The Life Care Management Handbook

By Jennifer Crowley and Shanna Huber

Helping future and current Life Care Managers start, grow, and maintain a successful Life Care Management practice.

A comprehensive handbook for anyone currently working or aspiring to work in the field Life Care Management. Packed with information including common challenges and practical solutions, resources, and helpfu

• Language: English
• Publisher: Author Academy Elite
• Release date: Mar 1, 2021
• ISBN: 9798218401733

Jennifer Crowley

Jennifer is owner and founder of Eagleview West, a leading Life Care Management & consulting company serving Northwest Montana and surrounding areas. She is author of 7 Steps to Long Term Care Planning, a guidebook to help individuals, families, and professionals design a roadmap for aging. Jennifer completed her Bachelor of Science degree in Nursing from The Ohio State University in 1993. Jennifer resides in Kalispell and enjoys time with fam-ily, exercising, travel, and doing most things outdoors. Jennifer spent many years of her career focused on critical care nursing. She also served as a U.S. Peace Corps volunteer in Papua New Guinea. Later, she relocated to Montana after completing a short-term assignment as a travel nurse. After many years working in the acute care setting, and while working full time as a critical care nurse, she founded her Life Care Management practice, Eagleview West. Having a vision to move her career outside the acute setting for a more flexible option, reduced stress and good potential for increased earnings while eliminating "shift work." Jennifer's experience of starting a business unique to Montana included many struggles, mistakes and opportunities for learning how to overcome some of the unique and common challenges for professionals in private practice. Jennifer found there was a lack of a simple resource which focused on planning for the many years spent in older adulthood. Jennifer published a book, "7 Steps to Long Term Care Planning" in 2017, a guidebook for individuals, families and professionals to utilize for designing a road map for aging. She also holds multiple credentials, including Certified Dementia Trainer and Practitioner (CADDCT), Certified Life Care Planner (CLCP), and Certified Care Manager (CMC). Her years of experience helps provide exceptional services to a diverse clientele while being responsive to the needs of all involved parties. Being a master of collaboration, along with a caring demeanor, compliments the business-minded approach Jennifer uses. Jennifer serves in many leadership roles and volunteers locally and at the state level. Jennifer served two terms as a public-school trustee for Flathead County, participated as a stakeholder expert to develop the "State plan for Alzheimer's and Related Dementia," and was more recently appointed by the Montana Supreme Court to serve as a member of the Working Interdisciplinary Networks of Guardianship Stakeholders (WINGS). Over many years as a volunteer for the Alzheimer's Association, Jennifer has helped raise much needed funding and improved aware-ness, helping connect others to valuable resources, education and support. Passionate about building a positive business culture with ever-present opportu-nities for personal enrichment and professional development, Jennifer hopes to encourage others to pursue leadership positions, stay connected to others in the industry, and volunteer regularly. Jennifer hopes to help other professionals have a better understanding of the field of Life Care Management, have a good foundation for being able to help others while capitalizing on their own experience and education, and understand the key areas of practice for Life Care Managers.

Book preview

SECTION 1

THE FIELD OF LIFE CARE MANAGEMENT

Chapter 1: What is Life Care Management?

Chapter 2: Demand and Opportunities for the Life Care Manager

Chapter 3: The Role of the Life Care Manager

CHAPTER 1

WHAT IS LIFE CARE MANAGEMENT?

With Guest Contributor C. Taney Hamill

The biggest adventure you can ever take is to live the life of your dreams.

~Oprah Winfrey

Life Care Management (LCM) is defined as a field of practice, utilizing educated and experienced professionals specializing in assessment and care planning, connecting to vital services and resources, coordinating care through collaboration, managing care and providing professional oversight and helping resolve issues to achieve optimal health regardless of age or ability.

A Life Care Manager (LCM) is typically a professional in the health and human services field or other disciplines. The LCM is often a college graduate with a bachelor’s degree. LCMs may include disciplines of social work, social services, nursing, rehabilitation, or community, and public health.

Life Care Managers may align their relationship with a professional organization for accreditation, acknowledgment, and continued professional development. See below for a review of some of those organizations.

The LCM works closely with family and friends who support the individual, commonly called their client. When an individual is struggling, the family, friends, neighbors, and or support system are also struggling. The request for assistance often comes from the support network and not the individual with the health condition and disability, prompting the need for help.

Professional LCMs often use a team approach, relying upon other professionals’ specialized knowledge and expertise within their network. When professionals effectively understand each other’s roles, strengths, and weaknesses, they can work together to provide person-client-centered care.

Many LCMs belong to the professional organization, Aging Life Care Association® (ALCA)®. LCMs affiliated with this organization identify themselves as an Aging Life Care Manager®. An Aging Life Care Manager® is a registered trademark with the ALCA®.

Care Manager Certification (CMC) through the National Academy of Certified Care Managers (NACCM)

At the time of this book, an LCM does not need to be certified to practice. The only certification available to care managers is the Care Manager Certification through the National Academy of Certified Care Managers (NACCM). A care manager may learn more about this certification and qualifications at https://ptcny.com/pdf/NACCM.pdf. Although the professional organizations that include the Aging Life Care Association® and the National Academy of Certified Care Managers are separate entities, they both recognize similar core competencies:

• Aging and Disability Issues/Chronic Disease Management

• Benefits and Financing Options

• Housing

• Family Support and Conflict Resolution

• Community Services and Resources

• Special Needs and Advocacy

• Legal and Ethical Concerns

• Crisis Management

Figure 1.1 8 Knowledge areas of the Aging Life Care Manager®. Aging Life Care Association® (ALCA)®, 2020. What You Need to Know. https://www.aginglifecare.org/ALCA/About_Aging_Life_Care/ALCA/About_Aging_Life_Care.

Copyright 2020 by the Aging Life Care Association®. Reprinted with permission.

History of the Aging Life Care Association® (ALCA)®

By Guest Contributor C. Taney Hamill, CEO

Aging Life Care Association®

The Aging Life Care Association®, as it is known today, was initially formed by a handful of visionary women in eldercare based in New York.

In the early 1980s, a group of social workers, psychologists, and nurses met regularly at the Manhattan home of Adele Elkind to discuss their work with older adults in the private sector. Out of these meetings emerged their newly formed group -- the Greater New York Network for Aging (GNYNA). The New York Times profiled this group in a June 1981 feature, Private Teams Help in Care of Elderly.

