For this piece, I’ve had the pleasure of interviewing Amanda Lambert. Amanda lives in Utah where she is a care manager and co-author of the book “Aging with Care: Your Guide to Hiring and Managing Caregivers at Home.” Over the last 25 years she has worked in mental health, home health and, most recently, care management and consultation. Certified as an Advanced Aging Life Care Specialist through the Aging Life Care Association, Amanda has written multiple papers and given presentation on how to work with older clients. You can find her webpage at mindfulaging.com
Editor’s note: This interview has been edited for length and clarity.
Debra Stang: Thank you for taking the time to talk with me. Can you tell me a little about what you do?
Amanda Lambert: I’m a care manager. Most of my clients are older men and women, but I occasionally work with younger adults who have disabilities. My job is to work with clients and their families to help manage healthcare, housing, advance directives and financial issues. I also handle situations where my client requires a guardian.
Debra: Tell me a little bit about guardianships.
Amanda: A client requires a guardian when he or she is incapacitated and has not selected a surrogate to make decisions. A guardian is appointed by a court of law. Usually, the court appoints a family member as guardian. In some cases, there is irreconcilable family conflict or no eligible family members exist. Then, the client needs a private guardian or, if he or she cannot afford one, a state guardian. Private guardians, though, are expensive and the state only steps in to manage emergency situations. This can leave incapacitated clients with no decision makers. That is why it is so important for a care manager to encourage clients to complete medical and financial durable powers of attorney.
Debra: What kind of health issues come up for your clients that might require a surrogate decision maker?
Amanda: As a care manager, I spend a lot of time in hospitals and doctors’ offices coordinating medical needs and making sure all the family members are talking with each other. I also work with families and designated decision makers to decide on next steps for tests and treatment. For instance, when the decision maker is trying to decide whether the client should undergo an invasive test, it helps to ask what he or she plans to do if the test is positive. Will he or she seek aggressive treatment? Would it make sense to try to intervene in the disease process? If not, why go through the test at all?
I also work with health care providers to determine my client’s prognosis. If appropriate, I encourage my client and his or her family to seek hospice care to manage symptoms and provide comfort. Studies have found that it’s better to go on hospice sooner rather than later – the longer you wait, the harder it can be to get pain and other unpleasant symptoms under control.
Debra: What is medical home health? How is it different from hospice?
Amanda: Medical home health is skilled care in the home. Rather than comfort, it is directed at cure or at least at significant improvement. The care might consist of skilled nursing, physical therapy, occupational therapy or speech therapy. In order to qualify, a patient must be home bound and have an order from a doctor. As a care manager, it is my job to emphasize to clients that this is not round-the-clock home care.
Debra: How do you pay for medical home health?
Amanda: Medicare is the most common payor source. If a client has a Medicare Advantage plan, he or she will probably have only a few providers to select from. If he or she has regular Medicare plus a supplement, almost any local provider can offer services.
Debra: Thank you, Amanda. I look forward talking to you more next week.
Please come back next week to read part two of our interview, when Amanda will talk about housing options for older clients.