New Beginnings–Aging Life Care Managers® Helping to Keep Older Adults at Home or Transition

Aging Life Care Managers® expand your resources and knowledge for making excellent choices related to wellness. 

Aging Life Care Managers®, also referred to as Care Managers (CM) at times, have been providing older adults and their caregivers’ long-term choices and advocacy since the 1980s.  The profession of Aging Life Care is still rather new and emerging.  Many Aging Life Care Managers include people of all ages.  The mission of Care Managers is to provide choices for people to live as independently as possible in the place that they call home.  There are several ways in which Care Managers do this including, navigation, support, and lastly empowerment.  Let’s break down the process for a better understanding of each step.


Researching and understanding available living options and services can be overwhelming.  Care Managers have the knowledge, experience, and resources to help you make an informed decision using current and past client experiences.   Care Managers will provide a comprehensive overview of living options and assistance available in the location you are seeking.  CM’s are knowledgeable of entitlement programs such as Medicare, Medicaid and Veterans Benefits, and will help you determine the best living arrangement based on current and future financial and medical needs.  The services of a CM are usually provided by a Nurse, Licensed Social Worker or other healthcare professional.  CM’s can help activate long-term care policies.


With so many resources available in the home today, remaining in your can be a viable solution.  A CM will help you determine if home is the best option.  CM’s have many years of experience and have developed relationships with a variety of resources that help support living at home.  CM’s resources include insurance counselors, physicians, rehabilitation providers, home-care agencies, meal providers, housekeepers, durable medical providers, home repair specialists, medication dispensaries, and more.  The ultimate goal of a CM is to meet long-term needs of the person with disabilities.   Help comes in many forms and CM’s are skilled at helping older adults find options to stay happy, stay healthy and stay home.


CM’s believe that empowerment is essential.  Every person should be empowered to take control of their own health.  When older adults are challenged with being able to advocate for themselves a CM can assist.  CM’s are trained at problem solving and advocacy.

In summary, home is where the heart is.  Care Managers understand that home is the foundation where life happens.  Home is where your friends know where to find you, where your kids come home to stay for holidays, it is the place you can walk with the lights out and still know where you are.  With a CM by your side, you can be at home with confidence knowing your needs will always be met.  CM’s can provide you with the resources and knowledge to make life easier.  CM’s can also help put worried older adult children at ease knowing there are boots on the ground watching over their parents.

This blog originally appeared here.

About the Author: Bridget Ritossa is The Owner of Careplan Geriatric Care Managers and serves as a regional board member for The Aging Life Care Association™ formerly known as The National Association of Geriatric Care Managers. Bridget is the Unit Leader for the Cleveland Aging Life Care Association. She has been practicing geriatric social work and care management for over 25 years in the Cleveland area working in hospitals, CCRC’s and in the home environment. She is a licensed social worker and certified care manager. She can be reached by phone (440-476-9534) or email (

Clean Hands Count – Aging Life Care Managers promote sanitary measures

Have you taken your handwashing routine to new heights during the COVID-19 pandemic? That’s great! Keep up the good work.

Unfortunately, 42% of respondents in a recent poll said they had lapsed in their handwashing practices. Pandemic burnout is cited as a common reason. Hand washing is critical, in addition to wearing a mask in public and practicing physical distancing, in reducing infection transfer.

Even though COVID-19 vaccines are available and many of us have taken advantage of this added protection, COVID variants are another concern. The practice of regular and proper hand hygiene is a must. These habits have also contributed to the lower rates of influenza and flu deaths over the past season.

As restaurants and sports arenas open, as schools return to in-person learning, and as we return to office environments, we need to be especially vigilant in our hand hygiene practices. Don’t let pandemic fatigue negatively impact these infection control practices. Your health and that of others depend on it.

May 5 is World Hand Hygiene Day

This year’s World Hand Hygiene Day is focused on healthcare providers. On average, healthcare providers perform hand hygiene less than half of the times they should. Routine, proper handwashing is essential to infection prevention.

When you are in a healthcare setting, don’t be timid about asking your healthcare provider to clean their hands if you have concerns.

Let this also serve as a gentle reminder to each of us to continue doing the following to ensure we are doing our part for infection prevention:


  1. Wash your hands properly and regularly.
  2. When soap and water aren’t available, use hand sanitizer that contains at least 60% alcohol.
  3. CLICK HERE for the CDC’s FAQs about Hand Hygiene.

