Serving Clients in a Geriatric Case Manager or Private Fiduciary Role

July 15, 2005 at 3:20 pm  •  Posted in Alzheimers Disease/Dementia by  •  0 Comments

By Pamela Bednar-Braun, MSW


A geriatric care manager is a professional who specializes in assisting older people and their families with long-term care arrangements. Care managers have a minimum of a bachelor’s degree or substantial equivalent training in gerontology, social work, nursing, or counseling.

As a care manager, I conduct in-home or facility assessments (evaluations)  to develop a care plan including a client’s needs for community resources such as home care services, home-delivered meals, emergency response systems, etc.

An older person may need to move into a retirement community, adult care home, memory-care or assisted living or a nursing home. I also review financial, legal and medical issues and make appropriate referrals for specific follow-up. I provide crisis intervention to clients and their families locally and abroad to make certain the clients’ needs are being met and communicate with families. I specialize in identifying problem areas such as declining health or cognitive functioning including mental health and dementia needs.

Arizona has many older individuals who moved from other parts of the country for the warm climate. After living in Arizona for 15-30 years, they may be hesitant to relocate to colder climates to be closer to family as their health needs change. After an onset of an illness, they may not be in a condition to even consider a move. Also, during many conversations with older individuals, they have shared that they do not want to be a burden to their families and respect their adult children and extended family have “their own lives”. This creates a dilemma for the older person to decide to stay in Arizona with only informal support at best vs. a move to their community of origin. They may also be faced moving near family, which may be in a community unfamiliar to them.

The Social Worker’s Role

As a social worker  who is a  care manager, my role is to support and empower these individuals who are “aging in place” and making all attempts to remain independent and residing in their own homes. I believe in the least restrictive setting and strive to coordinate services for individuals to maintain this living environment as long as possible. Often, safety issues, health and personal care needs, behavioral and cognitive problems, and costs can make this a challenging task.

I provide personalized services to my clients and feel I contribute to enhancing their quality of life through consistent intervention. The personalized service is a major component to care management services, as I know their families, routine, medical condition, care needs, etc. and after rapport building, it can be a beneficial professional exchange.

A Social Worker’s Fiduciary Duties

A “stepping stone” from care management can involve legal or court intervention for appointment as a fiduciary. A fiduciary is defined by the Arizona Fiduciaries Association, Inc. – An Affiliate of the National Guardianship Association as “someone who accepts the responsibility for taking care of the needs or property of another person for the benefit of that person. The fiduciary serves in a role of trust. This is crucial when the person receiving services is frail, vulnerable and incapacitated. A private fiduciary is a non-family member who serves professionally for a fee and who must be certified by the state.”

In a state like Arizona with a large population of older individuals, memory impairment due to dementia such as Alzheimer’s disease is prevalent. There are older individuals who have no children or are estranged from children or extended family. Their siblings are also elderly, may have health issues, and often reside out-of-state. Fiduciary services may be necessary in these situations to assist in the protection and well being of the vulnerable and/or incapacitated older adult.

Through court appointment, a private fiduciary can serve as guardian and/or conservator and make decisions regarding where the individual lives, medical intervention, and/or handling of their finances and property. The guardian handles affairs related to “the person” and the conservator handles “finances and property”. This legal appointment carries a great deal of responsibility and liability. Private fiduciaries are used primarily when a family member or “interested person” such as a long-time close friend is unable to serve in this role. The court favors family members unless contraindicated or an “interested person”.

The Sun Cities areas of Arizona have often promoted a strong sense of neighborhood as the individuals often watch out for one another in a supportive way. The 75-year old married couple may observe daily to ensure their 85-year old widowed neighbor with health issues takes in her newspaper daily. Churches and synagogues have also provided a support network. Often times, however, individuals may require more ongoing or specialized care than these support networks can provide. A neighbor may return to the Midwest for the summer months and the older individuals are left with no support as a result. A care manager and/or private fiduciary may then become involved.

Isolation can also be problematic as the individuals may have been active when initially retiring and moving to Arizona. After the death of a spouse, no connection with church/synagogue or neighbors and declining health, the individual’s homebound status may go undetected. A phone call from an extended family member out-of-state with no visits may not obtain the “true picture” as older individuals want to provide the impression that all is going well possibly fearing forced intervention or loss of their independence.

As a care manager and/or private fiduciary, the “whole picture” can be seen. It may initially be similar to putting pieces of a puzzle together especially if the individuals have memory impairment. Serving clients in these roles are best met using a “team approach” and acknowledging each team member’s role in the client’s life. This team may consist of the primary care physician, consulting specialists, family/friends, home health agency personnel, church or synagogue personnel, attorney, bank trust officer, etc. All have a significant role in serving the clients. A care manager and/or private fiduciary may act in a pivotal role in seeking out all the disciplines for their input for the best interest of the client. A care manager and/or private fiduciary ensures that follow-through is completed and that an individual care plan is devised and followed for each client.

Serving clients in these roles of a care manager and/or private fiduciary can be very rewarding to the professional. Ensuring quality of life for the clients in a safe, least restrictive setting is the goal to providing these services. Advocacy for these individuals is not only an art; it is the true base for being an effective care manager and/or private fiduciary.


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