What Is a Geriatric Care Manager?
A geriatric care manager (GCM), also known as an Aging Life Care Professional, is a qualified expert who helps families navigate the complexities of long-term care for older adults. These professionals act as a single point of contact, helping coordinate various aspects of a senior's life, including:
- Comprehensive Assessments: Evaluating a senior's health, living situation, and psychosocial needs to identify appropriate care options.
- Care Planning: Developing personalized care plans that outline necessary services, goals, and support strategies.
- Service Coordination: Arranging and overseeing a variety of services, including medical appointments, in-home care, and rehabilitation.
- Crisis Intervention: Providing timely assistance during emergencies and creating action plans for urgent health situations.
- Advocacy and Support: Assisting families with accessing community resources, providing emotional support, and advocating on behalf of the senior.
Why Medicare Doesn't Cover Geriatric Care Managers
Medicare is a federal health insurance program primarily designed to cover medically necessary services for hospital stays and doctor visits. It is not structured to cover long-term care or the broader, non-medical planning services a geriatric care manager provides.
The Distinction Between Medical and Custodial Care
- Medical Care: The type of care Medicare covers, which is ordered by a doctor to treat a specific illness or injury. For example, a home health aide providing skilled nursing care like wound dressing falls under this category.
- Custodial Care: This refers to non-skilled, daily living assistance, such as bathing, dressing, and meal preparation, and the overall management and coordination of long-term care needs. This is the primary function of a GCM and is not covered by Medicare.
Because a GCM's work focuses on managing and coordinating care rather than providing direct, medically necessary treatment, it falls outside of what Medicare is authorized to pay for.
Medicare Programs That Offer Limited Care Coordination
While Medicare does not cover GCMs, it does offer some programs that provide care coordination under specific conditions. It's important to understand the differences.
Chronic Care Management (CCM)
- What it is: A Medicare Part B program for beneficiaries with two or more serious chronic conditions, like arthritis or diabetes.
- What it includes: Development of a comprehensive care plan, 24/7 access to urgent care needs, coordination among providers, and medication reviews.
- Key Difference: Unlike a GCM's comprehensive role, CCM is a physician-led service focused specifically on the coordination of care for chronic medical conditions.
Home Health Services
- What it is: Medicare Part A and B cover certain home health services for individuals who are homebound and require intermittent skilled nursing care or therapy.
- What it includes: Medically necessary skilled nursing, physical therapy, occupational therapy, and medical social services.
- Key Difference: This benefit is for specific, medical-based services and does not cover long-term, non-medical oversight and planning that a GCM provides.
How to Pay for a Geriatric Care Manager
Since Medicare doesn't cover GCMs, families must explore alternative payment options. The cost of hiring a GCM can vary, with hourly rates typically ranging from $90 to $250.
Private Pay
- Details: Most families pay for GCM services using personal funds, such as savings, pension income, or proceeds from investments.
- Considerations: It is the most common method, offering flexibility and direct control over services.
Long-Term Care Insurance
- Details: Some long-term care (LTC) insurance policies may provide coverage for GCM services, or at least for the initial assessment.
- Action: Check your policy details carefully, as coverage varies widely. Many policies only cover a portion of the cost.
Medicaid and Waivers
- Details: Medicaid, a joint federal and state program for low-income individuals, may cover some community-based care coordination through Home and Community-Based Services (HCBS) waivers.
- Considerations: Eligibility is based on financial need, and coverage for specific services varies by state. It is not the same as hiring a private GCM.
Veterans Benefits
- Details: The Department of Veterans Affairs (VA) provides some coverage for long-term care services for eligible veterans.
- Action: Contact your local VA office to inquire about eligibility and available programs that may help with care coordination.
Employee Assistance Programs (EAPs)
- Details: Some employers offer EAPs that provide resources and services to help employees with elder care challenges.
- Action: Inquire with your or your family member's employer about available benefits that might help defray GCM costs.
Comparison Table: Geriatric Care Manager vs. Medicare Coordinated Care
| Feature | Geriatric Care Manager (GCM) | Medicare (e.g., CCM, Home Health) |
|---|---|---|
| Service Type | Comprehensive, non-medical planning and coordination | Medically necessary services and chronic condition management |
| Coverage Status | Not covered by Original Medicare; primarily private pay | Covered under specific parts (A, B) if criteria are met |
| Payment Method | Out-of-pocket, long-term care insurance, Medicaid waivers | Federal program, often with copays or deductibles |
| Focus | Long-term planning, social needs, housing, and financial oversight | Short-term, acute medical needs, or management of specific chronic diseases |
Finding a Qualified Geriatric Care Manager
When seeking a GCM, it's essential to find a qualified professional who meets your family's needs. The Aging Life Care Association provides a directory of certified professionals.
When you've identified potential candidates, consider asking these crucial questions:
- What are your professional qualifications and certifications?
- What is your experience with conditions similar to my loved one's?
- What is your fee structure for initial assessments and ongoing services?
- How do you handle emergency situations outside of regular business hours?
- Can you provide professional references?
Conclusion
While the answer to whether geriatric care managers are covered by Medicare is generally no, this does not mean that coordinated care is unavailable. Understanding the clear distinction between the roles and services helps families explore the right avenues for support.
For many, hiring a GCM is a valuable investment in a senior's well-being and a family's peace of mind, despite the out-of-pocket costs. By leveraging alternative funding sources, such as long-term care insurance or Medicaid waivers where applicable, families can ensure their loved ones receive the comprehensive, personalized care they need to thrive.