Meetings continued. Three years later, in 1984, the New York Times published a second article, Care for Far-Off Elderly Relatives Sources of Help, noting that others across the country engaged in similar professional work.

In October 1985, the First National Conference for Private Practice Geriatric Care Managers was held. Approximately 50 – 60 people were in attendance (Davis, 2012).

With commitment and persistence, many of the following individuals from New York, along with care managers across the country, began organizing, including Adele Elkind, Babette Becker, Jerie Charnow, Maureen Clancey, Sarah Cohen, Lenise Dolen, Jacquelyn Efram, Vanessa Gang, Leonie Nowitz, Ellen Polivy, Bernice Shepard, Gloria Scherma, Miriam Scholl, Mary Ellen Siegel, and Vera Themal.

After many meetings over coffee, these innovative women knew they needed to form an association and in 1985 created the National Association of Private Geriatric Care Managers (NAPGCM). It started with approximately 50 members (mostly nurses and social workers), who were business owners. The Association was a trade association – one dedicated to growing the businesses of members and positioning members to capture a large market share of this newly emerging field called Geriatric Care Management.

In 1993, NAPGCM recognized the face of care management was not exclusively in the entrepreneurial arena. Nonprofit agencies were providing services in this area as well. In that same year, the NAPGCM membership voted to change the Association’s name to the National Association of Professional Geriatric Care Managers and to expand the voting membership base to include those individuals who provide care management in all practice settings and those with a minimum of a baccalaureate degree.

As NAPGCM changed the profile of the Association to match that of the profession, the Association moved from being a trade association with the primary purpose of positioning and promoting member practices to a professional association with the primary purpose of advancing the profession.

Starting small and regionally, the logical focus was to promote members in this newly coined industry. The acceleration of the Internet led the leaders of NAPGCM to realize that to gain and maintain more significance in the rapidly growing interconnected society, advancing the profession would lift its members.

Similarly, the NAPGCM leaders knew that if they wanted to have more impact for their clients, elevating the profession among nursing, social work, and existing geriatric fields, they needed something concrete to which people could attach their membership.

The next step in developing the profession came when NAPGCM and Connecticut Community Care worked together to create a credentialing program for care managers. In 1996, together with eight aging network associations, they developed and initially funded the National Academy of Certified Care Managers (NACCM).

Creating a national academy that occupies itself with high standards of the entrance to certification and focusing on maintenance of these credentials became a significant differentiating mark for people focused on caring for older adults. Having credentials such as the CMC (Care Manager Certified) from a nationally recognized certifying body separated those who sought to elevate the profession and distinguish themselves from others who simply put out an Open for Business shingle.

As care management evolved, so did several other case management associations. Fragmentation of the profession was inevitable, as no one professional truly understood the complexities of the future. The healthcare environment also was changing. Managed care began to infiltrate the American healthcare system as never before. A variety of assisted living facilities began to offer services to compete with nursing homes. Organized coalitions of healthcare providers began to form as they positioned themselves to work within or outside of the managed care market.

As the face of care management was changing, the Association and the profession began to change. Technology, in the form of the NAPGCM website, webinars, member listserv, and social media, quickly evolved and started to enhance members’ and consumers’ access to information.

Regional and national conferences soon provided momentum. The Association formed after the first conference when the New York Group created a regional event in 1984. 2020 marked the 36th Annual Conference and was the first time it was held entirely online.

The next significant step for NAPGCM and its members took place in August 2006, when members voted to approve a new requirement that all members in the Advanced Professional category must hold at least one of four approved certifications: Care Manager Certified (CMC), Certified Case Manager (CCM), Certified Advanced Social Work Case Manager (C-ASWCM), and Certified Social Work Case Manager (C-SWCM). This requirement became effective as of January 1, 2010.

Certification became the bellwether of professional geriatric care management. By voting to approve this membership requirement, NAPGCM members elevated the profession and provided a way to recognize practitioners as having specific knowledge and expertise. This also increased consumer confidence in the services offered by NAPGCM members.

One year after defining certification models, in 2012, out of a desire to celebrate the profession, NAPGCM launched a new initiative: National Geriatric Care Management Month. This campaign afforded care managers the tools to educate their communities on aging well for the entire month of May. Members raised awareness and shared their holistic, client-centered approach to caring for older adults, and let families know that they were the experts in aging well.

Association chapters are another significant unifying feature of the Association. While ALCA® has nine regional chapters, until 2013, they were all independent nonprofit corporations. Chapters began to merge with the national Association to streamline their operations and free up volunteer time that could be spent providing members with more benefits and educational opportunities. As of the beginning of 2020, seven of the nine chapters have become a part of the National Association.

Timeline of Chapter Formation

1980 – New York Chapter

1985 – New England Chapter

1989 – Western Region Chapter

1990 – Midwest Chapter

1992 – South Central Chapter

1993 – Florida Chapter

1993 – New Jersey Chapter

1995 – Mid-Atlantic Chapter

1995 – Southeast Chapter

NAPCGM took the next bold step in the evolution of the profession in 2014 when it hired a branding consultant to evaluate the Association, its brand, and the profession it represented. After extensive research, evaluations, surveys, and discussions with members, consumers, and referral sources, the board approved a sweeping plan to reposition and rebrand the Association and the profession. The branding exercise discovered Baby Boomers would not identify with the term geriatric. Thus, effective May 1, 2015, the Association began operating under a new name: Aging Life Care Association® (ALCA)®. Members call themselves Aging Life Care Professionals®, Aging Life Care Manager®, Aging Life Care Specialist®, Aging Life Care Association®, and The Experts in Aging Well®.

As the Association was growing nationwide, so were its offerings. The first publication of the Geriatric Care Management Journal debuted in the winter of 1990. Initially only available to members, or by subscription, it moved online and became available to be public in 2013. Two years later, after the branding initiative, the Association renamed the journal as the Journal of Aging Life Care®. In 2020, the journal became a peer-reviewed publication.

The ALCA® Board of Directors and Association staff continue to work to meet the demands of the changing senior services environment through careful strategic planning, education, digital marketing, public relations, chapter support, and communication with its members and the public. Founded by innovative, entrepreneurial thinkers, the Association is future-forward minded. In 2020, the board and staff pivoted quickly to address how to best serve members who were equally concerned about how to best serve their clients in the changing climate.

The national office rapidly established a series of daily Member Forum Zoom calls for members to learn from others, how to help clients, and best practices. Members quickly explored telehealth options and creative ways to help their clients as traditional methods were shut down. Historically challenging times has highlighted the needs of the world’s elderly population and the importance of healthcare providers.