You may find this two-page flier helpful too: Handwashing at Home, at Play, and Out and About

About the Author: Contributor Keri Pollock directs marketing and communications for Aging Wisdom, an Aging Life Care® practice based in Seattle, Washington. She is a member of the Aging Life Care Association PR Committee and the Age Friendly Coalition for Seattle and King County, WA.

What is an Aging Life Care Manager?

As you manage the care of an aging loved one, it can be helpful to seek support from a professional. Learn about the unique role an aging life care manager plays and how to select one that meets your needs.

There are many different reasons you or your loved one may need extra care. Whether it’s help with managing their health, finances, activities of daily living, or other areas of life, it can feel overwhelming. Some families don’t have the expertise or knowledge to know where to start or help make decisions.

As the President of the New England Association of Aging Life Care, I guide many families through the process of considering an Aging Life Care Manager to help them navigate through the aging process efficiently and with the most appropriate resources available. In this role, I’ve worked with Hebrew SeniorLife in many different ways and am happy to share an incredible partnership.

What is an Aging Life Care Manager?

An Aging Life Care Manager ™ is a navigator – a personal guide through the maze of aging. We are often referred to as a consultant, coach, advocate, quarterback, coordinator, “hub of the wheel,” and team captain. Aging Life Care Managers, which have also been called geriatric care managers, are particularly useful in helping older and disabled adults and their caregivers find the right services and programs to relieve the burden of caregiving.

Care management has been called “the best-kept secret in eldercare.” However, care management is not a new concept. In fact, the practice of care management began in the early 1980s. If care management has been practiced for more than 40 years, why is it still such a well-kept secret?

The answer may lie in two places. First, it may be the complexity and variety of issues a care manager can address. When asked the question “what does a care manager do?” I have often heard colleagues respond, “What do we NOT do!” And while this is a true response, it does not contribute to the understanding of how a care manager can be helpful.

An Aging Life Care Manager is an expert in the issues adults face as they age and how those issues affect lifestyle, care, and housing. Aging Life Care Managers are trained to help clients and their families understand the implications of chronic illnesses such as diabetes, chronic obstructive pulmonary disease (COPD), heart disease, and many other chronic illnesses. The care manager can help educate the person and their family about how to manage these diseases and what to expect if there is a flare-up or exacerbation. Care managers are well-versed in issues that affect behavior and cognition such as dementia, Parkinson’s disease, and mental health challenges, and how those issues can affect the delivery of care in both the short and long term.

Another reason care management is hard to describe in generalities is the approach and plan for each person varies. For a care manager’s recommendations to be helpful, they must develop a deep understanding of the person’s needs, abilities, and desires. This requires thoughtful consideration, extensive listening, and information gathering and solutions that are specific to each person. Therefore, how a care manager is helpful to one family may be very different than how they are helpful to another.

Responsibilities of an Aging Life Care Manager

Care managers perform comprehensive assessments of the multifaceted needs of an older adult or a person with special needs. In the course of this assessment, a care manager is looking at the person’s life holistically including diagnoses and medications, the caregiving system already in place, social and emotional needs, financial and legal issues impacting care, unmet needs, the person’s wishes, etc. The goal of the care manager is to come up with recommendations for the client and their family that allow for maximum independence while also considering safety and well-being.

Aging Life Care Managers have extensive knowledge about the costs, quality, and availability of resources in their communities and can give specific direction to their clients. While many families are inclined to do this work themselves, most find that care managers can save them both time and money.


Aging Life Care Managers are typically hired by the hour for an hourly rate and provide as much help as needed. Medicare and Medicaid do not cover geriatric care management services, and most private health insurances don’t either. Some long-term care insurance policies may cover a portion of the cost but it’s best to check with your insurance provider. Typically in the New England Area, an Aging Life Care Manager can cost anywhere between $125 and $200 per hour.

How Do You Know if you Need an Aging Life Care Manager?

Although there are many reasons or ways to use a care manager, there are some common themes that most people and their families are facing such as:

  • Family dynamics that are challenging decision-making
  • Caring for a loved one at a distance
  • Difficulty with managing medications or medical appointments
  • Multiple hospitalizations or unstable living arrangements
  • Experiencing challenging behaviors or situations
  • Difficulty managing chronic or multiple medical issues
  • Caregiver stress and burden that is causing burnout
  • Deciding between levels of care or between at-home vs. community-based care
  • Need for oversight or monitoring of care

It’s important to look thoroughly at any life care manager you’re considering. You want to make sure they have qualifications that are important to you and your family and are providing resources and relief to the caregiving process.

