I live 1,000 miles away from my elderly father, who needs more day-to-day help than I, with three young children, can provide. What’s a geriatric care manager, and can they help my situation?

Dr. John Connolly

Welcome to the so-called "sandwich generation" of adults trying to juggle child care simultaneously with elder care. As you already must know, working out an arrangement that's amenable to all parties involved would be no picnic even if you did live near your father. The good news, however, is that you heard right: Your situation is exactly one in which a geriatric care manager can be of help.

Geriatric care managers, GCMs for short, act as a more knowledgeable you--informing you and your parent about what kind of care alternatives are available within the community and helping you assess all the medical, financial and legal issues involved with any given choice. Depending upon the scope of the GCM's practice, you can get assistance with the following:

• Evaluating your parent's individual need for outside support within or outside the home, taking into consideration your father's own wishes and expectations and foreseeing potential problems you may hit
• Analyzing your and your father's ability to pay for care provided, with conserving assets ranking among the goals
• Providing counseling and support to all parties involved
• Screening and arranging whatever care services you ultimately choose
• Helping move your parent to or from any care facility
• Monitoring the care being provided and alerting you of current and potential problems

As a member of the same community as your father, the GCM you consider should be thoroughly knowledgeable about what kind of care is available, along with the cost and quality of each alternative, be it an in-home nurse service, a retirement complex or a long-term care facility such as a nursing home. Keep in mind, too, that these people do not represent insurers or other organizations whose cost-cutting policies may conflict with your father's health-care needs. The GCM represents your interests alone.

That said, note that it's also important for you to choose the right GCM. So far, geriatric care management is not well regulated; in other words, anyone can pass himself off as a geriatric care manager, care coordinator or care advisor. Before hiring a GCM, ask about his or her training, education and background. The candidate should have been a GCM for some years and should be a member of the National Association of Professional Care Managers. (For a list of the GCMs within a given region, you can call the Arizona-based Association at 520-881-8008.)

Responsiveness matters plenty. Ask for details on how your prospective GCM keeps in touch--cellular phones, pagers, answering services, voice mail, etc. How large is the GCM's practice or agency? What happens if you call after office hours or when your GCM is off or on vacation? And will you and your father have one GCM as a central contact?

The above list of possible GCM services is not all-inclusive, nor would all the services mentioned necessarily be available from every GCM. Be sure you understand all that the GCM will do for you, and how the GCM determines billing rates. In fact, you should get a written service agreement that provides this information in detail.

Your last step is to ask for several references and check them. After all, you have enough to worry about from such a distance without having to monitor the person you're paying to monitor your father's care.

Dr. John Connolly is President & CEO of Castle Connolly Medical Ltd., America's "trusted" source for identifying top doctors. He has an extensive background in management and healthcare. For more than a decade, he was President of New York Medical College where he successfully revitalized the school while insuring its financial security. Dr. Connolly is extensively involved in healthcare activities including serving as a director of the New York Business Group on Health, as founder, a director and past chair of the American Lyme Disease Foundation, as a member of the Presidents' Advisory Council of the United Hospital Fund of New York, and as a Fellow of the New York Academy of Medicine. He has also served on the boards of two hospitals and as chairman of the board of one, and is currently Chairman of Professional Examination Service, Inc. He also is a frequent guest on regional and national TV and radio shows, including 20/20, CNN and Good Morning America.