Aging Life Care Managers® are essential as dedicated professionals coordinating care as part of a team between older adults, families, and their life needs. Building upon a strong history, the Association sees a bright future for the field of Aging Life Care Management, our members, and the Association.

What is Case Management?

Although there is some overlap, and some case managers become care managers and vice-versa, there are apparent differences. With the continued growth and demand for case management in the medical field, people often associate care management with case management. The terms care management and case management may confuse some people due to their similarities. Understanding the differences will allow professionals to explain better and educate their clients to minimize confusion and maximize outcomes.

The Case Management Society of America® (CMSA) defines case management as a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost-effective outcomes (CMSA, 2017). Case Management serves as a means for achieving client wellness and autonomy through advocacy, communication, education, identification of service resources, and service facilitation (CMSA, 2017).

Case Management has exploded in recent years and continues to be a growing field. Many Case Managers work in hospitals or physician offices to decrease readmission rates and coordinate care. In 2017, the Commission for Case Management Certification announced a collaboration with the Case Management Society of America (CMSA) (CMSA, 2017).

Rather than get caught up in the differences, which often seem subtle or misleading, the professionals seeking to work in Life Care Management should focus on their own best practice by utilizing established standards of practice and consistent methodology.

We acknowledge the help of C. Taney Hamill, CEO of the Aging Life Care Association® for her contributions in this chapter.

Helpful Resources

Aging Life Care Association® (ALCA)®

www.aginglifecare.org

Case Management Society of America® (CMSA)

www.cmsa.org

Commission for Case Management Certification (CCMC)

www.ccmcertification.org

National Academy of Certified Care Managers (NACCM)

www.naccm.net

References

Case Management Society of America (CMSA). (2017). What Is A Case Manager? http://www.cmsa.org/who-we-are/what-is-a-case-manager/

Davis, J. (2012, Spring) Our National Association history. Inside GCM, 23(1), 7-8.

CHAPTER 2

DEMAND AND OPPORTUNITIES FOR THE LIFE CARE MANAGER

Expect change. Analyze the landscape. Take the opportunities. Stop being the chess piece; become the player. It’s your move.

~Tony Robbins

Professionals have increasing opportunities to work in the field of Life Care Management. The increased demand stems from the growing older adult population and the rise in adults with health conditions living a projected prolonged life expectancy. Stakeholders will continue to seek mechanisms for providing care most efficiently while balancing the rising costs of healthcare.

Life Care Managers (LCMs) play a pivotal role, serving as a powerful connection for clients to obtain optimal well-being, regardless of age or disability. The model of health care, which resembles a fragmented network, is one that is outdated. The newer models rely upon evidence-based practice, the need for continuity, and an integrative treatment approach.

The American Psychological Association (APA) (2020) defines integrated health care as an approach characterized by a high degree of collaboration, with a sharing of information among team members to develop a comprehensive treatment plan. The diverse team of professionals includes physicians, nurses, care managers, medical assistants, psychologists, and other mental health specialists.

Physicians often lack the time necessary to teach their patients wholeheartedly about their health, missing opportunities to engage in conversation about social concerns, personal wishes, long term care planning, and advance directives. Physicians have a growing number of patients with complex health conditions and less time to spend with patients due to increased patient loads. The decreased time for patient care creates the need for a more one-on-one, personalized approach.

The interprofessional or multi-disciplinary model uses diverse healthcare team members to share the responsibilities that help improve outcomes. Each professional offers guidance and practical knowledge within their scope of practice, depending on the patient’s needs. By working together cohesively, the healthcare team wraps its services around the patient, using a person-centered approach. Through goal sharing and regular communication, the team will achieve better outcomes.

The Life Care Manager is often the bridge between the health team members, person-family connections, the financially responsible entity, and community partners.

The LCM considers all aspects of care: helping identify needs and directing and referring to essential services. The LCM’s role remains central, helping to make valuable connections to the community. Most of the population prefers to stay in their own homes through old age and end of life for personal and practical reasons. The cost of long-term residential care is out of reach for many, barring reliance on public benefits. The LCM becomes a vital link for identifying the resources within their community and making the most appropriate referral.

Medical case managers may find it challenging to meet the needs of the increasing population in their caseload, mostly due to time, but also because of policy constraints. Most case managers embedded in provider offices or other more extensive healthcare organizations cannot work in the community, outside the medical home setting or provider office, making it more challenging to provide a complete, person-family-centered approach. A person-family-centered approach considers all aspects of an individual’s life. This includes education level, socioeconomic status, support system, environment, geographic location, safety and security, and other important determinants of health, making care management ideal for comprehensive care.

The LCM in the community setting typically enters into direct, person-to-person interactions with the client and their family members and friends. The meetings occur in the individual’s residential location, helping to understand their characteristics and attributes better. The community-dwelling care manager assists in making essential connections and provides professional oversight while considering the influential variables that lead to successful outcomes. The LCM can help by keeping abreast of the available community partners and agencies and communicating back to the case manager within the provider office any updates or concerns that may influence the care plan.

The case manager within a provider office often helps target the higher risk population, namely those who lack resources, have complex disease states, have suffered a recent health decline, or are experiencing a significant transition. Case managers identify the high utilizers of the healthcare industry. This term signifies a group more likely to have frequent emergency room visits, re-hospitalizations, and difficulty with compliance and engagement in their health. The case manager working alongside a primary care provider or other specialists may find their tasks impossible at times, given the increasing number of patients needing assistance or falling within the high utilizer cohort. There is a growing number of individuals with multiple chronic conditions, with additional complicating factors including mental health conditions, substance abuse or addiction, and physical deconditioning, due to such conditions as arthritis or obesity.

LCMs will continue to be in demand due to the exponential rise in the number of older adults reaching old age, the demonstrated effectiveness of having person-centered support and engagement through education, patient navigation, and advocacy. Whether it be in the provider office, a long-term care residential facility, or community setting, care managers will continue to play a vital role.

LCMs may work in private practice, either through direct ownership with limited or no staff or as an employee of a more extensive practice. Either way, the competent, informed, and skilled care manager can positively influence and truly change the course of a person’s life. Situations may be chaotic, with individuals lacking the wherewithal to manage their health or chronic conditions. The LCM has excellent opportunities to help individuals and their families make informed decisions, improve self-management, and achieve optimal well-being.

