Geriatric Assessment

What is geriatric assessment?

A geriatric assessment is a comprehensive evaluation designed to optimize an older person's ability to enjoy good health, improve their overall quality of life, reduce the need for hospitalization and/or institutionalization, and enable them to live independently for as long as possible.

An assessment consists of the following steps:

An examination of the older person's current status in terms of:
- Their physical, mental, and psycho-social health
- Their ability to function well and to independently perform the basic activities of daily living such as dressing, bathing meal preparation, medication management, etc.
- Their living arrangements, their social network, and their access to support services.
An identification of current problems or anticipated future problems in any of these areas.
The development of a comprehensive "Care Plan" which addresses all problems identified, suggests specific interventions or actions required, and makes specific recommendations regarding resources needed to provide the necessary support services.
The management of a successful linkage between these resources and the older person and that person's family so that provision of the necessary services is assured.
An ongoing monitoring of the extent to which this linkage has, or has not, addressed the problems identified, and the modification of the Care Plan as needed.

When is a geriatric assessment needed?

A request for a geriatric assessment would be appropriate when there are persistent or intermittent symptoms such as:

memory loss,
confusion,
or other signs of possible dementia.

Often, what looks like Alzheimer's or dementia can be the result of medication interactions or other medical or psychiatric problems. Because of the thoroughness of the geriatric assessment, it is one of the best ways to determine what the actual problem and cause is or is not.

Who performs a geriatric assessment?

A geriatric assessment can be done in many different settings such as:

a hospital,
a nursing home,
an outpatient clinic,
a physician's office or
the patient's home.

It is an assessment that is comprehensive in scope, involving a complete review of the current status of the older person in all of its complex dimensions, and because it is so comprehensive, it can only be successfully conducted by a multi-disciplinary team of experts. This team might include:

physicians,
ancillary personnel,
social workers,
physical and/or occupational therapists,
dieticians, psychologists,
pharmacists, and
geriatric nurse practitioners.

You can request a referral for a geriatric assessment from a primary care physician. Also, check with any large hospital or university to see whether they have a geriatric assessment unit.

Geriatric care managers

A geriatric care manager (GCM) is a professional with specialized knowledge and expertise in senior care issues. Ideally, a GCM holds an advanced degree in gerontology, social work, psychology, nursing, or a related health and human services field. Sometimes called case managers, elder care managers, service coordinators or care coordinators, GCMs are individuals who evaluate your situation, identify solutions, and work with you to design a plan for maximizing your elder's independence and well being.

Geriatric care management usually involves an in-depth assessment, developing a care plan, arranging for services, and following up or monitoring care. While you aren't obligated to implement any part of the suggested care plan, geriatric care managers often suggest potential alternatives you might not have considered, due to their experience and familiarity with community resources. They can also make sure your loved one receives the best possible care and any benefits to which they are entitled.

Help provided by geriatric care managers

Geriatric care managers facilitate the care selection process for family members who live at a distance from their elderly relatives, as well as for those who live nearby but do not know how to tap into the appropriate local services.

You can hire a care manager for a single, specific task, such as helping you find a daily caregiver, or to oversee the entire caregiving process. Geriatric care managers can help families or seniors who are:

new to elder care or uncomfortable with elder care decision-making;
having difficulty with any aspect of elder care;
faced with a sudden decision or major change, such as a health crisis or a change of residence;
dealing with a complex situation such as a psychiatric, cognitive, health, legal, or social issue.

In addition to helping seniors and their families directly, geriatric care managers can act as your informed connection with a range of other professionals who are part of your elder care network, including any of the following service providers:

Attorneys or trust officers. A care manager can serve as both elder advocate and intermediary with financial and legal advisors. The GCM is often a good source of referrals if a family needs services from these professionals.
Physicians. The GCM is an ideal liaison between doctors and other health professionals, and the elder patient and family members.
Social workers. It is useful for hospital and nursing home social workers and discharge planners to know that their senior patient will have someone to coordinate their care and assist them on a long-term basis.
Home care companies. The GCM will know local agencies and be able to explain options, costs, and oversight of home care workers. The care manager can also assist in dealing with patients' social issues, help link to other community resources, and suggest possible placement options.
Residential facilities. The GCM can help identify types of care facilities and assist you in selecting an appropriate one for your situation. The GCM may also be able to streamline the transition into or out of a senior community, for both the elderly resident, family members and staff.

Finding a geriatric care manager

In addition to the many References and resources available, a good place to start your search for a geriatric care manager is with your family physician. Other sources for referrals include:

your local Area Agency on Aging (call 1-800-677-1116 for the AAA in your area)
local hospitals and health maintenance organizations
senior or family service organizations
senior centers
religious affiliations including churches and synagogues
Yellow Page listings for Senior Citizens' Services, Care Management, Home Care, Home Health Services and similar subject areas
Medicaid offices
private care management companies

While geriatric care managers are frequently licensed by the state within their respective fields of expertise, there are no state or national regulations for professional care managers per se. For this reason, anyone can use the title case or care manager. Membership in a professional organization and/or certification in care management are good indicators of appropriate background. The National Association of Professional Geriatric Care Managers recognizes the following designations for a "Certified Care Manager": CMC, CCM, C-ASWCM and C-SWCM. Each of these requires testing and continuing education.

When interviewing potential geriatric care managers, the NAPGCM suggests asking:

Are you a member of a professional care or case management association?
Are you certified as a care manager? Do you hold other professional licenses or certifications?
How long have you been providing care management services?
Are you available for emergencies?
Does your company also provide home care services?
How will you communicate information to me?
Can you provide me with references from past clients?

The NAPGCM website also provides a directory of geriatric care managers located throughout the nation.

Costs of geriatric care management

Private geriatric care managers' fees can range from $50 - $200 per hour, depending on where you live and what services you need. You may also be charged an intake fee of $50 - $300 for the initial visit, which is when the in-depth assessment takes place.

While this may seem costly, bear in mind that a GCM will likely save you money in the long run, by assessing your precise needs and helping you choose the specific services that will best serve you now. In addition, most people require geriatric care management only intermittently once support services are in place. Following the initial assessment, your GCM will help your family carefully estimate the ongoing cost of service delivery.

Although geriatric care management fees are not covered by Medicare or Medicaid, some employers, insurance companies, health plans and financial service providers are beginning to subsidize or cover these services for their members and clients. Long-term care insurance is most likely to include care management.

If you are unable to afford a private care manager, there are other options. Low-cost or no-cost geriatric care management is often available through a community agency, senior services organization or other non-profit agencies; your local Area Agency on Aging (call 1-800-677-1116 for the AAA in your area) will be able to refer you to a city, county or agency source.

In addition, most states offer a Medicaid waiver program that provides geriatric care management and in-home services for individuals 65 and older, who are eligible for both nursing home placement and Medicaid. In California, this program is available through The Multi-Purpose Senior Services Program (MSSP) throughout the state.

References and resources about geriatric assessment

Additional online resource for geriatric care management

How to Find Help – Web locator for each state's Area Agency on Aging, which should be able to provide care manager referrals. (Administration on Aging)

Consult a Geriatric Care Manager If... – Signs of caregiving challenges that may indicate a need for a professional care manager. (ElderCARE Network)

Geriatric Care Management (Assessment) – Describes how a geriatric care assessment works. (SeniorMag.com)

Senior Services Assessment – A geriatric care assessment questionnaire for family members to take, to determine your areas of need and how a care manager can best help you. (Advanced Senior Solutions, Inc.)