Never heard of a nurse care manager? You wouldn’t be the first to say that. We may be the best kept secret in elder care! Here are some FAQs (Frequently Asked Questions) and answers to help you learn more.
- Can a nurse care manager save you money?
- How does the service work?
- What is a care plan?
- What is a nurse care manager?
- When is a nurse care manager needed?
- Are these services covered by insurance?
Can a nurse care manager save you money?
The answer is yes! And time. And headache. For instance:
- Effective planning, monitoring and prevention can help you avoid expensive and painful crises such as a fall, or hospitalization.
- Deep knowledge of community resources and eligibility requirements allow you and your loved one to avail yourselves of existing free or low cost services that may mean the difference between staying at home or having to move to an expensive facility.
- Thorough understanding of Medicare, Medicaid and long-term care insurance helps assure that the proper billing occurs and that all covered medical, hospital and facility expenses are paid to the fullest extent allowable. Duplicate coverage, duplicate medical tests, and other inefficiencies can also be identified and addressed.
- Extensive experience working with elders, and their families, helps you avoid common, and emotionally/financially costly mistakes. Fewer days off work. Fewer moves. Easier transitions.
How does the service work?
As a general rule, a nurse care manager begins by doing an assessment. This involves meeting with the elder (client) over the course of a visit or two to the home. They discuss the elder’s personal priorities and values, any concerns he or she might have, and what activities and interests are most important to him or her.
Over the course of the visit, the nurse care manager will observe physical and mental capabilities. A few tests or physical exams may be administered. The assessment is as much about identifying strengths as it is about addressing problems, since building on existing strengths is key to promoting independence and quality of life.
Other assessments may include a review of the home for safety hazards, and a review of insurance and financial resources to help the client and family maximize use of any social service programs that may be available.
Following the visit, an individualized care plan will be recommended. The elder and family then have the option to proceed with this plan independently, or retain the services of the nurse care manager to assist with the plan’s implementation.Return to top
What is a care plan?
A care plan involves a series of recommendations for current support options, as well as some suggestions for likely needs within the next 6 months or so. Some elements that might be included in the care plan are:
- Home modifications to improve safety and reduce risk of falls.
- Medication management strategies to reduce the likelihood of over/under-medication and a consequent hospitalization.
- Recommendations for meals, transportation, housekeeping, pet care and other services.
- Review of insurance coverage and analysis of eligibility for services covered under existing policies.
- Hiring of professionals such as bill payers or legal or financial services.
- Periodic visits and reassessments to assure appropriate supports are working as expected and to monitor in case new needs develop.
- Personalized suggestions for appropriate housing arrangements such as in-home care, assisted living, residential care, or skilled nursing facilities.
What is a nurse care manager?
A nurse care manager is a professional who specializes in assisting older people and their families as they navigate the aging process. Health challenges, memory problems or living far away, all contribute to a daughter or son’s worries. Loss of independence, loss of dignity, loss of friends and community are concerns that haunt seniors and threaten their quality of life. A nurse care manager brings a firm grasp of the physical, emotional and mental complexities of the aging family and works with everyone to develop a mutually agreeable plan of care.Return to top
When is a nurse care manager needed?
Nurse care managers are usually called in when the time and the stress of providing care to an aging relative conflict with a family member’s work or other obligations. Perhaps the closest family members live far away.
Sometimes there’s a crisis, such as a fall and a broken hip, which requires a temporary change in support. Perhaps a spouse has died and the remaining elder is having trouble with grief and loss, making the adjustment to widowhood. Other times a holiday visit may bring to light memory problems or other difficulties that bring into question the safety of the current living situation.
Nurse care managers are often called in when there is disagreement among siblings and a professional, objective opinion is needed to determine the best course of action.Return to top
Are these services covered by insurance?
Because Medicare and Medicaid only pay for the services of physicians and facilities, the assessment and care coordination of a nurse care manager are not a covered service. Some long-term care insurance policies will cover the costs of a nurse care manager. Also, we can help you determine if there are other options, such as Veterans Aid and Attendance, to help defray the out-of-pocket expense.
Give us a call if you are concerned about:
- Whether your parent should still be driving
- Whether your parent is taking his/her medicines as directed
- Whether your parent is safe living at home
Similarly, give us a call if you are worried about your family member’s needs and how they are impacting your work, your spouse and kids, your own health and well-being.
You don’t have to do this alone. We can help. Call us at 248-798-6914.Return to top