Private Care Managers Hold Promise for Future Case Management

July 22nd, 2024

By Melinda Young

By 2030, all baby boomers will be ages 65 or older, a demographic shift suggesting a huge need for healthcare systems to prepare for an influx of elderly patients.

When the first baby boomers were born in the 1940s, the United States was evolving from a multigenerational home culture in urban and rural areas to a nuclear family suburban home culture. This shift over the next six decades has resulted in smaller share of Americans living in multigenerational family households. The share was 24.7% in 1940, falling to 12.1% in 1980, and rising a little in the decades since then, according to the Pew Research Center.¹

As a result, more older people in the United States live in nursing homes or assisted living facilities. Some estimates say there will be a 50% increase in the number of seniors moving into nursing homes by 2030.²

Because of these demographic changes, more older Americans will need care coordination and case management in the years ahead. Their adult children may live hundreds or thousands of miles away from them, unable to provide in-person caregiving or care coordination assistance. For those families with financial resources, one solution to dealing with their elderly parent's health crises could be hiring a private care manager.

“The family is completely overwhelmed and needs help,” says Jean Ross, BSN, MHA, chief executive officer and cofounder of Primary Record in Fishers, IN. Ross spoke on the topic of health information laws and care transitions at the 2024 Case Management Society of America Conference, held June 4-7, 2024, in Providence, RI.

Although these same patients also may receive case management services from health systems or managed care plans, those episodes are short and not all-encompassing.

“Those care managers are often given large caseloads or only have the tool of a phone to do their best care management,” Ross says.

Private care managers take more time and can dig deeper into finding solutions. They’re hired by the family to solve a problem for the elderly parent.

“Care managers look at how to solve a problem and help the patient learn to manage their own care more effectively,” Ross explains.

Private care managers can be helpful to health system case managers, as well. This is true whether the patients are residents of the same county or when they are from another county or state.

“I’ve worked with some private care managers who were already in place when the patient arrived at our doorstep,” says Sue Brown, MSN, RN, CMGT-BC, CRRN, CCM, CMAC, a complex case manager at Health First in Rockledge, FL.

Their patients often are elderly, and the private care manager will plan their medical travel, make arrangements, and — sometimes — even travel with them, Brown adds.

“Private care managers connect with hospital case management,” she says. “If there is not a private care manager, the hospital discharge planner should be able to coordinate the discharge plan.”

Brown sometimes has spoken with private case managers about how travel insurance works and how to prepare their clients for travel in the event of a medical crisis.

“In South Florida, there are a lot of care managers,” Brown says. “They’re with agencies or are contractual. Usually, a care manager will oversee the patient’s care, depending on what the person needs. It’s all individualized.”

Private care managers often love their work when they begin to work with clients. Soon, they realize they need a system as their client list expands, Ross notes.

“They need a system to manage the business and enter all data,” she says.

Private care managers also need skills to deal with family conflict and communication across the miles.

“Care managers start off trying to do everything, and some come up with a service package,” Ross says. “Some package themselves as someone who goes to medical appointments with the parent and is an advocate for the parent.”

They make sure patients have the best recovery from surgery or a hospital stay. They may also contract with dementia group homes, overseeing the work of the caregiving agency and in-home workers.

They can contract for a flat fee to monitor a particular person's health in the dementia home, Ross says. Private care managers need to have registered nursing (RN) degree to provide the full spectrum of care needed in care management.

“They make sure they have transportation to care appointments and medication management. They are like an air traffic controller,” she says. "They're trying to manage the person’s care and spends an inordinate amount of time on communication — personalizing messages to the family members.”

The healthcare system is overly complicated and bureaucratic, making it challenging even for well-educated patients and caregivers to navigate. That's why a personal care manager could be a good fit for many people and a growing field as the baby boomers age in places far from their children and grandchildren.

Case managers love working with patients and families and have the necessary skill sets to get answers and appointments with large health systems, Ross says.

“Half of the problem is not knowing the right question to ask and the right referral to choose.” she adds.

References

1. Pew Research Center. The Return of the Multi-Generational Family Household. March 18, 2010. https://www.pewresearch.org/social-trends/2010/03/18/the-return-of-the-multi-generational-family-household/
2. Hallstrom L. Total and Percentage of Elderly in Nursing Homes: 2023 Data. aPlaceforMom.com Sept. 13, 2023. https://www.aplaceformom.com/senior-living-data/articles/elderly-nursing-home-population