You go home visit your parents and notice something’s off. The mail is stacked on the counter. There are pill bottles everywhere, and Mom can’t say which ones she took this morning.
So you do what plenty of families do: You start making calls. To the doctor, the pharmacy, the insurer, your brother. And you find out fast that nobody in the system is actually in charge of helping your parent.
The hospital handles the hospital. The doctor handles the appointment. Medicare pays the claims. Coordinating all of it? That’s apparently your job now — from three states away, between work and your own kids.
There’s a professional who does exactly that job. They’re called aging life care managers, though you may have heard the older name, geriatric care managers.
Julie Wagner, CEO of the Aging Life Care Association, told Paula Span of KFF Health News that the group’s members charge $150 to $350 an hour, with big swings depending on where you live.
Here’s the part that stings: The National Institute on Aging says that neither Medicare nor Medicaid covers it. Most private health insurance won’t either. Long-term care insurance might cover some of it, so check the policy if you’ve got one.
For most of us, we’re going to be paying out of pocket.
Let’s run the numbers. One firm in Span’s piece charges $185 an hour in 15-minute chunks. A 10-hour month is $1,850. At the top of the range, it’s $3,500.
That’s real money. Now compare it with the price of a bad assisted-living choice, a missed medication or a sibling fight that never heals. Here are five situations where I think the fee earns its keep.
1. The warning signs are piling up and nobody’s in charge
The National Institute on Aging has a short list of red flags worth checking on any visit. Is your parent cooking and using the stove safely? Bathing and dressing for the weather? Keeping the house reasonably uncluttered? Taking the medications they’re supposed to take?
Add mood swings, worsening memory and shaky decisions, and you’ve got a picture.
When you’re seeing several of these signs and nobody has a plan, that’s when a care manager’s first assessment pays off. The NIA warns that initial evaluation can be pricey, and the cost varies. But a professional plan beats a family improvising one crisis at a time.
2. You live too far away to show up
The NIA says these managers can be especially useful for long-distance caregivers, and that makes sense. You can’t drive Mom to the dentist from Chicago. A care manager can — driving clients to appointments is on the job list Span describes.
Span’s column profiles an engineer in Massachusetts who leans on a care management firm to look after his parents, two older siblings and an aunt, all in Maryland. When something went wrong, he told her, they were there.
That’s what you’re buying: the services of somebody local who picks up when you can’t get on a plane.
3. A move is coming
Moving a parent into assisted living — or from independent living to memory care in the same building — can be one of the most expensive decisions your family ever makes. And it can get made in a hurry, after a fall or a hospital stay.
Care managers arrange and oversee those moves, according to Span’s reporting. And unlike some “free” placement services, they aren’t paid by the facility to steer you there. More on why that matters in a minute.
4. The insurance paperwork is eating your life
Medicare, Medicaid, a supplement plan, a drug plan, a denial letter, an appeal deadline. Span reports that dealing with insurers, including Medicare and Medicaid, is part of what these managers do.
If you’re the family member stuck on hold every afternoon, that’s the clearest sign you’re doing a second job without pay. We’ve written about how that happens one small favor at a time — it’s called caregiver creep.
One thing a care manager can’t draw up is missing legal paperwork.
If Dad can’t make decisions anymore and never signed a power of attorney, read what families can do when there’s no power of attorney. And if your own documents aren’t done, get them signed before your kids face the same mess.
Before you go — I write this newsletter the way I’d talk to a friend over coffee: honest, plain, and out to make you richer, not to sell you something. Sign up for the free Money Talks Newsletter. Free forever, and easy to quit if I ever bore you.
5. The family is fighting
This is the one people don’t expect. Kristin Martinelli, a care manager at Mir Care Consultants, told Span that part of the work is refereeing between relatives and acting as a sounding board.
One sibling wants Mom at home. Another wants a facility. A third lives nearby and is burning out. A neutral pro with a nursing or social work background can break that logjam faster than another family shouting match.
When relatives disagree about a parent’s health, the paperwork decides who’s in charge — here are five moves to make before it happens to you.
Money fights deserve the same outside help. If a sibling wants to be paid for caregiving, don’t do it on a handshake — here’s the one document that prevents a family war.
Try the free help first
Before you spend a dime, make two calls.
The first is to the Eldercare Locator, a public service of the federal Administration for Community Living. Call 800-677-1116 and it can connect you to local help, including in-home aid and rides.
Your local Area Agency on Aging gets federal money that can pay for case management, transportation, personal care, chores and adult day care. Span also notes that some big-city social service agencies charge for care managers based on what you can pay.
The second call is to your parent’s doctor.
If your parent has at least two serious long-term conditions — think arthritis and diabetes — that should last a year or more, Medicare covers chronic care management: a care plan, round-the-clock access for urgent needs, help moving between care settings and a medication review.
It’s not free — you’ll generally owe 20% after the Part B deductible — and it’s not someone who’ll drive Mom to the dentist. But it’s coordination Medicare already pays for, and it’s worth asking about.
How to hire a real one, not a salesperson
Here’s where families get burned. Plenty of companies call themselves senior care advisers or placement services.
Span points out that facilities pay referral companies like A Place for Mom when a new resident moves in through them. Wagner put it bluntly: “They’re really marketers, salespeople.”
A real care manager works for you — the family paying the bill — not for a hospital or an insurer. Most come from nursing or social work. To check one out:
- Search the Aging Life Care Association directory by city or ZIP code.
- Ask for credentials. The association’s Advanced Professional members must hold at least one approved certification, such as Care Manager Certified or Certified Case Manager.
- Get the fees in writing, including what the first consultation costs.
- Ask whether the company also sells home care. If it does, you want to know who benefits from its recommendations.
- Ask about emergencies and get references.
One more dose of skepticism: You’ll see a survey where 93% of clients and family members said the benefits outweighed the cost. The association paid for it, and one of its co-authors acknowledged that its nearly 200 respondents weren’t a representative national sample.
Encouraging? Sure. Proof? No.
Bottom line
Our health care system will pay for the surgery, the scan and the rehab — sometimes. It won’t pay for a care manager to make all the pieces fit together. That gap lands on families.
Use the free help first. But if your parent is slipping, you’re far away or your family’s at war, a few hours of a pro’s time can cost less than one bad decision. I’d rather spend $1,850 on a plan than find out what no plan costs.
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