There will be increasing demand for Life Care Managers

Demand due to Aging

Lower fertility and increased longevity have led to the older population’s rapid growth globally and in the United States. In 2015, among the 7.3 billion people estimated worldwide, 617.1 million (9%) were aged 65 and older. By 2030, the older population will be about 1 billion (12% of the total population), and by 2050, 1.6 billion (17%) of the total population of 9.4 billion will be 65 and older (Roberts et al., 2018). According to Roberts et al., (2018), the people of Northern America, which includes the United States, will retain its position as the second oldest region globally in 2050, with 21.4% of the total population 65 and older.

Baby Boomers were born between 1946 and 1964. By 2030, all Boomers will be at least 65 years old. Older adults will outnumber children under age 18 for the first time in U.S. history by 2034, according to the United States Census Bureau (2019). However, the youngest generational cohort in the United States is named Gen-Z and will become the largest generation (Knoema, 2020). The Baby Boomers will continue to drive the need for improvement and expansion in areas involving financial security, health, and health services planning. There will be many people with chronic health conditions primarily due to the exponential rise in the number of persons living into very old age, the growing number of seniors reflects the need for life care management services.

Our world is becoming more and more mobile. Children no longer live near parents, and many are working. Families have an increased need for a care manager who lives near the older adult and has the time and expertise to guide the family through this transition in life.

Figure 2.1 Total US Population by Age and Generation.

Knoema, 2020, US Population by Age and Generation in 2020. https://knoema.com/egyydzc/us-population-by-age-and-generation-in-2020#

Demand Based on Disability

A disability is any condition of the body or mind (impairment) that makes it more difficult for the person to do a particular activity (activity limitation) (CDC, 2019). There are many types of disabilities, such as those that affect a person’s vision, movement, thinking, remembering, learning, communicating, hearing, mental health, and social relationships (CDC, 2019).

People will be affected differently and have unique needs. The LCM can assess individual needs and support them to give them the best quality of life and live as independently as possible.

As advances are made in health care, people with disabilities are living longer. The number of disabled in the United States is growing, with 26% of all adults in the United States having some form of disability (CDC, 2019). The graph below shows the percentages of adults with functional disability types. Two out of every five adults, 65 and older, have a disability (CDC, 2019). With the growing population of those 65 and older and advances in medicine, this number will continue to rise.

There will be growing opportunities for Life Care Managers

Figure 2.2 Percentage of Adults with Functional Disability Types.

Centers for Disease Control and Prevention (CDC), 2019, Disability Impacts All of Us.

https://www.cdc.gov/ncbddd/disabilityandhealth/documents/disabilities_impacts_all_of_us.pdf

The Life Care Manager in Independent Practice

Some LCMs want to work independently. They may have a background in the healthcare field, social work, or human services, as discussed in the chapter "What is Life Care Management." Other times, an individual has a personal experience that makes them passionate about helping others. When individuals go to work for themselves practicing care management, this is considered an independent practice. The individual can be a solo practice, doing all the work themselves, or hiring employees or contractors to assist with the care management practice.

With an independent practice, the individual is responsible for their clients, billing and receiving invoices, and hiring others to grow the practice. The elderly and disabled population is increasing. Each year there is a rising demand for care managers to assist and support families who live at a distance and do not have the time to provide direct support and care to their loved ones who may need it.

The LCM has specialized knowledge to help those with chronic health conditions, the special needs population, and their loved ones navigate care complexities. This specialized knowledge is priceless when it comes to assisting families to feel at ease.

The LCM who opens an independent practice has the difficult task of marketing, ensuring payment for services to keep the doors open, and managing the day-to-day operations. The greatest rewards include having a flexible schedule, being your own boss, and growing a successful and rewarding business that helps others.

The Life Care Manager in the Elder Law Office

Elder law practices and the LCM often share the same client demographics. Elder law attorneys usually work with older adults and special needs populations, including developing and managing trusts and other formal legal arrangements. The elder law attorney is frequently the greatest referral source to an LCM. The LCM may also refer clients to the elder law attorney for assisting the client with tasks such as estate planning, trusts, Medicaid, and more.

Some elder law attorneys prefer to refer to the independent care management practice for a client’s care needs. Other times, elder law attorneys hire LCMs to work in their practice. In this model, the LCM is an employee or independent contractor to the elder law practice. The attorney bills for the LCM’s time and pays the LCM an hourly wage or salary.

The LCM in the elder law practice does not have to worry about the billing and pricing of services; the elder law practice does this. The attorney will give the LCM cases to work on and often direct what services the LCM will provide. This type of model can also be rewarding. The LCM working within an elder law practice may also have flexibility and independence. The LCM would typically be working in the field, not confined to an office or strict schedules, as seen in other health or human service organizations.

Since the elder law attorneys are not trained in care management, the LCM needs to have some experience and training. Frequently, the LCM may be the only individual with this role in an elder law practice. Support from an organization such as the Life Care Management Institute or other mentor is essential for an LCM’s success when working in an elder law practice. An LCM must always have a place to ask questions and get support when needed.

The Life Care Manager in a Financial Practice

Some financial practices work in teams to provide a holistic approach. They may have a team that includes an elder law attorney as well as an LCM. Part of the financial advisor’s assessment of a senior or individual with special needs includes bringing each specialist to the table to discuss what each can do for the individual to provide a holistic approach. The financial model of care that also consists of a legal and care management approach appeals to families who want a one-stop-shop for all their needs. Professionals working together for the best quality of life in collaboration can save time and money and help reduce errors or duplicate efforts.

The Life Care Manager in a Nonprofit

There are LCM practices that apply for grants and are self-funded. Some nonprofits specialize in Life Care Management and add those services as part of their offerings. An example would be the nonprofit organization, meals on wheels or an organization that provides transportation. The nonprofit can add Life Care Management as one of the services they offer with other benefits.

A nonprofit is rewarding because it can provide LCM services that are needed across all socioeconomic classes. The LCM in private practice and the elder law practice is typically private pay, which may exclude individuals who don’t have the means to afford this professional service type. By working for a nonprofit, these individuals can have access to LCM services. An LCM in a nonprofit can connect the individual with much-needed resources and improve their quality of life.

To learn more about the various opportunities current Life Care Managers may have to expand their business with multiple sub-specialties, please refer to the chapter Diversifying for Sustainability.

What About Hospital-Based Care Management?

