

In any case, I’ve based my practice on two main philosophies that benefit my clients and help me sustain my business: Despite who foots the bill, I work for my client — not the adult children, attorney, or nursing home administrators. In addition, my goal is to make my clients as independent as possible.

To be sure, I don’t assess a patient’s needs based on what her daughter wants. While it’s true that the assessment of needs is a holistic process – which includes input from clients and their families, and a physical, emotional, psychological, financial, and lifestyle review – the client is always the first priority. As a result, a GCM’s goal is to dish out some tough love. That is, in an encouraging and gentle way, develop a care regime that provides the client with the very highest level of independence from a healthcare and financial perspective.

That could mean installing ramps in a home; hiring a home-health aid to visit twice a week; coordinating with community volunteers for rides to the grocery store; admitting a client to an assisted living community; or working out the details, with an eldercare attorney, on long-term care. 

Do You Have What It Takes?

What kind of person becomes a GCM? As in any profession, there is no one personality or type of person that makes a successful care manager. But there are some general observations that I’ve made during my 10 years as a GCM that should prove helpful to newcomers thinking about the profession, as well as practitioner who are looking to grow their business.

As previously noted, experience, patience and a sense of humor go a long way to diffusing problems and working out solutions. But being creative and observant are also important skills. Consider the care assessment, which is the initial stage of a client-GCM relationship. Some times, it requires a bit of detective work and a lot of tact. 

For instance, to assess whether a client can still manage everyday living, I often ask for a cup of coffee and watch for problems – physically, with preparing or pouring the coffee, or mentally, such as forgetting where the coffee is kept or how to make it. I’ll also gingerly point out stains on clothing or hygiene problems to see if the client’s reaction and explanation seems justified or indicative of something more chronic. In fact, I’ll sometimes ask for a tour of the home to search for clues of a client’s physical or mental state.

Beyond the assessment state, regular client visits can run the gamut from checking that pain medicine is being dispensed during a hospital stay, to monitoring the level of care at a long-term care facility, to surprising a client with a birthday cake, or participating in a sting operation to thwart a crooked financial advisor.

At the children’s request, I once convinced a client to allow me to escort an insurance appraiser through her home to value the house and its contents as part of an investigation. The client’s children suspected that their mother’s nurse was stealing from her – and they were right. Apparently, the nurse made off with $40,000 worth of the client’s goods over a period of six months before she was caught.

Intangibles 

You earn every penny you make as a GCM, but frankly, the intangible rewards always seem to outweigh the challenges. In fact, there is a satisfaction quotation that is hard to measure in dollars and cents. 

For instance, helping a client regain independence after a stroke, or comforting them before an operation, or working to sort out financial woes that exploded into a crisis-induced family feud, all have the potential to turn an ordinary work day into a great one.

What’s more, the fantastic oral history you collect along the way is a side benefit I never considered until I became a practitioner. 

The stories are amazing. One client supported herself during the Roaring Twenties by playing the organ for silent movies. 

Another tells the story of having to pay a penny to walk across the Mansfield Memorial Bridge in the McKeesport (a suburb of Pittsburgh) area to go to school, only to be forced to play hooky on days when buying a piece of penny candy seemed more important than reading and writing.

Still another client, a pioneering woman of sorts, retells tales of a cross-country trip taken to Yellowstone Park in the 1930s – a sojourn taken with several college roommates in a Model T Ford. 

Then there is the client from Chicago who became a Vaudeville chorus dancer in Ziegfield-type extravaganzas, and the client who energetically describes Atlantic City during its pre-Trump heyday.

There are moments of more significant victories too, that leave you with a sense of gratification that only comes with truly making a difference in someone’s life.

I have a client that suffers from a bi-polar disorder. When I met her, she was non-responsive, barely communicating with family or her physician, and disoriented. 

Her children and doctor gave up on psychiatry after several failed attempts and anti-depressant medication didn’t seem to help her condition. So when I suggested another round with a different psychiatrist, my idea was immediately discounted by her doctor.

Keeping in mind that my client was my priority, and not the doctor’s ego, I persisted, until I found another psychiatrist that specialized in bi-polar disorders. I then convinced the family to give it another try. About five months into working with the new psychiatrist, my client asked me to take her Christmas shopping. She’s talking to her family and looking forward to celebrating the holidays with them.

I don’t take credit for her hard work or the psychiatrist’s skill. But I do take credit for keeping a clear focus on my client’s needs, and striving to bring as much independence back into her life as possible.


Paula Tchirkow is President of Pittsburgh-based Allegheny Geriatric Consultants which specializes in geriatric care management for aging parents and seniors planning for the future of their middle-aged children who have chronic illnesses. Paula is also a daughter of an elderly mother. Visit her website: www.caregivingadvice.com or reach her by email at .