Making Life Better for Older Adults
As we age, there comes a time when we may need assistance
making it safely through the day. Perhaps you have a nagging
suspicion that an older adult (a spouse, your parents…)
needs that help right now. Of course, you want to avoid
being forced to confront a crisis where an older adult has
deteriorated, physically and/or mentally, to the point where
they are a danger to themselves or others. What can you do
to plan ahead?
The first step is to be aware of warning signs rather than
waiting for a crisis to occur. The next, and often the most
difficult, step is taking action and getting appropriate help.
Early signs that an older adult might need help
The National Association of Professional Geriatric Care
Managers has compiled a list of some of the early warning
signs that an older adult might need help, including:
- Personal hygiene Is he shaving? Does she shower less
frequently, wear dirty clothes, or have neglected teeth? Are
there any injuries that you can see? Is there a urine smell?
- Forgetfulness Are there stacks of unopened mail or
newspapers, unpaid bills, unfilled prescriptions or missed
- Interaction/Behavior Does she constantly repeat questions?
Can he carry on an extended conversation? Does he refuse
any suggestion or does he agree with every suggestion?
Does he retain what was said? Are there any apparent mood
swings? Is he unusually loud or quiet? Is she angry? Does she
make phone calls at all hours of the night?
- Relationships Do friends call? Do friends or neighbors
express concerns? Has she quit socializing or participating
in group activities?
- Mobility/Medication Can she get around? Can he
take medications without supervision? What are the
medications? Who goes to the doctor with him? Is she
going to the doctor at all or does she refuse to go?
- Refrigerator/Eating Habits Does the refrigerator contain
adequate food? Is there any spoiled food? Have his eating
habits changed? Has she lost weight? Has she missed meals
or is she generally not hungry?
- Shopping Does he have any problems making change or
- Buying things he doesn’t need Is there evidence of excessive
shopping, ordering. Is the mail full of charitable letters, a sign
that he is giving out money to anyone who asks?
- House Does it look maintained or is it in disrepair? Is
dust and/or trash accumulating in what was once an
- Driving Can he drive safely? Is her reaction time adequate
on the road? Is there any evidence of automobile accidents?
Taking action at this stage to address problems can forestall a
full blown crisis.
Obstacles to securing help
There are significant obstacles to securing help for older adults,
however. Just because you have observed warning signs
doesn’t mean that others will agree with your observations.
One of the biggest obstacles to securing help is denial that a
problem even exists. Children are reluctant to acknowledge
that their parents, the ones who have been the traditional
family caregivers, now need care themselves. A spouse,
even the person needing help, is likely to deny the need for
additional assistance because of a combination of fear and
anger about their declining health. Moreover, how do you
arrange and monitor care for someone if they don’t live in
close proximity to you? Move them into your home?
A Geriatric Care Manager (GCM) is an excellent resource
to help you avoid an elder care crisis or, in the unfortunate
event one occurs, to help you deal with the crisis and, as
the name implies, manage the care. A GCM can evaluate an
older adult’s current living situation, their needs, including
physical and mental health, and their resources, including
family, community and financial resources and create a
comprehensive care plan. As a trained, experienced and
objective third-party, the GCM can help overcome the many
psychological and family dynamics obstacles to care.
Once the care plan has been recommended, it is up to the
older adult and the older adult’s family to determine next
steps. GCMs can coordinate implementation of the plan, from
the simple (having grab bars installed in the bathrooms and
other safety measures) to the complex (screening, arranging
and monitoring in-home help, identifying institutional care
facilities...) Once services have been established, GCMs can
monitor and coordinate them, or leave that up to the family.
GCMs can be used on a one-time basis, or they can serve in an
on-going role, depending on the situation. At the very least,
plan to bring in the GCM periodically to reevaluate the older
adult’s ongoing needs and revise the care plan as necessary, as
continued deterioration is likely.
Unless the older adult suffers from a severe cognitive
disability, he should play a significant part in the evaluation
and follow-on care. Remember, the GCM works for the older
adult and if the older adult does not accept the process and
recommendations, nothing is going to change.
Aspiriant maintains a list of helpful resources, including
Geriatric Care Managers. Please contact your client service
team for a referral or you can go to the website for the
National Association of Professional Geriatric Care Manager,
In selecting a GCM, some important things to look for include:
- Length of time as a Geriatric Care Manager
- Degree in a field related to nursing, counseling, mental
health, social work, psychology or gerontology
- Previous occupation as an RN, social worker or geriatric
- Independent from any service providers (no conflict
- Experience using community based resources
- Available for emergencies
- Member of the National Association of Professional
Geriatric Care Managers (GCM)
GCMs bill by the hour for their services and their fees can
range from $150 - $300 per hour depending on location and
needs. The initial evaluation could take two to three hours
and a written care plan a bit more, so the total initial cost is
likely to be about $1,000. This is a very small price for our
clients to pay for an objective, competent plan for dealing
with such a critical issue, and for the access to an ongoing
resource for the older adult and his or her family.
Even if estate tax reduction planning is not currently urgent,
families of any wealth should review the effects of the new
laws on their existing revocable living trusts. The increase
in the exemption to $5,000,000 raises some of the same
funding concerns raised in 2009 when the exemption was
$3,500,000. Plus, the new portability rules provide additional
Brett Gookin, CFP®
Director - Wealth Management, Principal