Team-based models of care in the hospital setting have grown in recognition of the solo healthcare provider’s inability to provide the comprehensive care required for many patients. One study, published in the Journal of Patient-Centered Research and Reviews, focused attention in the hospital setting. The study found a positive relationship between team-based care and patient outcomes, but with identifiable barriers to the amount of success of such teams (Will et al., 2019). The article reviews 21 published studies involving interprofessional, multi-disciplinary, team-based care. Nearly half of the teams included in their matrix a care manager often referred to as case manager, nurse manager, or care coordinator. This can cause confusion for the LCM when distinguishing their profession from that of the traditional case manager.

Team-based care’s success depends on the influence of cultural differences amongst team members, the availability of interprofessional training and support, reimbursement and revenue considerations, and guidance through team development and progress.

Hospital-based case managers often handle a significant caseload while streamlining utilization through communication to the insurer and initiating the referral and authorization process for such items as durable medical equipment or skilled services. Their role is just as crucial as the community-dwelling LCM, but it’s often burdened by the lack of available time necessary to commit to helping an individual beyond the immediate concern for what landed them in the hospital. Their role depends on a hand-off to a capable professional who can help bridge the gap and continue health efforts.

The hospital-based case manager will continue to rely upon the community-based LCM to help carry out their well-intended care plan. Their direct involvement and continuation of services typically end with discharge, although this will depend on the transitional care model at their respective facility or agency.

It has become commonplace for physicians to rely upon the work being done behind the scenes by support staff who can reach out to help carry out instructions or check on the status following discharge, for example. Without a capable, knowledgeable LCM who understands the patient’s unique situation, physicians must sometimes go weeks or months before knowing how their patient is doing. Will et al. (2019) found that healthcare teams which represented more than two professions and worked closely together to address the patient’s issues, could yield greater patient satisfaction.

References

American Psychological Association (APA). (2020). Integrated Health Care. https://www.apa.org/health/integrated-health-care

Knoema. (2020). U.S. Population by Age and Generation in 2020. https://knoema.com/egyydzc/us-population-by-age-and-generation-in-2020#

United States Census Bureau. (2019). 2020 Census Will Help Policymakers Prepare for the Incoming Wave of Aging Boomers. https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html

Centers for Disease Control and Prevention (CDC). (2019). Disability Impacts All of Us. https://www.cdc.gov/ncbddd/disabilityandhealth/documents/disabilities_impacts_all_of_us.pdf

Roberts, A. W., Ogunwole, S. U., Blakeslee, L. & Rabe, M. A. (2018, October). The population 65 years and older in the United States: 2016. American community survey reports. https://www.census.gov/content/dam/Census/library/publications/2018/acs/ACS-38.pdf

Will, K., Johnson, M. & Lamb, G. (2019). The population 65 years and older in the United States. J. Patient Cent Res Rev, 6(), 158-171.

CHAPTER 3

THE ROLE OF THE LIFE CARE MANAGER

Knowledge has a beginning but no end.

~Geeta S. Iyengar

The Life Care Manager (LCM) possesses the education, background, skills, and experience required to render appropriate professional services while using a methodology based on the industry’s standards of care. Professionals working in the health and human services industry often have a vast amount of experience, a strong educational foundation, and an inherent desire to help others, making them solid candidates for work within Life Care Management.

The professional LCM relies upon his/her educational background and experience. Professional LCMs builds upon that foundation through specialty accreditation and certification through a recognized professional organization within their industry.

As discussed in the chapter Demand and Opportunities for the LCM, the LCM works in many different settings. Whether work is done independently, as part of an elder law practice, a financial advisor’s office, non-profit corporation, hospital, or other location, the LCM’s knowledge and role does not change.

The Aging Life Care Association® is a professional organization many professional Life Care Managers rely upon for guidance. This organization outlines eight areas in which a care manager has expertise. Those areas are covered throughout the various chapters of the book in detail.

Areas of Expertise: Health and Disability

The LCM has sound foundational knowledge about everyday health and what it means to be healthy. The LCM understands the aging and disability process and the impact on body systems and function. The LCM must understand how illness and disability affect the human body and have good working knowledge regarding disease management.

The LCM should be knowledgeable about the Americans with Disabilities Act (ADA). The ADA became law in 1990 (ADA National Network, 2020). ADA is a civil rights law that prohibits discrimination and guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, state and local government services, public and private places open to the general public, and telecommunications (ADA National Network, 2020). The LCM should be familiar with the available protections to help advocate on their client’s behalf. Please refer to the chapter entitled "National Guidelines on Aging and Disability" for more information.

Areas of Expertise: Financial

The LCM helps identify options and resources for clients and their supports. The LCM should be comfortable discussing and researching the costs of services and assisting clients in making decisions based on their financial sustainability. They should have good knowledge about the geographic costs of services and acceptable payment sources.

An LCM may make referrals to professionals who specialize in financial advisory or management services, as well as attorneys. Clients often need to be strategic and encouraged to focus on financial planning for the protection of assets.

LCMs can work closely with and may cross-refer clients to attorneys and financial advisors. The LCM can help the financial advisor project the costs of care to plan for the future properly. Most people who seek expertise from an elder law attorney may also need help managing their care needs. Cross referrals from attorneys and financial advisors are a perfect match for providing holistic care.

Areas of Expertise: Housing

The LCM assesses the current living situation while considering safety, finances, client’s wishes and goals, and family dynamics. The LCM helps guide the client and family with housing options, which include a review of safety and security and costs. The LCM helps project long-term solutions with anticipated future needs.

The LCM must be knowledgeable about resources available to support the client in the home, the different levels of care, including day programs, senior centers, and other community offerings that help improve socialization and prevent isolation and loneliness.

An individual’s plan for where they will reside will be significantly influenced by their relationships with family and friends, their current health status, support systems available to them and finances.

The LCM’s insight and education can help improve an individual and family’s ability to be more thoughtful and prepared, making informed decisions ahead of a crisis or sudden change.

Areas of Expertise: Family

The LCM must be knowledgeable about family systems. The LCM is not typically hired to simply assist the client. The LCM will also need to support the whole family system, including close friends and other supports. The family may include biological relations or those who, through marriage, common-law, or friends, are considered family. Families may have different values, beliefs, and perspectives. The LCM needs to have an open mind and maintain an individual approach while offering person-family centered care.

