What is a Geriatric Care Manager, and what do they do?

This week we learn about Geriatric Care Managers. Who are geriatric care managers (GCMs) and what do they do?

GCMs play a huge part in the work that we do to help clients prepare for Medicaid. In general, most GCMs are nurses or social workers by trade, but that is not always the case. They can also offer a wide variety of services and not all of them offer the same services. The following are the primary services offered, that we request the most often, and how they help our clients.

Far and away the most common service that our clients need help with, and the one that most GCMs provide even if they provide no other services, is finding appropriate housing options in an adult family home (AFH), assisted living facility (ALF), skilled nursing facility (SNF), or continuing care retirement community (CCRC). Any GCM will have a list of facilities and the cost for each within any given search radius. The better GCMs will also be able to provide information about: past and present complaints or actions against the facility; anecdotal information about the quality of care; and a sense of what the overall feel/personality of the facility is. They can tell you whether or not your loved one who hates Asian food or only speaks in Cantonese or wants hotdogs every Tuesday will fit in. When it comes to housing research, many GCMs will not charge because they receive payment from facilities where they place a client. Some will charge by the hour if they do not receive such payments or if they are looking at facilities that do not make such payments. You should always clarify what you will be charged ahead of time and ensure that, regardless of the fee, the GCM is willing to look at facilities that do not make payments to the GCM for the placement.

The other thing that separates a good or great GCM form the rest is their willingness and ability to use their connections within the facilities to negotiate shorted private pay periods. As you may have read elsewhere in this firm’s writings, most non-SNF facilities that accept Medicaid expect you to pay privately for 2-4 years. GCMs can often negotiate terms where a larger deposit is made up front and the private pay period is shortened or even eliminated completely. Attorneys can make similar negotiations, but we have less of a direct connection with the facilities and that lack of a relationship can make it much harder to strike the same bargain.

Similarly, GCMs facilitate the finding and hiring of care providers to provide in-home care for their clients, such as driving them to appointments, fixing meals, or paying bills. They are familiar with local agencies that have good reputations and they are skilled at finding individuals who do not work for an agency if you want to avoid some of the agency mark-up. They are also very good at helping identify the pros and cons of using an agency or an individual based on the merits of your individual needs. Once a care provider is hired, the GCM can also serve as an overseer, checking in to be sure that the care is appropriate and the care providers are doing all that they are being paid for. To start out, this might be weekly check-ins and then ease back to monthly or even quarterly check-ins.

The second most common service that our clients need is a functional assessment and care plan. In order to qualify for Medicaid, and sometimes just to successfully create a plan for future benefits, it is important to know what help a client needs, how often they need it, and what it will cost them if they pay for it privately. GCMs can assess the needs of the client and put together a care plan that tells family members what they should be doing or what they should be hiring someone to do. It is very helpful to ensure that Medicaid does not understate the needs of the client, to create a contract for paying loved ones for care before the time for a Medicaid application, or for several other planning options that may be in consideration. A thorough assessment with a well prepared care plan makes my job much easier and provides invaluable information to the family and friends of someone who is in need of care

GMCs will often help coordinate and schedule appointments, attend medical and/or legal appointments, and then help relay and explain the conversations that were had to loved ones or to the client. They are also great at translating on the spot when a doctor starts using a lot of medical jargon and then asks a client to make a decision that could dramatically affect their life. Having someone with you who “speaks the language” can make a big difference.

GCMs are also available to help loved ones who have chosen to be the care provider. A good GCM can help find short-term respite options for someone who just needs a break but does not want to give up providing the care. This could range from finding care providers that are willing to only work one or two days per week, for limited hours, to allow the care provider a chance to get out, or it could be helping identify local adult daycares that will provide great quality care on an irregular schedule.

And So Much More.

We have also known GCMs to serve as agents under a financial and/or health care power of attorney, serve as weekly hired companions to just spend quality time with lonely individuals, coordinate family discussions to avoid or resolve misunderstandings and disputes, and so much more.

It is very important to find a great elder law attorney when planning for your future or the future of your loved ones. It is equally important to find a great GCM to work with. We have several great GCMs that we work with and we are happy to make introductions between our clients and our trusted GCMs.

What to do with your parents money.

This week in Crisis Corner, we want to discuss what to do when mom or dad gives you a large sum of money as part of their Medicaid planning.

It is a very common practice for aging parents, especially those with a new diagnosis of Alzheimer’s or Parkinson’s, to give a large portion of their assets to their children and start a “five year look back period.” In most cases, Medicaid will not pay benefits for an applicant that has made a gift within 60 months of applying. The period of time that the applicant is ineligible is based upon the size of the gift. Under the current standards (these change at least once per year) a gift of $631,450.00, give or take a little bit based on leap years, is enough to trigger a five year penalty. If the gift is less than this amount, it might be worth applying right away, or it might still be better to wait. That is a separate discussion that has to be had on a case by case basis.

Whether the gift is part of a plan to apply soon or a plan to apply after five years, you may be left wondering what to do with all of that money. In general, there are three options:

  1. Spend it. When a gift is made for Medicaid purposes, it has to be a true gift. That means that mom or dad cannot give it to you on the condition that you will only use it for them until they die. You can quit your job and take a month long trip to Europe, by a Ferrari or two, or just pay off your own debt. Most children do not do this but it is an option.
  2. Put it in the bank. Some children put some or all of the money in a bank account that is dog-eared for use that benefits mom or dad. This is totally acceptable and, for smaller gifts, it may be the best way to handle the funds. This gives you the flexibility to still use some of it for yourself and it is readily available to help mom or dad if they need help.
  3. Put it into a Safe Harbor Trust. If the gift is a significant one (that means different things to different people), and you want to use all or most of the money for mom or dad’s needs, then putting the money into a Trust for their benefit has a lot of advantages.
    • If the gift was made to several children who all want to help mom or dad, they can all put their gifted money into one Trust and not worry about who is paying more from their gifts.
    • If you rear-end someone on the freeway or otherwise get sued, the money is protected from the lawsuit.
    • Similar protection is there if you predecease mom or dad.
  4. You, and any others putting money into the Trust, can designate where the money will go after mom or dad dies. For example, there are two kids but one was disinherited over a silly fight and both kids feel like the estate should be shared when mom or dad passes so the gift goes to only one of you and they put it into a Trust that says when mom or dad dies everything in the trust goes to both of you.
    • You are able to avoid temptation. You might really want to save the money in case mom or dad needs it but you also really want a new car/home/vacation. You know that once you buy yourself one thing you will want to buy yourself more things. It might be easier if you keep enough of the gift to buy yourself one thing and the rest is securely in a Trust that cannot be used for the benefit of anyone except mom or dad.

When the plan to give you the gift was made, the attorney suggesting the gift should have talked to mom or dad about these options. If you came to Life Point Law and had a Family Meeting, the attorney should have also talked to you about these options. If you have not talked to anyone about what to do with the gift you received, or if you have a loved one that is waiting to run out of money so that they can apply for Medicaid (because they do not realize that these options exist), please give us a call and see how we can help you understand your options.