Far From Home

      You live in one state. Your elderly parents live in another state.
      When an accident, acute illness or Alzheimer's disease hits your parents, you enter the state of panic because you can't just pick up and move near them to help out.
      But a new professional has emerged to breach this long-distance gap: the geriatric care manager. As American families continue to be mobile and dispersed, a network of professionals is emerging to serve as liaison between the elderly and their far-flung relatives.
      Mike Kalashian lives in the San Francisco Bay area. His 84-year-old mom lives in Las Vegas.
      After she broke her hip a couple of years ago and was ready to be released from a local convalescent center, Kalashian and his brother didn't know if their mom could resume living alone in her apartment. Kalashian called Mary Shapiro, a geriatric case manager who lives in Las Vegas.
      A gerontologist by training, Shapiro is also a member of the National Association of Professional Geriatric Care Managers, whose members include nurses, social workers and others who have received geriatric training. Kalashian simply dialed the Arizona-based association and received a list of care managers located in Southern Nevada.
      First, Shapiro did in-depth interviewing of the mom's wants and needs and also assessed her abilities and limitations. Then Shapiro -- who is familiar with local senior services and housing -- prepared a list of options for the family to consider.
      With Shapiro's information, the mother and sons eventually reached a consensus that Mom would do best living in a nursing home where she had 24-hour assistance, although she does not need skilled nursing care.
      "I feel less apprehensive and less guilty," having a professional such as Shapiro evaluate his mother's well-being and to research the alternatives, admits Kalashian, 53, who is single and travels a great deal for his job as a marketing manager with Hewlett Packard Co.
      Shapiro is "my eyes and ears in Las Vegas," says Kalashian, who also periodically sees his mother, but sometimes needs to go a month or two between visits.
      Kalashian pays Shapiro's fee, but he points out that Shapiro did not act as his agent, so much as his mom's: "My mother fell in love with her. (Shapiro) is very compassionate, asks the right questions without being threatening. ... She gained my mother's respect."
      Initially, the family had decided to have Kalashian's mom move back into her apartment -- after convalescing -- with aides coming in frequently to assist her with bathing and light housekeeping. But that was not adequate, they soon judged -- thanks in part to Shapiro's ongoing monitoring of the situation. Moving to a nursing home was the next, natural step.
      According to Kalashian, his mother has always been extremely independent. He believes she agreed to move to a nursing home largely because of Shapiro's objective stance.
      "Mary is not her family," Kalashian says. "She feels she can be completely open with her, and (Shapiro) will not be judgmental or embarrassed."
      For his part, Kalashian checked in with Shapiro several times a week during his mom's transition period from convalescence center to apartment to nursing home. He still confers with her every couple of weeks to make sure the home performs up to the family's expectations.
      "Your narrow focus is `How can I help the older person best continue in dignity, with a sense of worth?,' " Shapiro says. Her wider focus is to help the older person or couple's family reach consensus on what is best.
      She says she's able to gain rapport with her older clients by explaining upfront that her role is not to force them from their homes and autonomy: "You want to assist the person to stay in their home for as long as possible."
      Sometimes Shapiro's job is simply to assess the older person's current living arrangement, head a family "summit" meeting to present a series of proposals for possible changes, and then bow out.
      In other cases, she is responsible for executing the selected plan of action -- everything from making sure any home aides are punctual and do a good job to making sure the older person's checks to pay the utility bills are written and sent.
      Shapiro's gerontology practice is not devoted exclusively to care management. She also leads a support group for families dealing with Alzheimer's disease and trains caregivers of the elderly. She has chosen not to offer sophisticated financial services to her clients -- although some members of the National Association of Professional Geriatric Care Managers do.
      Some of the larger corporate members of the association even offer tailor-made services such as escorting an elderly person from one airport gate to the next, if the person has to fly alone and change planes in a city where no family member is present.
      Donna MacDonald of Las Vegas is the only other member of the association who lives in Southern Nevada, according to its membership directory. A nurse with geriatric training, MacDonald is director of nursing at El-Jen Convalescent & Retirement Center, and occasionally gets referrals for geriatric care management.
      Both MacDonald and Shapiro say their referrals come mainly when a concerned grown child -- or even a family friend -- calls the national association or a lawyer about an older person whose capabilities may be deteriorating.
      Demographic data shows that Southern Nevada is probably ripe for increased presence of geriatric care managers. Many older residents have retired here from elsewhere, with few or no relatives nearby.
      In 1970, seniors 65 or older constituted 5 percent of the Clark County population, according to census data from the county's planning department. In 1980, that age group swelled to 8 percent. In 1990, it swelled to 10.5 percent.
      The National Association of Professional Geriatric Care Managers was founded in 1986. It now has 950 members.
      According to Laury Adsit, its executive director, care managers charge for their work in various ways.
      Some have an hourly charge. A care manager performing home aide functions may charge $20 per hour, while a care manager who does psychoanalysis might charge $150 per hour, Adsit explains.
      Other geriatric care managers charge a flat fee for the initial assessment and then negotiate a flat monthly fee for an agreed numbers of hours of service per month. Depending again on the services supplied, a monthly bill could range from $100 to $3,000.
      The association's set of ethical standards requires members to put information about fees in writing prior to starting services. Services rendered should be billed by a clearly itemized statement.