Care Managers and Home Care: Competitors or Colleagues?

This fall there was a lively email discussion among Aging Life Care™ managers about the relationship between home care companies and care management. The consensus was that home care companies, of course, are motivated to develop a referral relationship because a care manager can be a great source of new business.

One-way referrals?

Many care managers commented that it tended to be a one-way relationship, however. For these care managers, home care companies did not seem to refer any of their clients for care management. There was conjecture about the reasons why, ranging from perceived competition—they already have “care managers”—to not understanding the ways an Aging Life Care manager can help. This seemed like an important topic to research with the goal of improved collaboration.

Collaborations that work

Other care managers in the discussion noted that they had developed very strong and positive referral relationships. I took the opportunity to follow up with some of those home care agencies already working with Aging Life Care Managers. As well, while at the Florida Chapter of the Aging Life Care Association™ conference, I interviewed several home care agencies that were there as vendors. All very generously shared their thoughts about optimal collaboration between the two branches of elder care.


When a care manager is advisable

These home care business owners said that there are situations when a home care company simply does not have the bandwidth or the skill set to provide the type of care a client or family wants or needs. Listed below are the most common “red flag” situations when they felt it was especially beneficial to refer to an Aging Life Care Manager:

  • Multiple medications. Care managers can work with pharmacists to determine if there are any hazards for adverse reactions (and potential hospitalizations). They can also work with the pharmacist to identify optimal combinations that will reduce unpleasant side effects and enhance adherence.
  • Multiple doctors/specialists. Although a home care company might provide transportation to medical or PT appointments, it is beyond their scope to communicate treatment decisions back to the families, let alone coordinate the suggestions of multiple providers or advocate for patient preferences while at the doctor’s office.
  • A sudden change in health. Situations such as a stroke or a fall and broken hip can result in a drastic change to daily care needs. The client will be distressed and their life disrupted, and family members will need a lot more attention and explanation and reassurance about care needs, functional ability, and the “new normal.” There may be new specialists involved and new medications (see the first bullet point for ways in which care managers can positively affect these complex medical situations). Transitions in the face of an acute or unexpected change are much smoother for everyone if a care manager is involved to handle the extra communication and coordination needs.
  • Distant and involved family members. According to the National Institute on Aging, about 15% of adult daughters and sons live an hour or more away. These are the families that have the greatest need for home care services. They often make up a significant share of a home care company’s client base. Without eyes and ears on the ground, these long-distance family caregivers feel helpless, anxious, and even more guilty (if that’s possible!) than those who live closer. Much as they are worried about their loved one and want to be involved, the distance makes that unrealistic. In their heart of hearts, they want someone to be there to act in their stead. Depending on the level of detail and the activities involved, these family requests can become more than a home care company can provide. Although a care manager is not there to replace a daughter or son, he or she can serve as those eyes and ears and—with the client’s permission—communicate to family members and provide reassurance and perspective about their relative’s health, well-being, and changing needs and prognosis.
  • Multiple family members. Much as family members mean well, the more players there are, the more confusing it gets. The home care company is simply trying to ensure the client is cared for reliably and professionally. They don’t have the bandwidth to handle talking with several different family members and keeping them all up to date. An Aging Life Care Manager has systems in place to handle—and bill for—this scenario, which allows the home care company to concentrate on what they get paid to do.
  • Difficult family dynamics. Unless a home care agency is headed by a social worker, family conflict is not usually within their comfort zone or area of expertise. Sibling rivalry and dysfunctional families are a fact of life, however, and they can be very time consuming for a home care business. Moreover, clients often lose when there is tension in the family. An Aging Life Care Manager is trained in problem solving and family dynamics and can provide professional guidance, facilitate a family meeting, etc. Families that learn to set aside their differences and put the needs of Mom or Dad first are much easier clients for a home care company to serve.

To find an Aging Life Care Manager in your area, go to the member directory of the Aging Life Care Association™.

In my next two blog posts, I’ll talk about the role of money and finances in the home care/care manager referral process. If you haven’t yet connected with me here on LinkedIn, please do! Then you will get notification in the upper right corner of your LinkedIn home page when the next posts come out.

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