Some questions to consider are:

  • Are they a member of the Aging Life Care Association?
  • What are their professional credentials?
  • How long have they been providing aging life care services?
  • Are they available in emergencies?
  • How do they typically communicate with clients and their families?

If you would like more information about care management, find a care manager in your area.

This blog originally appeared in the Hebrew SeniorLife blog.

About the Author: Jennifer Pilcher, Ph.D., CMC was awarded her doctoral degree in Gerontology from the University of Massachusetts in Boston in 2005. Her professional experience has focused primarily on care and housing arrangements for elders with Alzheimer’s disease and related dementias, including policy and fundraising work for the Alzheimer’s Association of Eastern Massachusetts, the Alzheimer’s Association of Utah and the Massachusetts Association of Older Americans. Dr. Pilcher has had career-long experience working with people with dementia and their families. For seven years, Dr. Pilcher was affiliated with Hearthstone Alzheimer Care Assisted Living programs in Massachusetts and New York, where she held a number of management positions. For 8 years, Dr. Pilcher worked both as a Care Manager and as the Director of Operations for AZA Care Management of Boston, MA. In 2018, Dr. Pilcher founded Clear Guidance in order to return to her passion of working directly with clients and their families. Dr. Pilcher also presently serves as President of the New England Association of Aging Life Care and is the Editor in Chief of the Journal of Aging Life Care.

Women’s History is Our Future


March is National Women’s History Month and May is National Aging Life Care Month – so for the final week of April – we are featuring a lovely account from ALCA Board Treasurer and NY Chapter President Anne Sansevero.

ALCA has roots going back to a seminal day in NYC on March 8th, 1857. Garment workers took to the streets demanding improved working conditions, a ten-hour day, and equal rights for women. March is a time to celebrate all the accomplishments women have made over the years and give attention and momentum to the work ahead on women’s empowerment.

As CEO & Founder of HealthSense, a women’s owned business, I am acutely aware that my success as an entrepreneur has flourished because I stand on the shoulders of the brave and determined women’s advocates that came before me. Women like the marchers and picketers, the journalists and authors, and those early corporate pioneers who edged their way in the door of the C-Suites. These trailblazers gave voice and inspiration to those who long felt ignored and undervalued. This month also gives me pause to reflect on educators, mentors, and organizations that have given me the courage to start my own business.

In 1996, when I first felt a stirring of “Can I do this?”, I joined an incredible non-profit membership and networking organization called the aging life care association. Thanks to the amazing support of national and regional women entrepreneurs, I successfully launched my care management consulting practice. When I need a business refresher or retreat, I often gravitate to offerings that focus on women’s needs. For example, the woman-owned coaching business, Wide Awake Business, offers vibrant and empowering Lead Her Up retreats. Women leading other women up is uniquely important as we understand the inherent challenges and opportunities for women to thrive in the workplace including: work-life and family balance, flexibility, mentorship, collaboration, and community. Beyond women supporting women, we also need the support of men–fathers, brothers, sons, educators, work colleagues, and leaders who believe that an empowered and supported woman has much to give to the world. To that end, women’s empowerment is a core value both personally and professionally and women’s history month reminds me to try every day to pay it forward for others.

This article originally appeared on the HealthSense blog.

About the Author: Anne C. Sansevero, RN, MA, GNP, CCM, is the founder and CEO of HealthSense LLC, an Aging Life Care management consulting practice. She is a master’s prepared geriatric nurse practitioner, and a seasoned nursing professional with over 30 years of experience in the field. Anne has a sub-specialty in neurological disorders and is well versed in all aspects of geriatric nursing. She has particular expertise with communication disorders relating to stroke and dementia and has developed a number of innovative nursing assessment tools and standards to improve the nursing care for frail elders. Anne is a member of the Aging Life Care Association® (ALCA) and Fellow of the Aging Life Care Leadership Academy. She is currently serving on the board of the ALCA, and is Vice President of the New York Chapter. In addition, Anne is a member of the American Academy of Nurse Practitioners and the Nurse Practitioners of New York. Anne is a registered nurse, certified care manager, and a master’s prepared geriatric nurse practitioner.

