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Helping Low-Income Seniors: One Geriatric Care Manager’s Story
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Comments (2)My friend, Erin Koebler, who lives in Pittsburgh, works in a Medicaid waiver program sponsored by Allegheny County’s Department of Aging. Her department is the payor of last resorts for home care and modifications, when both private insurance and Medicare have denied needed services for seniors in their homes. I spoke with her recently about her job—as the Pennsylvania governor’s Long-term Living System Initiative is trying get people back in their homes and save Medicaid dollars—and as Erin said, “by July 1 of 2007, we hope to get 180 people out of nursing homes in Allegheny County alone."
So I asked how she meets most of her clients. Her response: “Usually a potential client or a concerned family member contacts the Department of Aging or they are pointed in our direction by a concerned social worker. Then they are pre-screened for income and medical eligibility.” It is then that Erin or another geriatric care manager receives the client and speaks with them once or twice on the phone to set up an appointment. I wondered what it was like to first meet a person at their home. “Generally it is a polite situation. People think, ”�She’s here to help’ and so they normally are quite welcoming to me. Most people are only annoyed by the lengthy processes of paperwork.” That being said, Erin mentioned she is entering strangers’ homes and as such has run across a few odd occurrences—or, worse yet—situations that are dangerous for the senior.
Erin provides a safer home for her clients in a very real physical sense. She said before poking around, she asks some basic questions, such as how the elder bathes. “The lady I saw today had a bathtub only—and she had a hard time swinging her legs over tub. So we plan to demolish one side of the tub and put in a tub seat so she can get in and out easily. Mostly it is about adaptive equipment.” Erin went on to explain that a personal emergency response system is given to most clients. So even if a client should wait for aid when bathing but does not, he or she can contact help in case of emergency. Erin admits she sometimes does lose sleep over clients. “You know about Pittsburg toilets?” I admitted my naiveté. “Well they are toilets in basements usually without surrounding walls and one client I know will walk down her stairs—even though she shouldn’t—to empty her commode. The thought of her on those stairs where she knows she shouldn’t be...it’s too much.”
Erin told me of another client who, when asked how she got out of the house, stated that she had stopped going outside as her daughter could no longer carry her down her steps. Erin continued, “It’s sad that these people don’t realize they could have contacted us much sooner sometimes.” Erin’s office also contracts with home health care and home care agencies, two types of long-term care providers. One of these agencies even will act as an intermediary so the consumer is employer, but the agency assumes all the responsibility of being the employer, with regard to taxes and insurance. This way, consumers can pick a relative, neighbor or a person they know to oversee their care. Erin explained that this program began with the younger disability community in mind, but has now expanded to address the needs of older adults: “Many want someone they know in their home. I know I would."
As we spoke I knew that Erin’s work was admirable, but I couldn’t help but wonder if her efforts ever felt the least bit intrusive. “Some clients refuse the help and if they are of sound mind there is little that I can do other than explain why a particular service would be beneficial.” But how do you get people to listen? Erin laughed, “I’m not sure why, somehow they usually trust me. But with some I’ve definitely had to work harder than others. I always explain why the service would be beneficial to them—and maybe this is why—I also tell them you don’t have to continue with any service, if you hate having someone in your house then we can get rid of them, just try it.” When I ask her about adult day care she answered, “The seniors I see are almost always reticent to try it.” Erin pointed out again that it was about enhancing the positive aspects, “It’s mostly daughters who act as family caregivers and many of these older adults worry about burdening their daughters. Some want to meet people and others enjoy the activity schedule.”
Erin often takes her laptop with her on her visits. It is her responsibility to come up with a care and service plan. “It used to be that you had to have a supervisor and a nurse sign off on your plan, but now if the cost is over $54.99/day then it needs to go through state.” I quickly calculated what that meant: the people who need the most help have to wait the longest. “Exactly! Because we want to keep people in their homes, but it’s problematic to get the funds for the neediest among them.” Erin checks up on her clients every month if they have no caregiver support system, or every two to three months for those with an informal system set up. All clients are reassessed every six months. Many of her clients go in and out of nursing homes as their medical needs change. “One woman I grew very close to, as I visited her often. She never let me leave without a little gift. It was very sweet that she wanted to thank me each and every time I was at her house.” As we were wrapping up our conversation I told Erin I had one more question for her.
What’s the best thing about your job? “Being able to go out and meet people who are so happy to stay in their home.”
Until next time,
Lara Belonogoff
Gilbert Guide provides information to help you find the GCM that is right for you along with listings of GCMs in your area. |
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Posted in: Elder Care, Essential Resources, Geriatric Care Management, Geriatric Care Managers: How They Can Help, Homecare
I didn’t even know about this sort of thing until I stumbled across your site while doing a search. I was told my mother requires the services of a geriatric care manager but I wasn’t sure what they really did. I do like that she tells her clients just to *try* something. My mom isn’t big on leaving her house, but maybe this might work to get her out a bit more.
I’m a private geriatric care manager in Pittsburgh. I make referrals to the county pretty often. The county does the best it can but sometimes the funds aren’t there. Sometimes a private care manager can help find services to supplement what’s available from the county. You can find geriatric care managers in the Greater Pittsburgh area at http://www.pittsburghpagcm.com.