Areas of Expertise: Local Resources

The LCM functions best when they have a clear understanding of the resources available within the geographic area of practice. Maintaining knowledge regarding availability and the credibility of community agencies and partners is required to serve clients best. Awareness of cost of care, insurance coverage, and out of pocket costs help guide the family to make long-term sustainable goals and identify solutions through informed decision-making.

Areas of Expertise: Advocacy

The LCM is an advocate for the client and family by being familiar with standards and codes of ethics within the professional organizations to which they belong. Standards are developed to help guide practice and ensure the LCM is working in the client’s best interest while maintaining professionalism and integrity.

Being knowledgeable about similar professional roles and the applicable standards of practice and guidelines allows the care manager to fully advocate on the client’s behalf with other professionals. The LCM must ensure the client is receiving the best care and service available.

LCMs must be willing to spend time and money on continuing education to equip themselves with knowledge. Knowledge improves the LCM’s ability to advocate for the client in any situation properly. Most practice guidelines for LCMs include a requirement for continuing education focusing on ethics, including end-of-life scenarios and other topics such as financial exploitation and decision-making authority.

Areas of Expertise: Legal

The LCM should have basic knowledge of when to refer to an attorney. Attorneys have different specialties, including special needs and trust arrangements, elder law, probate, estate planning, veteran’s planning, Medicaid, and guardianship proceedings. The LCM should never give legal advice since this is typically outside the LCM’s scope of practice. Instead, the LCM should know when to recommend an attorney and provide the necessary information to help the client make an informed decision for help in reaching the intended goals.

Areas of Expertise: Crisis Intervention

Most people reach out to an LCM when they are in crisis. Although reaching out before a crisis and heading off the situation is ideal, most people are reactive rather than proactive. The LCM must be knowledgeable about how to handle multiple opinions and decision-making styles. This pertains to not just the client, but family and support systems during the crisis as well.

The LCM must prioritize tasks and interventions. To achieve maximum health and wellness, the LCM should provide continuous, ongoing assessment of outcomes to manage the plan of care.

The LCM should always have a plan in case of an emergency, not only for the client but for their entire household and care team members. Having a back-up plan in place, in case of sudden changes in health or the situation, is highly recommended. The LCM plays a pivotal role in helping ensure clients have considered the what-if scenarios. Additionally, the LCM should have their own back-up plan if they are no longer able to provide the necessary services due to a sudden or unforeseen interruption. Please refer to the chapter on Emergency and Disaster Preparedness for additional information regarding this topic.

Figure 3.1 The LCM Method

The Life Care Management Institute, 2020. Copyright 2020 by The Life Care Management Institute. Reprinted with permission.

The LCM may feel overwhelmed by the multitude of information involving just one client. It is essential to have a method that can be used for each client or situation and relied upon for a consistent, understandable approach. The LCM Method uses the initials L.C.M., which represents three larger steps of a process: Learn, Create, and Manage. Each step encompasses specific objectives and tasks within each step to help the LCM stay on track.

This LCM Method is a dynamic and interactive process, with each step influencing each other and creating progress or the need for change, depending on the situation.

LEARN

Understand the situation through a comprehensive assessment.

The LCM’s role is to complete a holistic assessment, discussed more thoroughly in the chapter The Comprehensive Assessment. The LCM then identifies the client’s strengths, needs, challenges, concerns, and preferences.

Learning about the client through completing a holistic assessment includes assessing the client’s demographics, medical health status, daily habits, function,

cognitive status, safety, financial, and psychosocial needs. By learning about each area of focus, the LCM can move on to the next phase of Creating.

What matters to the patient is as important as what is the matter with the patient

It is essential to learn the story behind each case by interviewing, listening, and gathering insight. This step requires patience, while the discovery of information is taking place, rather than jumping too fast towards immediate action.

It is likely the LCM may encounter a situation where more immediate action is necessary for a client’s safety and well-being. However, where possible, go slow, learn as much as possible, and then move onto the next step.

CREATE

Develop a plan of care with recommendations.

The client and family discuss their goals with the LCM during the learning phase. The LCM Creates a plan of care, which is a roadmap to help meet the goals and develop action items or interventions.

The LCM, client and family collaborate to develop a care plan using a person-family-centered approach, considering what is most important to the client and family. The care plan cannot be developed without first learning about the situation and understanding each client’s personal attributes and characteristics.

The care plan is a dynamic document that changes as the client’s needs or situation changes. It is recommended that the LCM include an action item to review the care plan regularly and with each alteration in health or situation.

MANAGE

Implement the plan of care and monitor progress

This step is all about how the LCM will Manage and monitor the ongoing provision for care. Manage includes providing support for changes in the client’s situation and the potential constant adjustments in the plan of care. The LCM helps the family adjust to the situation and reach the goals by being dynamic and responsive to the client’s current needs.

While overseeing care, the LCM continues to learn about the current situation and determines if the client is responsive to the care plan recommendations. The LCM must continue to know if the client is moving toward achieving the set goals. If not, the LCM creates new recommendations to help the client and family make progress towards their goals.

The Learn-Create-Manage Method does not necessarily happen one step at a time. The LCM must be skilled in monitoring any concerns and recognizing the stability versus potential disruption of a situation and taking appropriate action.

The LCM must keep abreast of the current situation for successful outcomes. The LCM may need to work collaboratively or rely upon mentors, advisors, and community supports, when handling more complex or difficult cases.

Asking for help does not mean that we are weak or incompetent. It usually indicates an advanced level of honesty and intelligence.

~Anne Wilson Schaef

Helpful Resources

The Life Care Management Institute

www.LCMExpert.com

References

ADA National Network. (2020). What is the American’s with Disabilities Act (ADA)? https://adata.org/learn-about-ada

SECTION 2

LEARN-CREATE-MANAGE

Chapter 4: Proactive Planning

Chapter 5: The Comprehensive Assessment

Chapter 6: Assessment Tools

Chapter 7: The Plan of Care

Chapter 8: Residential and Facility Placement

Chapter 9: The Cost of Care

CHAPTER 4

PROACTIVE PLANNING

Before anything else, the preparation is the key to success.

~Alexander Graham Bell

The aging demographics are helping shape care delivery and community preparation. People are living longer than ever before and often with multiple chronic health conditions. This may lead to difficulty with day-to-day life or when handling unexpected changes. Our population’s growth with a projected longer life expectancy means more demand for services, including health care, lifestyle, and personal management.

It is the responsibility of each individual to plan for their needs accordingly. However, most Americans do not adequately prepare for their own potential needs, often outliving their assets or relying heavily on public assistance.