“Born in Ireland, I come from a strong medical family of physicians and nurses. I was naturally drawn to a career in health care where you can make a real difference in the lives of others. In the 1980s, I was recruited for a nursing career opportunity in the United States and fell in love with the energy and optimism that is part of this country’s cultural DNA. In the acute care work setting, I became very attuned to how stressful hospitalization can be for older, frail adults. I found my calling as a nurse practitioner and Aging Life Care Professional while advocating for the elderly and working to improve their quality of life and to avoid hospitalizations. I have a deep appreciation for the wisdom and resilience that I see in my older clients and feel grateful to be able to contribute to helping them and their families lead happier lives.”

Ten signs of when you need to be involved:  the Coronavirus factor

Paying attention to situations that can affect the well-being of older adults can make all the difference. The effect of the COVID19 virus has raised the risks of ignoring signs that indicate it is time to intervene.   There are ever-changing regulations, testing regimes, surges in cases, availability of vaccinations, and even access to healthcare. This means there are a lot of factors that families can consider when caring for an older adult.

Here are some signs on when to be concerned:

  1. Families living at a distance: Not only are subtle signs of change easily ignored, but travel restrictions have limited regular interactions by family who would normally be there to notice symptoms.
  2. Changes in emotional state: Those who experience social isolation, limitations in daily living acitivites, vulnerability to serious illness and death has shown increased depression, anxiety and symptoms of mental illness.
  3. Changes in physical condition: Covid doesn’t stop the declines older people experience as the normal process of aging brings to many. What has changed is restrictions on face-to-face visits to physicians, an overburdened healthcare system and a triaging of interventions. Fear of Covid could delay being seen in emergency rooms for health issues that need immediate attention.
  4. Undergoing a crisis: The restrictions limiting contact of informal supports, additional precautions postponing routine medical care and delayed response to medical needs  can mean situations can become more serious before they are attended to.
  5. Moving in or out of facilities: Transitioning to a new residence is often associated with stress and trauma. New considerations regarding safety, social restrictions and availability of beds have challenged both residents and facilities. Balancing the risks and benefits of moving has to be carefully evaluated.
  6. Signs of cognitive decline: Forgetfulness, reduced logic and the inability to organize are always troubling.  Ignoring safety measure during the pandemic can be deadly. Wearing masks, limiting social interactions and taking precautions can be ignored.
  7. Care options and coordination: Obtaining proper care, assuring that safety precautions are taken and balancing the risks of having contact with others who may be at risk for contagion takes preparation, thought and coordination.
  8. Hospital discharge: Limitations due to skilled nursing closures and high risk of contagion often make placement directly to a home or assisted living facility a safer and more realistic option.  A care plan must weigh risks and benefits of all options.
  9. Trouble coordinating care: The added burden the Covid has added to caregiving can be overwhelming. Not only is the older adult at risk, but family caregiver are often burdened with additional family, home schooling, as well as economic and health challenges of their own.
  10. Family Conflict: under normal conditions, almost half of adult siblings will have conflicts involving caring for an aging parent. The added additional challenges and decisions that COVID brings with it have added to the strain on the family system. Unresolved conflicts often complicate an already overwhelmed situation.

You don’t have to do it alone. The multi-disciplinary approach of an Aging Life Care Professional can assist. (

About the Author: Bunni Dybnis, MA, LMFT, CMC brings 30+ years of professional experience role as President of Aging Life Matters.  She uses her skills and background as a Licensed Marriage Family Therapist, Certified Care Manager, trained meditator to provide consultation, family conflict resolution and expert witness testimony and support for aging & dependent adults and the families and advisors involved with their needs.

Bunni is considered a national leader and spokesperson for her profession and as well recognition for her involvement in the aging community of Los Angeles. She is a Fellow in the Leadership Academy, past board member and president of the Western Region and chair of numerous committees of the Aging Care Association receiving the highest achievement awards from her peers.

Dad Had A Stroke… Now What? (Part II)

In my previous blog post, we learned Mr. Smith needed skilled rehabilitation services after his stroke. His son, Paul, selected a facility near his home with the goal of his dad returning home after he received skilled rehabilitation. Mr. Smith was motivated and worked hard on his physical, occupational and speech therapy. After about three months, Paul and his dad were informed by the facility social worker that his dad had reached a plateau. This meant that Mr. Smith was no longer making enough gains or progress with his therapy as required by his insurance to continue receiving therapy services. Paul’s dad continued to require assistance with all aspects of daily living (referred to as ADLs). Mr. Smith and Paul were confused and disappointed as to why the therapy services had to end. They both believed, with more therapy, Mr. Smith would continue to get stronger and improve overall. There was no way at this time Mr. Smith could safely return home.

