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  • Gwyn Blackwell

How Geriatric Care Managers work with Guardianship Cases

GERIATRIC CARE MANAGEMENT Q. What situations are most appropriate for Geriatric Care Management. A. A geriatric care manager (GCM) is often called after a crisis with a parent or older adult (perhaps a stroke or a scary situation with someone diagnosed with dementia, such as a car crash or when family members realize that they are not available, not effective and/or have no clue regarding the next (caregiving) steps for an older adult. It is beneficial to contact a GCM early, such as upon a dementia diagnosis or when family members/friends start to recognize someone slowing down, physically and/or cognitively. If you are wondering if Mom is eating enough or taking her medicine or you really fear getting in the car when your Dad is driving or you just worry about changes in their personality or daily routine or their lack of contact with other people, that would be a good time to bring in a Geriatric Care Manager.

Q. How do we get started? A. Please feel free to give us a call (at 914-574-1568) or email us at and describe your situation. We will discuss how our services might be of assistance to you and how to get started. Sometimes, you may need ideas for getting us in the door. We can strategize with you to identify the best opportunities to work with the older adults in need.

Q. How much does it cost? A. We charge on an hourly basis. The fee includes face time with the older adults(s), caregivers, family members and others as well as telephone time and can also include research, report-writing and time to coordinate services. A budget can be created to estimate how much time to be spent each month and the scope of services to be provided. It is important to determine what services the family will provide and what is expected of the Geriatric Care Manager. Our initial assessment is provided for a fixed fee; the total fee is capped at a certain number of hours.

Q. Is there a minimum amount or scope of services required? A. No, there is no minimum. Services can be limited based on your criteria and can end whenever appropriate.


Q. What is a medical power of attorney? A. A competent individual can assign another person to be their agent and to act on their behalf in the event that they lose decisional capacity. The person appointed to be Medical Power of Attorney ("POA") learns the desires of the individual, and is called upon, if necessary, to make important medical decisions. If a Medical Power of Attorney has already been appointed, it is often possible to avoid court to appoint a Guardian if the individual becomes incapacitated.

Q. Why would I need a third party power of attorney? A. Some individuals do not have someone in their lives willing and appropriate to become their agent. For instance, anyone without children or other relatives appropriate and prepared to step into the role of power of attorney might choose a professional to fill that role. If there are conflicts within the family, it may be appropriate to choose an outsider for the role rather than increase the tension among family members. Or, perhaps all family members live too far away and are unable/unwilling to take on the role. Q, How do you work as a Medical Power of Attorney? A. Ideally, we meet with the individual initially to learn what is important to them, regarding health decisions. Pertinent information, such as names of physicians and family members are shared. Often, it is many years before a Medical Power of Attorney would need to be invoked. It is recommended that the individual contact the POA on a regular basis and certainly communicate if there are any significant changes in health status. Q. What is the cost? A. We charge on an hourly basis. Typically, a few hours up front will acquaint us with you and your needs. A periodic (i.e., annual) review of needs would involve minimal hours. Only if the POA is invoked, might there be additional charge billed. A qualified Geriatric Care Manager should be able to provide an estimated quote of the time needed to spend on each client. this is the case, a court hearing is required to first determine that the individual lacks decisional capacity and second, the court enters an order for someone to be appointed as Guardian, to make health decisions (including caregiving, residency decisions as well as medical decisions.) (A similar designation of Conservator is to manage finances for a person.)

Q. When is a third party Guardian necessary? A. If there are no appropriate family members or friends to take on the role of Guardian, then a third party Guardian may be appropriate. Sometimes, family members are in conflict and the appointment of one family member over another would be troublesome to the individual. A third party Guardian can be the ultimate decision-maker in that case, taking family member recommendations into consideration, while communicating clearly with all members.

Q. How much does it cost? A. Volunteer mediators are often available for individuals who are isolated and without funds. Some state do not not have state-funded guardianship program which would serve such people. A few County Departments of Social Services provide guardianship services but only in limited circumstances.

Visit The Guardianship Alliance to learn about volunteer guardians. Third party guardians can be appointed to provide medical oversight for individuals. The services provided are similar to those by a Geriatric Care Manager, with the added ability to make decisions on behalf of others. ELDER MEDIATION/FAMILY FACILITATION Q. What is elder mediation/family facilitation? A. Mediation is a process that includes an impartial facilitator to help two or more people communicate and resolve differences when they are not able to do on their own. Elder mediation involves elder-related issues and may directly involve the elder's health and well-being or may may revolve around their property. Visit for more information. Q, What are some typical situations appropriate for elder mediation? A. Often, family members have different ideas about caregiving decisions, such as who should provide day-to-day caregiving, where caregiving should occur and whether a move is to a facility or retirement community is appropriate. Sometimes, issues occur after death, regarding disposition of property. Medical decision-making can generate conflicts - whether to proceed with a particular therapy or surgery or how to approach end-of-life concerns. Blended families can exacerbate any of these decisions. Q. What is the process to get to an elder mediation? A. We typically hear from one party who would like to resolve the differences in their family/situation. We can help that person to invite others to join into the facilitation process. It is important to bear in mind that the process is voluntary, so we cannot force anyone to take part. Once a group of people agree, the facilitators contact each party to learn their interests and to identify the important issues. Then, we meet together - often around the same table! If necessary, we can meet in separate rooms. Q. Should the elder be included?

A. It depends! We can help determine the appropriateness of including the elder. Or, identifying someone to share the elder's voice. Q, What is the cost? A. We charge by the hour and typically the charge is shared among the parties. Therefore, each party pays a small portion.

Q. Can our attorneys attend? A. If parties are represented by attorneys, they can certainly join in the process. If not physically at the table during the facilitation, we recommend that parties talk with their attorneys before making any agreements.

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