The greatest challenge in preparing a life care plan is knowing where to start. Life Care Managers (LCMs) play a pivotal role in helping educate others on the importance of planning and preparedness regarding health and personal livelihood. The LCM can help alleviate the fears of talking about aging, understand how to get started, and navigate through difficult conversations. In most cases, the conversations are not as tricky as they are unfamiliar or awkward.

In a society that tends to value youth, it can be challenging to find someone talking about their vision for their life through old age. A complete road map for aging moves beyond retirement savings, life insurance, and investments. Although these are all important, some of the most powerful conversations, and potentially most impactful, involve personal values and wishes.

The number of centenarians (those living to or beyond 100 years of age) grows steadily. Living a longer life allows family and friends to learn from their elders, gain valuable insight, and have more opportunities for spending time together. Living longer also increases the chances of requiring assistance in certain areas of life, relying on others to assist with long term care needs.

The cost of long-term care may rise suddenly with a change in health, such as in an unexpected illness or exacerbation of a chronic health condition. Sometimes long-term care needs increase over time, as the condition progresses, and normal aging-related changes worsen. It is helpful if the client can anticipate what to do in a crisis or sudden shift in a situation, thus relying less on others to make decisions and decrease the limitations posed by impulsive decision-making.

A failure to plan early can result in a tremendous financial and emotional burden, and the deterioration of the person-centered approach.

Many changes accompany aging through the normal degenerative process. This may include sensory changes involving hearing and vision and decreased strength and balance, resulting in an increased risk of falls or accidents. A chronic condition may aggravate these normal degenerative changes, making lifestyle changes necessary, and relying on others for assistance.

Sometimes just telling someone it is okay to talk about their aging is enough to open their mind to the possibility of doing such a thing. The resistance to planning ahead may be based on fear of talking about the what ifs, as if something terrible will happen if spoken aloud. Some have difficulty envisioning a life into the elder years. Cultural beliefs and values passed down from generations may interfere with the comfortable manner in which an individual approaches the various topics of long-term care planning. Everyone avoids this conversation. Generational differences or varying personality and learning styles may impact initiating a life care plan.

Learn

How to get clients thinking and talking about their road map for aging

• Start slow unless they specifically requested it.

• Ensure a nonjudgmental and nonthreatening space for sharing deeply personal information.

• Learn about the critical family members. Who will be involved in the conversation?

•Discuss how to broach the subject of honoring and respecting the client’s wishes.

•Share your knowledge. Provide opportunities for learning about aging expectations, long-term care, activities of daily living, and supports and services.

•Revisit or return to the conversation multiple times, if necessary.

Create

How to help clients be pro-active and design a road map for aging

•Use a step-by-step method or process to navigate through important discussions to help avoid overwhelm.

•Document important details and notes regarding wishes, goals, and must-haves.

•Prioritize any urgent needs, revisiting other steps later, if necessary.

•Develop the life care plan using a custom or purchased format.

•Designate a place to keep essential planning documents and legal paperwork.

Manage

Once the process of learning about the individual is complete and the LCM has created a care plan, the LCM can then begin to manage the individual plan of care. This is discussed further in future chapters.

Aging demographics and associated issues threaten communities and governments on a global and local level. There are many challenges. Communities and governments are promoting aging-friendly agendas, with many towns creating programs to enhance or add services. Relying on funding through government sources and private donations does not always allow communities to provide services in a cost-efficient manner.

The reality is that planning for long-term care is highly personal and the responsibility of everyone.

It is vital for individuals and families to engage in meaningful discussions early and have a plan. LCMs can use their experience and knowledge to help navigate clients through a process to complete a care plan which focuses on the highest level of independent function and quality of life. The comprehensive road map to aging will likely include a breadth of information on essential topics. These typically include specific health conditions or disability and their management, medications and the treatment plan, legal documents, finances, and estate planning, personal values and wishes, age in place considerations, available family or friends for support, healthcare and aging industry demographics, and community resources.

The lives of humans can be complicated, especially when involving essential decisions about personal livelihood and wishes. Depending on their family and position in the community, another person’s experience can be complicated under normal circumstances. The LCM must make many discoveries and learn each individual’s unique characteristics. It is easy to veer off course during interviews and allow the conversation to go more deeply into unrelated topics.

Having a system or method for staying on topic is essential. The organization and flow of the conversation may quickly become overwhelming. Not just time, but mental energy is at stake, resulting in higher fees for the client, exhaustion, avoidance, and rejection.

One method involves using a step-by-step process to help elicit information and regain focus when the conversation goes astray. Adopted from the book, 7 Steps to Long Term Care Planning (Crowley, 2017), this method helps individuals, families, and professionals navigate through essential conversations.

Although planning is a dynamic process, the 7 Steps help simplify an otherwise complex process and provide a mechanism for return to conversation areas that require further discussion and actions.

The method uses the mnemonic U-D-E-C-I-D-E to indicate the area of focus, encouraging establishing goals throughout the process and review at regular intervals.

7 Steps to Long Term Care Planning©

By Jennifer Crowley, BSN, RN, CLCP, CADDCT, CDP, CMC

Step 1. Understanding Your Needs

Step 2. Develop Goals

Step 3. Evaluate what you want

Step 4: Consider Accessibility

Step 5: Identify the Unpaid Caregiver

Step 6: Discuss Finances

Step 7: Evaluate Paid Services

The steps are further explained, to help define the role of the LCM and provide helpful tips.

Step 1. Understand the Needs

This first step involves learning as much as possible about the given situation. LCMs relies upon their assessment and interview skills to develop a good grasp of the situation. In this step, the LCM utilizes the assessment, tools, or other resources to collect data and learn about the client. The LCM puts the person-centered approach into action to discover details about the client’s health, physical, and cognitive function, relationships, and who they are as a person.

The LCM does not typically have the medical records to identify the health conditions of the client quickly. It is usual for individuals not to have a list that details their health history or directly state their medical diagnosis. They may have undiagnosed conditions, such as cognitive impairment or dementia. Some concerns are apparent. The LCM is fortunate when a client understands exactly what their needs are, based on a good understanding of chronic health condi-tion(s), expectations for disease progression, and the treatment plan.

When things are less obvious, start with the medications. Review routine, daily medications, making sure to include over-the-counter medications, supplements, and vitamins. The LCM may learn more from reading a prescription bottle than from the client.