Unfortunately, as an Aging Life Care Professional® working privately with families through this process, all too often I have experienced the disappointment, frustration and fear families face at this time of uncertainty. What happens next? How much will this cost? Will my loved one ever return home?

Mr. Smith will now require custodial care and will “move” to the facility’s LTC (Long-Term Care) wing, located around the corner from his current room. The difference will be the cost and services. For the first 20 days Mr. Smith was receiving skilled therapy services, his costs were covered 100% under Medicare. From day 21 until day 88, when he was informed he had reached a plateau, he was responsible per his supplemental insurance for 70% of the cost of his room and board. The skilled therapy services (PT, OT & speech) he received five days a week for three hours a day were covered under Medicare.

These costs vary from facility to facility. When making decisions about receiving care and services from any facility, it is especially important to understand and consider costs. The room rates are typically different when an individual is receiving skilled therapy versus custodial care. Remember, Mr. Smith’s supplemental insurance required him to pay 70% of his room and board from day 21 to day 88. Every insurance plan is different, so understanding and verifying each plan is important. For example, the room rate for the skilled rehab for Mr. Smith was $200 per day. Mr. Smith was responsible for 70% of his room rate from day 21-88, meaning he was responsible for $140 per day for the 67 days he was there. He was responsible for $9,380.

Now that Mr. Smith is moving to LTC, he will continue for a period of time to receive therapy services. The therapy will be covered under a portion of Medicare and potentially his supplemental insurance. The therapy services will not be as rigorous or of the same duration he had previously received when in Skilled Rehabilitation. In LTC, his new schedule for PT and OT will now be three to four sessions a week at 45 minutes per session.

In LTC, Mr. Smith is now responsible for 100% of his custodial care costs, including his room and board. The room rates again will vary from facility to facility, based on several different factors including the most common: size of the room and single or shared room. The typical cost in our area for LTC is between $200 to $550 a day. The cost of long-term care can quickly become overwhelming. The big question most families have is, “What happens when we run out of money?” Will their loved one be kicked out? Where will they go? This is important information to understand and know before selecting a facility.

Most LTC facilities accept Medicaid benefits. Medicaid is different than Medicare. Medicare is based on age and/or disability and covers portions of short-term skilled rehabilitation only. Medicaid is based on income and does cover LTC. There are facilities that do not accept Medicaid and families should be aware ahead of time. If a loved one ends up moving to a facility where Medicaid is not accepted, begins privately paying for LTC and runs out of money, the person will need to leave the facility and find one that does accept Medicaid. Moving from place to place at this stage of LTC can be difficult and requires a good transition plan.

It is important to understand how the process works when making decisions about where to go for skilled rehabilitation. For most people, the goal of skilled rehabilitation is to get stronger and return home. Unfortunately, things do not always go as planned. It is worth the time to know what questions to ask from the start.

About the Author:  Jennifer Beach, LSW, MA, C-SWCM established Advocate for Elders in Rocky River in 2010. Jennifer has 25 years of experience in working with and advocating for older adults and their families. Jennifer is a licensed, insured Social Worker and an Advanced Aging Life Care® Professional. She has served as the Midwest Chapter President of the Aging Life Care Association and additionally served 7 years on the Board of Directors. In 2018, Jennifer was honored as the recipient of the ALCA Midwest Chapter Outstanding Member of the Year Award. Learn more at

Jennifer is also a monthly contributor and author of Caregiver Corner for Northeast Ohio Boomer and Beyond blog and magazine.

Staying Safe Post-Vaccine

After almost a year of living during a pandemic, there is finally a light at the end of the tunnel! Thanks to the rollout of vaccines for the coronavirus, we finally can hope to return to a state of normalcy by the end of the year. But it is important to continue to exercise caution and maintain safety protocols even after we get vaccinated. Here are some tips for staying safe and healthy during this uncertain period:

