THE SHORT HISTORY OF GERIATRIC CARE MANAGEMENT

Geriatric Care Management (GCM) was born in the late 1960's as a result of caregivers to older loved ones having difficulty dealing with the myriad of fractured services surrounding long term care for the elderly.  Many of these caregivers were not aware of government programs that could have helped, especially through the Older American's Act. However, some caregivers who knew about the government programs still wanted to avoid public programs or were too financially well off to qualify for them. They wanted a private way of continued care for their loved ones and were willing to pay, usually after government funds paid whatever they would. In the 2001 survey, GCM respondents claim that 61.8% of the remuneration that they received came from the client/patient with 46.7% coming from the family or caregiver. Most of the clients served (74% were female and widowed (69.6%) with modest incomes and 35.1% of the time, the GCM is hired by a relative who lives out of town from the client/patient. (Parker and associates, 2002).

Some early demonstration projects are credited for inspiring this creation of this industry. Some of the better known projects include Triage, the On Lok Senior Health Services, ACCESS, the Channeling Project, and Project Open. Of course a major impact of how this industry was created was based on the existing providers and payers of long term care. The demonstration projects may have shown how to create the programs, but the way to pay for those ideas had to mess with current practice as much a possible to save out-of-the-pocket expenses. One of the most important concerns today is that the payers, especially the large national chains that have been created (such as Living Strategies and LivHome), may be more interested in their system making a profit than in individualized services to the client/patient (Parker and associates, 2002).

The industry was not coordinated in the early years and clinicians did not know about each other. To help answer questions about this new industry, a survey was commissioned in 1987 by the new National Association of Professional Geriatric Care Managers (NAPGCM) and Marcie Parker, one of the founders of the industry as well as one of the founders of the NAPGCM, was able to get a 100% response from the 100 members of the organization at that time. This survey was repeated in 2001 after tremendous growth in the industry had occurred and was only able to achieve an 18% response on this second wave. It was interesting to note that those who did respond the second time had all responded to the first wave as well. Competition had grown so intense in those few years that most of the people involved in Geriatric Care Management would not answer the survey, many stating that they felt the questions were too intrusive (Parker and associates, 2002).

The original definition of care management included seven concepts:

"Identifying and attracting the target populations, screening/intake and eligibility determination, assessment, care planning, service arrangement, monitoring, and follow up and ongoing reassessment (Parker and associates, 2002)."

Today the NAPGCM ethics include serving more than only the long term care elderly. They have expanded to include vulnerable groups of all ages, naming developmentally disabled and mentally ill/retarded individuals along with the needs of the elderly. The industry is practiced in a wide variety of ways through a huge variety of practitioners. This has lead to the call, by some, for regulating the industry while others feel that the existing professional degrees should suffice. There already are designations that one can earn to become a part of the industry. Among these are the Certified Case Manager (CCM) which is awarded by the Commission for Case Manager Certification (CCMC) and the National Academy of Certified Care Managers (NACCM) offers a Care Manager Certification (CMS). There are a number of less comprehensive certifications such as ones given to insurance agents for working in a specific market, like long term care insurance (Parker and associates, 2002).

Originally its main focus was on the medical aspects of care, and one split in the industry is still focused on that medical care today. Some of the services that GCMs may provide in this area include: Transition services from the hospital to the home, “home health aides, home health care, setting up medications, make appointments and getting patients' to the doctors, speech therapy, physical therapy, occupational therapy,  psychotherapy, nursing home placement,  and even a 24 hour a day hotline.” This type of service may also include working directly with the patient's physician to coordinate care and even filling out the health insurance and Medicare/Medicaid forms for the doctor to sign (Parker and associates, 2002).

But then industry has also grown, in many practices, into a holistic package with most GCMs including the psycho social aspects of care as well. Today some GCMs have gone even further to becoming a one stop shop for nearly all the care needs of the client/patient. Other such services that some GCMs include such varied areas as: “Companion services, family/caregiver counseling, family needs, support groups, personal needs, spiritual needs, home maker services, chore services, financial counseling (usually daily money management), retirement planning, family dynamics, legal services, guardianships/conservatorships, estate management, housing placement,  in-home meals, transportation, respite care, friendly visiting, adult day care, senior care, and even person-environment fit”  (Parker and associates, 2002).

As of the 2001 study, 82.2% of those GCMs who did respond are for profit, with 17.8% non-profit. Independently managed firms constituted 80.6% of the respondents. Most (90.1%) do social assessments and evaluations for community based long term care (88%). Functional assessments are high on the list (90.1%) with ongoing monitoring of the client/patient coming in at 94.8%. Coordinating services for the client was found in 95.8% of the GCM respondents and referral services for the client scored 93.8%. Cognitive assessment is practiced by 88.5% but psychological assessment is only 55.2%. Assistance in completing forms was found in 78.6% of the GCMS who responded and helping clients choose a retirement facility came in at 84.9%. There were other services recorded, but they were scored at less than 60% other than education the client/patient about services, funding, federal systems and the like which scored and impressive 62.5% (Parker and associates, 2002).