This learning and discovery step takes time but will help the LCM prioritize the most significant and most urgent needs. The person-family-centered approach can only begin when the LCM has taken the time to learn about the person and the family, whether it be partners or adult children.

Step 2. Develop Goals

The LCM may quickly initiate this step since it involves creating goals or identifying needs and the most appropriate action to take. Without this step, no one may ever take action to help fulfill an objective, which leads to an intended outcome. It is crucial to utilize the SMART method for establishing goals. The LCM can help the client to develop the needs list, encouraging the development of simple goals that are reasonable and attainable. Please refer to the chapter The Plan of Care for a more in-depth look at goal setting.

Commonly, the LCM assists clients who need to complete their legal documents related to decision-making, end-of-life wishes, or advance directives. If the client has completed these documents, it is still essential to recognize the need to regularly review those documents and ensure that the designated proxy understands their role and the wishes of the client. It makes sense to include the review of legal documents in this step. This is an action item that should be addressed in any care plan, whether it be for initiating and completing legal directives for the first time or reviewing the paperwork to determine if any changes need to be made.

Step 3. Evaluate what is wanted

The LCM continues to direct the client through discussion regarding their personal values, wishes and plans, if any. The client’s lack of experience in thinking about their journey into old age can make this step tricky. They may have a general idea of what it might be like to get old, but they often base their ideas on ageist attitudes.

Clients may be afraid to talk about their desires for their life. They may not necessarily know how to respond and have intense emotions. Revealing desires may be a difficult step due to the intentional focus on a phase of life which is not appreciated as much as youth, a realization of time which has passed all too quickly, or what they want no longer matching what they need. For example, the client may want to live independently and not give up the freedom yet needs an assisted living setting.

Step 4: Consider Accessibility

In this step, the LCM can provide education on the importance of reviewing the home an individual chooses to reside in and its suitability through old age. One must consider a number of factors, including safety, security, and ease of maintenance. This is reviewed more extensively in the chapter Home Safety and Age in Place Considerations.

The LCM can use tools and other resources to complete a home safety evaluation. This will assist the LCM in not overlooking any details. The LCM will be using the data together with the functional and cognitive assessment to help educate all parties on the findings and help them to make the most informed decision, as appropriate.

The residential construction industry does not have a standard which ensures, through regulation, universal accessibility at the time of construction or remodel of a new home. The LCM will inform the client of the customary modifications which can be made to the home to improve safety and functionality. This may require collaboration and/or referral, depending on the current dwelling and plan.

Normal aging-related changes may become aggravated by chronic health conditions. Clients who choose to remain in their own home through the end of life should review their residence and determine if any additions or changes need to be made. An individual with a chronic health condition or disability may need additional education and insight to be able to understand the impact on the human body over time.

Modifications to a home may not be possible due to the cost of making changes to a home. Such changes may be impossible to make in a rental property.

An individual may have a chronic illness or disability which is progressive in nature and impacts their functional independence or a cognitive impairment, such as dementia, which will cause greater concern with the safety, security, and functionality of a home.

During this step the LCM can help develop a plan for the client to remain safely in the home or consider the myriad of options when planning a relocation or transition. Return to Step 2 and add the appropriate action items, as necessary. This step may develop more depth as the individual discovers who and where their greatest support is and starts to understand their housing options and other factors impacting their comfort and safety.

Step 5: Identify the Unpaid Caregiver

A geriatric workforce shortage is already taking shape in most communities, causing delays in services and rapid turnovers, resulting in caregivers who may be ill-prepared. There is increased demand for families and friends to take on roles of caregiving, often a role with which they have little or no experience.

Caregiving is one of the most difficult jobs, with burn-out and stress. While it can be rewarding, caregiving may have negative consequences, impacting the health and livelihood of the caregiver. Caregivers report numerous challenges and stress to their physical, emotional, and financial well-being.

The LCM can help educate and raise awareness of these concerns, while helping clients develop a list of potential helpers within their immediate family, faith community, or amongst friends. The LCM should be aware of red flags to look for when choosing an informal caregiver and how to prevent problems and maintain the relationship.

The LCM should encourage the client to engage in discussion with those they intend to ask for help, reminding the client that human nature is to help one another. Affording another an opportunity to provide help can be mutually beneficial. People lead busy lives and often need to be reminded of the opportunity and held accountable through directly asking and then scheduling the date and time they are needed.

Step 6: Discuss Finances

Many individuals will have a good understanding of their bank account balance, the things they own, and the debt they have incurred. Fewer individuals will have the experience or knowledge which helps them understand the cost of care, should they need it. It becomes quite shocking to an individual or family to learn how expensive support services and residential care may be, often resulting in fewer options due to a lack of preparedness.

The client may have many misconceptions about the role of public services and benefits, as well as payer sources and out-of-pocket expenses. The LCM’s role in this step is to inform and help guide the client through a process which helps improve understanding and prepare as necessary and able.

Referral to third party professionals, such as financial advisors and attorneys, may be appropriate to assist with fiduciary management, asset protection, and allocation of funds. The client should be encouraged to use a worksheet or other form of documenting their assets and liabilities and have a thorough grasp of their financial plan. The LCM is not typically providing financial advice and may find this area of conversation tricky. However, some LCMs may include fiduciary services or money management in their scope of practice if they have the education, experience, and certification.

In this step, the LCM is an important catalyst for improving the options for clients as they become more knowledgeable and prepared, and helping create a plan for financial stability.

Step 7: Evaluate Paid Services

The LCM must be knowledgeable about their specific geographical service area and the number and type of services available. This does not mean the LCM cannot travel outside their normal service area or consult on a case which may be at greater distance than usual. The LCM would rely upon collaboration and research to best learn about unfamiliar areas.

The client may not currently require assistance. In this step, the LCM would assist with education and emphasize the importance of planning ahead and preparing for the projected and unexpected needs. This step helps provide another level of understanding for consideration of the need to relocate or plan for an eventual transition.

Sometimes, the caregiver is a family member who is providing all the care, and the family has not considered the need to hire outside help. In some families, depending on a family member for care needs is expected, and there is no plan for hiring outside help.

The LCM can help influence the health of a caregiver-family relationship by providing education on the impact on the caregiver if not provided respite and offer solutions which will help sustain a healthy relationship over time.

When care is already in place or the individual is found to need care at the time of the assessment, the LCM’s role is expanded in this step to include coordination of care. The client would be guided through informed decision-making where possible