Care Managers and the Importance of Objectivity

by Lisa Bayer, J.D., CCM

Heidi and I founded LMR Elder Care, LLC with the mission that “care management” would remain our core focus. For more than 15 years we have held true to that mission. 

Every new client of LMR Elder Care receives a disclaimer when they onboard with us. This disclaimer is as much for our clients’ protection as it is for ours. We want our clients to know that, with the help of their families, friends and trusted advisors, we will hold their hands and guide them to make informed elder care plans and decisions. But we also want our clients to know that we will always strive toward “the best interest of the client” and that we will not substitute our judgment for that of our clients or of their authorized agents. We believe in a collaborative approach to elder care and we encourage our clients to lean on all of their trusted professional and paraprofessional advisors.

One core pillar of our business is that we do not accept referral fees. That means that when we include an organization or service in our directory or recommend a provider to a client, it is because we believe that provider will provide a necessary service.  At the heart of what we do is protecting our clients. While we do our best to promote long-term care planning and healthy aging, the reality is that most clients hire us when there is already an actual (or near) crisis. It is important to us that families are not taken advantage of when they are at their most vulnerable. 

The elder care space has evolved a lot over the last 15 years since we started our practice. In this regard some home health care agencies have started offering fee-for service private pay care management services. In this instance, a client is paying the agency for care management and the client is also paying for home health care. This arrangement creates the potential of a “dual relationship” for the care manager as he or she is duty bound to the client and to the employer who is both providing the services and who is paying the care manager’s salary. With a dual relationship the boundaries are blurred and objectivity can become diluted.

Dual relationships can also rise to a true conflict of interest between the care manager and his or her clients. For example, consider a company that provides both fee-for-service private pay care management AND home health care services.  Would the geriatric care manager even be allowed by his/her employer to recommend a more appropriate agency or caregiver? What happens if the home health aide is not performing his or her job adequately or the client simply does not like the caregiver? Simply put, without the checks and balances of independent providers comes the potential for exploitation and abuse. We have seen and heard everything over the years; home health aides offering sexual favors for extra cash, dementia clients abandoned overnight when they were supposed to be under watch, and theft of family valuables. Unfortunately, anything can happen at any time, but the opportunity to correct and protect is diminished when “Peter is Paul” and “Paul is Peter”.

When working with older adults and persons living with disabling conditions, it is important to  insist on transparency, ask necessary questions, and perform reasonable due diligence on all service providers. At LMR Elder Care our number one priority is what is in the best interest of our clients. We advocate for you and only for you.

I’m Sorry, But What Did You Say???

By: Lisa Bayer, J.D., CCM

Recently, I met with Dr. Rhee Rosenman-Nesson, Au.D., CCC-A to learn more about the importance of good hearing health for everyone, but particularly older adults who may be showing signs of dementia and other age-related medical and psychological conditions. Dr. Rosenman-Nesson is the owner and founder of Hearing Doctors of New Jersey with an office in Livingston, New Jersey.

According to Dr. Rosenman-Nesson, poor hearing can increase the risk of:

·       Falls

·       Cognitive Impairment (such as Alzheimer’s disease and other dementias)

·       Social Isolation

·       Depression

Poor hearing has been associated with an increased risk of falling. A person with low hearing may miss auditory cues (such as a pet underfoot). In addition, it takes a lot of mental energy, particularly for a person experiencing hearing loss who is trying to compensate using their other senses, thereby leaving less bandwith for concentration on balance and posture.

According to Dr. Rosenman-Nesson, hearing loss can lead to an increased risk or earlier onset of Alzheimer’s disease and other dementias. She explained that when a person is deficient in one sense (hearing) they use their other senses such as watching a person’s lips while they speak, to interpret and compensate. If the hearing part of the brain remains unused, it begins to atrophy. “Use it or lose,” explains Dr. Rosenman-Nesson.

Hearing loss can also lead to social isolation and depression. Dr. Rosenman-Nesson explained that when a person is constantly asking people to repeat what they are saying they tend to, at some point, give up and sit quietly at the dinner table or alone at a party. Eventually, they may decline social invitations and avoid activities altogether leading to social isolation and consequent depression. 

Dr. Rosenman-Nesson explained that there are many new and innovative solutions for helping her patients improve hearing and that it is not “one size fits all.” For example, for active adults who do not want their hearing aid to show (if they cannot cover it by growing their hair longer) there are small, clear-colored devices that are barely noticeable. What I was most interested in are the new products that make it easier for caregivers to assist my clients with their hearing aids. For example, they make larger, more manageable devices that are harder to lose and that can be clipped to a person’s clothing if they inadvertently take them out. They also make devices that can be tracked by GPS with a smartphone.

LMR Elder Care and Hearing Doctors of New Jersey’s team approach helps to keep our clients and patients connected and living healthy, productive lives.

To learn more about Hearing Doctors of New Jersey please visit https://hearingdoctorsofnj.com/ or call Dr. Rosenman-Nesson’s office at 973.577.4100.  

The Alphabet Soup of Medicare

by Lisa Bayer, J.D., CCM

It is open enrollment time for Medicare supplemental plans and anyone who has tried to navigate the process is faced with a myriad of choices and terminology. There’s Medicare A, B, C and D. Part A is your inpatient insurance, Part B is your outpatient insurance and Part D is your prescription drug coverage. Part C is sort of a combination of A, B and D and these plans are known as “Medicare Advantage” plans.

If you do go the traditional Medicare route and you are considering a Medigap policy (a supplemental plan that helps to fill in Medicare coverage gaps) you could be looking at another mouthful of letters! For the heck of it I put in our zip code and the Medigap plans available in LMR Elder Care’s area, 07039, include A, B, C, D, F, G, K, L, M and N. And if that is not enough would I want a high deductible or “regular” Medicap plan? So how does one decide? To start, make a list of your medications and medical providers. Next, enter your information at www.Medicare.gov, access a state SHIP counselor (a volunteer trained to provide objective Medicare benefit counseling - https://www.state.nj.us/humanservices/doas/services/ship/ - in New Jersey), or get in touch with a private insurance representative that can help you select a plan at no fee to the Medicare beneficiary.

It is important to note that if you are not subject to a special enrollment period this is the only time of year that you will have the opportunity to review, and possibly decide to change, your supplemental insurance and prescription drug coverage. As Eric Cohen, Managing Director of Benefit Quest, Inc points out, “It’s important to sign up at the right time if you want to make any changes or adjustments to your health coverage or your prescription drugs.” For 2021 this review period takes place from October 15 through December 7, 2020.