How Can a Care Manager Help You?

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?

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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.

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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 Stang: I know many older people with medical needs want to stay in the home. What are their options?

Amanda Lambert: Hello, Debra. Sometimes friends and family will be able to provide the necessary care for an older adult to be safe in the home. If not, the client will need to have private-duty care. Some long-term care insurance policies cover this, but Medicare and supplemental policies do not. When I work with a family as a care manager, I’m very frank about the costs. I send many of my clients to elder law attorneys to help them protect their assets.

Debra: When the finances are worked out, what do you tell clients to look for in private-duty home care?

Amanda: First of all, determine exactly what care the agency provides. Can they administer medications? Help with bathing? Prepare meals?

Next, ask the agency whether your loved one will receive care from a certified nurses aide – CNA – or a personal care attendant – PCA. Ask the agency what the caregivers can and can’t do. For instance, in some states, CNAs can’t give medications.

Finally, ask who in the agency you should speak to if a problem comes up. Can you call this person for regular progress reports? Will the agency call you if caregivers notice a change in your loved one’s condition?

Debra: What options exist for adults who can no longer remain at home?

Amanda: As a care manager, I deal with this issue on a regular basis. One solution is assisted living. Most assisted living facilities are owned by private corporations. They may appear to be quite luxurious, but a fountain in the lobby doesn’t necessarily mean good care. Talk to the administrator or admissions coordinator about the services provided. Be sure to ask about the costs involved. Some facilities raise their rates as a resident’s needs increase.

Another option is long-term care in a nursing facility. Many people think Medicare will pay for this, but unfortunately it doesn’t. If your loved one has few or no assets, you can help him or her apply for the state’s medical assistance program which will cover the cost of long-term care.

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Debra: How do your clients feel about the prospect of leaving their homes?

Amanda: Most of them don’t like it. They would rather age at home where everything is familiar. But the interesting thing is that when older adults leave their homes, they often do better. Many older adults living at home become socially isolated. At a facility, they make friends. Older adults who have health problems and who live at home alone tend to skip meals or eat junk food. The facility can ensure that your loved one is getting proper nutrition and hydration.

Debra: Are there any topics that I should have touched on but didn’t?

Amanda: I’d like to mention that falls can wreak havoc on an older person’s health. It’s important for your loved one to get some kind of exercise to improve balance and flexibility. As a care manager, I also recommend removing fall hazards like clutter on the floor or area rugs from your loved one’s living space.

Finally – and this concept is difficult for the families I work with – people have the right to make bad decisions. As long as an older adult is not incapacitated by a mental illness or dementia, he or she can choose to live in an unsafe environment or to refuse medical care. I can mediate between older adults and their families, but I can’t force my clients to do anything.

Debra: Amanda, thank you so much for your time and for your insights. I’ve enjoyed talking to you.

Amanda: Thank you, Debra. I’ve enjoyed talking to you, too.