  • Keep masking up! While we may be frustrated with wearing masks (not to mention, having to remember to bring them everywhere we go!), it is important to keep masking up when around others or in public, even after you have been vaccinated. The vaccines are not 100% effective, and it is possible that we can pass the virus on to other people even if we ourselves do not get sick. It is better to act on the side of caution, especially when we are around our elderly loved ones and other vulnerable people, so let’s keep our masks on for now.
  • Maintain social distancing. We are all eager to see friends or family members, especially ones that we may not have seen in months, but it is probably best to hold off on throwing a big party for now. As more of us get vaccinated, it will be safer to finally see our friends and family in person, but we should still exercise caution, maintain safe distancing, and limit the amount of people that we have contact with.
  • Keep those health protocols going! While following certain health protocols was advisable pre-pandemic, we all became more vigilant once COVID hit. Now that we are regularly practicing activities such as frequent and thorough hand washing, using hand sanitizer, and avoiding unnecessary touching, these habits should become a regular part of our daily lives for optimal health and disease prevention.
  • Retain positive quarantine practices. While having to quarantine, isolate, and stay indoors, we all developed certain routines or habits to help us cope. Some habits were not so healthy, but we also incorporated some healthy changes to our lifestyles, that we can and should continue once quarantine restrictions begin to loosen.  Maybe we spent more time taking walks outside and enjoying the outdoors. Maybe we cooked at home more, tried new dishes, and ate healthier. Maybe we discovered new hobbies or interests or honed our skills. And maybe we routinely checked in with people in our lives, through phones calls or Zoom meetings. Perhaps the forced distance from our loved ones made us appreciate them even more. Once we can start socializing again, it is a lovely idea to continue regular calls or video chats to check in with our loved ones, especially those who are not nearby, or can’t get out.
  • Respect everyone’s comfort levels. Remember that, even after being vaccinated, people will still be concerned about getting sick. Respect their concerns. We do not need to cajole people into going out or doing anything they are not comfortable with. It is a good idea, before seeing anyone in person, to establish what all parties feel comfortable with. You may think Aunt Jean is going overboard if she comes to your house and keeps a mask and gloves on the whole visit, but if it keeps her healthy and feeling safe, do not judge her. Appreciate everyone’s concerns and efforts to stay healthy and safe and enjoy the opportunity to visit.

While we are all eager to resume our lives, it is still important to be smart, safe, and vigilant of health risks. When in doubt, err on the side of caution. Continue to engage in healthy practices such as mask wearing, social distancing, and hand washing. Keep up with beneficial activities such as exercising, reading more, and eating better. And above all, remember how important our loved ones are and what a privilege it is to have them in our lives.

This article originally appeared on the Connie Rosenberg & Associates Care Management website.

A Preventable Disaster Saddened and Frustrated Me

“Living with a Visionary” is a beautifully written essay by John Matthias, Professor Emeritus and writer, published in the New Yorker on February 1, 2021. It starts out as one of the most touching descriptions of living with a person with dementia that I have ever read. His wife, Diana, had Lewy Body Dementia and he describes, with skill and compassion, how he took care of her and learned to cope with her bizarre hallucinations, so typical of this condition.As the story unfolds, it becomes much darker and it ends with a disaster that could have been avoided.  My heart went out to him and to his late wife as he described their struggles to keep going as her dementia progressed. He became lost in her bubble of unreality and neglected his own self-care. A crisis is reached when Diana is found wandering outside and the neighbors call the police. They are both taken to the hospital. Diana is sent to an assisted living facility near their daughter and Mr. Matthias is finally discharged back home. Meanwhile, Diana catches COVID-19 at the assisted living facility and dies. Due to the pandemic, Mr. Mattias is unable to travel to be at her side.

I was deeply affected and shaken by this article and by this couple’s unnecessary suffering. They were educated, sophisticated, and obviously had some financial resources. We can’t prevent all heartbreak, but so much of their ordeal was preventable. Their story highlights the importance of planning for one’s care before the crisis. This couple and their daughter would have truly benefited from developing a relationship with an Aging Life Care Manager® when Diana’s dementia was first diagnosed or preferably when they were both still in reasonable health and able to plan for their futures. Aging Life Care Managers are trained to work with older people and their families to help them stay as independent and as safe as possible for as long as possible. We are experts in dementia and end-of-life and we support couples and individuals as they age. Many of us work with people with disabilities and with mental health issues. We ensure that clients are safe and receiving adequate care, but more importantly, work with them to enhance their quality of life.

Since this article was published, I started working with a family in a very similar situation. The couples’ son contacted me about two years ago when the dementia of the husband Peter was starting to impact their lives. At the time, his wife, Susan, did not see the necessity of meeting with me.  Recently, Susan was hospitalized for a medical condition, and Peter, who now has quite severe dementia, became distraught and aggressive. The police were called and he was hospitalized in a psychiatric unit. The son contacted me when the hospital refused to discharge Peter, as he was still agitated. I helped facilitate Peter’s transfer to the convalescent hospital where the wife was receiving care. As soon as he was back with his wife, he calmed down. I assisted in the discharge process, coordinated their return home with 24-hour care, and referred them to a company that could make needed safety accommodations in the home.  An important aspect of this process is the support and counseling I am providing to the couple’s son in dealing with his fiercely independent mother who is finding it very hard to accept strangers in her home. This is what we do!

If I had been involved sooner, we may have been able to prevent some of this mayhem. But without the help I provided in navigating these treacherous waters, Peter would have stayed at the hospital for much longer and might have declined to a point where he could no longer live safely at home. The son might have caved into Susan’s pressure and agreed to inadequate care on their discharge home – and this would have brought about another hospitalization and more chaos. Aging Life Care Managers are not miracle workers, but we can help families in tough situations.

I encourage you to have open conversations about you and your loved ones’ situation – it is never too soon. Reach out to a local Aging Life Care Professional®. We are there to help you plan your lives as you age, and also to step in when needed in a crisis.

About the author: Brenda Shorkend, MA, CMC is an independent Certified Aging Life Care Manager at Shorkend Care Management. She has extensive experience working with older people and people with disabilities and their families. She has a background in rehabilitation psychology and is a strong advocate for her clients. She is Chair of the ALCA Standards Committee.

Racial Bias in Requesting Caregivers: How to rise above this problem!

“My father will not tolerate a ____________ (fill-in-the-blank) caregiver.  Can you promise me a ____________ one?”

Having run a home care business for over 30 years I have heard this request many times over to my disbelief and sadness that an adult would not just want the best trained, most experienced, and kind caregiver for their parent.   However, these types of requests continue and most home care staff like mine explain to families that we do not discriminate and base our matches on needs, training, interest, and personalities.  Sometimes they just hang up and move to another agency with the same request.

Families usually blame the elder for the request and say they are not biased, but that their parent would not let an XYZ in their home because of a past incident with someone of that background or because of dementia.  This is where we talk about working with a professional Geriatric Care Manager, now also called an Aging Life Care Expert(r), on how that person would work closely with their family member in making the match work.

If this is something you have experienced with a parent in need of care, there are lots of approaches that can help break that color or nationality barrier.  What a professional care manager will do before bringing in a caregiver is to meet the elder or talk to them on the phone about their interests, their life story, and their current needs.

We hear that your dad was in the Navy and has a passion for sailing; he loved to play softball, had a vegetable garden, and loves country-western music.  We also hear that he needs some fitness training to build strength after a long hospital stay, lives alone, and is a little depressed.  The daughter has no idea where his bias came from, but she has heard him over the years talk despairingly about certain groups of people and that is why she made such a request.

We will take all those interests he has and find a match and tell him about the person before the introduction.  We will also let the caregiver know he might not be the most cordial based on information from the family.  A wonderful black caregiver of ours who was chosen caregiver of the year said that she just walks in the first day and says, “You really don’t want me and I know it, but give me a chance and see what we can do together to make life better.”   She says it is not just about her color but about “care” in general – no one really wants to be interdependent.

One thing I have seen in this circumstance is that we send a caregiver that loves to garden, also was in the Navy, and enjoys singing country-western.  The caregiver might also have been a physical therapy assistant and can help him meet his goals to walk without a walker.   We tell the client that this is just a trial assignment and he has to agree to keep the caregiver for two weeks and if he is unhappy after the two weeks we will look for another match.

Nine times out of ten this approach works with clients resistant to care or who had expressed a bias against some group of people to family in the past.   When this works it is most often a match made in heaven and the relationship becomes stronger and the individual with the bias, even if they have dementia, just sees a loving, caring, companion who is making their life joyful again.  It is actually very beautiful to see and witness these types of relationships.

To find a professional Aging Life Care Manager to help you, and your family, find the right care for your elder loved one, heal the racial bias, and build a good relationship of care and quality of life, go to the “Find an Aging Life Care” professional search at Simply enter your zip code and you will receive results of Aging Life Care Professionals you can then interview to find someone who can assist with this challenge.  Aging Life Care Experts have backgrounds in counseling, gerontology, mental health, nursing, occupational therapy, physical therapy, psychology, or social work; with a specialized focus on issues related to aging and elder care.  Most are also certified as Care managers besides their educational degree and/or license.

About the Author:  Linda Fodrini-Johnson, MA, MFT, CMC who is a consultant, counselor and coach for family caregivers.  Linda is in the San Francisco Bay Area and can be reached at or  Linda has been a care manager since 1984 and is a Past President of both the National Association of Geriatric Care Managers now called the Aging Life Care Association and of the Western Chapter.  She owned a full-service care management, home care, and family education business for 30 years and sold it in 2019.  She has received numerous awards and those can be seen on her website.

Dad Had a Stroke… Now What?

Mr. Smith is 79 years old. A week ago, he had a stroke while home alone. Thankfully, his youngest son arrived minutes later and got Mr. Smith admitted to the hospital.

After a week, the hospital discharge planner contacted Mr. Smith’s oldest son, Paul, who is listed as his healthcare POA (Power of Attorney). The discharge planner emailed Paul a list of rehabilitation facilities. He was to select the top three places in order of preference for his father’s rehabilitation. Paul would need to make his selections by the end of the day, as the plan was to move Mr. Smith the following day. Naturally, Paul was overwhelmed; he wanted to pick the best place for his dad but had no idea what any of these places are like. One place is listed as a nursing home; another as  a health care campus. What are the differences? A nursing home is the last place Paul wanted his dad to be.   

First, it is helpful to understand the terminology. It can be very confusing, as multiple words are used interchangeably to describe similar services and places:  Skilled Rehab, Skilled Nursing Facility, Long-Term Care Facility Continuum Care Campus (CCC), Health Care Campus. Generally, all these places offer skilled rehabilitation services in addition to long-term care. Further, some offer Independent Living, Assisted Living and Memory Care. 

Skilled Care and rehabilitation typically refer to inpatient, medically necessary services offered by licensed nurses, physical, occupational and/or speech therapists. Skilled services or rehabilitation are temporary, time sensitive and expensive. Usually, rehabilitation is partially covered by Medicare, Medicaid and private/supplemental insurance.

When patients arrive at a facility for rehabilitation, they are assessed by the skilled services team, often referred to as the therapy department (PT, OT, speech and nursing). The therapy or skilled team determines the person’s needs and goals. A plan is developed to meet the intended goals within a determined period. An individual will either progress, stay the same or decline. 

Let’s suppose that Mr. Smith has made little progress after three months of rehabilitation services at a Skilled Nursing Facility. He remains paralyzed on his left side and requires assistance to do most things… getting dressed, hygiene, cutting food, getting in and out of bed. All these activities are referred to as Activities of Daily Living (ADLs).  

At this time, Mr. Smith will no longer qualify for skilled services or rehabilitation. He still is not able to go safely home, as his needs are too great. He will now require what is called custodial care. Custodial care means an individual needs assistance with ADLs but does not require or qualify for skilled care or services. A caregiver/aid can provide custodial care to meet all his ADLs, and his ongoing medications and medical needs will now be considered part of his custodial care needs. Mr. Smith has completed his rehabilitation and is now moving into a long-term care situation.  

 Long-term care refers to a facility providing custodial care. Individuals for many different reasons are not able to receive custodial care safely in their homes, therefore require a long-term care facility (often called a nursing home). Long-term care facilities offer services which include Skilled Rehabilitation. Mr. Smith started out in short-term skilled rehab. After a period, he no longer showed improvement, despite receiving skilled services (physical, occupational and speech therapies). He then required custodial care. His family would not be able to safely provide the care he continued to need 24/7. 

Mr. Smith then “moved” to Long-Term Care within the same facility. Sometimes a facility will divide their building into sections with skilled services and rehabilitation in one area and long-term care in another. Others may provide skilled care and when the person requires ongoing custodial care, those services continue in the same room. What changes between skilled rehabilitation and long-term care are the type of services and costs? 

The first step in making informed choices about where to go for rehabilitation is to understand the differences in services offered at a facility. Other considerations include: What happens if a person is not able to return home after receiving skilled therapy services? Are long-term care services or custodial care offered and what are the costs? We will tackle these questions in next month’s blog entry, when Mr. Smith cannot return home and settles into Long-Term Care.

About the Author:  Jennifer Beach, LSW, MA, C-SWCM established Advocate for Elders in Rocky River in 2010. Jennifer has 25 years of experience in working with and advocating for older adults and their families. Jennifer is a licensed, insured Social Worker and an Advanced Aging Life Care® Professional. She has served as the Midwest Chapter President of the Aging Life Care Association and additionally served 7 years on the Board of Directors. In 2018, Jennifer was honored as the recipient of the ALCA Midwest Chapter Outstanding Member of the Year Award. Learn more at

Jennifer is also a monthly contributor and author of Caregiver Corner for Northeast Ohio Boomer and Beyond blog and magazine.