National
Association of Professional
Geriatric Care Managers
1604 N. Country Club Road
Tucson, AZ 85716-3102
(520) 881-8008
(520) 325-7925 Fax
TDD: (520) 326-2467
*These Standards
were adopted by the National Association of Professional Geriatric
Care Managers on October 20, 1990 at the 6th Annual Meeting held in
Washington, D.C., and revised June, 1991, October, 1992, June 1996,
March 1997, and October 1999.
Preamble
These standards
have been developed because professional geriatric care management
is a human service specialty provided by professionals from diverse
backgrounds and academic preparations to a vulnerable and often frail
population. No one profession can claim exclusive domain over the
knowledge and skills required to provide geriatric care management
services. Thus, professional geriatric care managers may be members
of formal professions, such as social work, nursing or psychology,
or may hold advanced degrees in gerontology, counseling, public health
administration, or other fields of human service specialization.
In addition, these
Standards have been developed because certain issues of particular
concern to professional geriatric care managers have not always been
included in the standards developed by other organizations. Thus,
the purpose of these Standards is to supplement already existing standards
of other professions and organizations and to provide guidance to
the members of the National Association of Professional Geriatric
Care Managers, (GCM), in the many complex situations presented by
their practices. Members of GCM are expected to abide by the standards
of their respective professions, as well as to these Standards developed
specifically for their practices in professional geriatric care management.
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Standards and
Practice Guidelines
- Who
is the Client?
- Fostering
Self-Determination
- Right
to Privacy
- Definition
of Role to Other Professionals
- Development
of Plans of Care
- Integrity
of the Older Person and PGCM
- Fees
for Service
- Advertising
and Marketing
- Undertaking
Fiduciary Responsibilities
- Knowledge
of Employment Laws
- Disclosure
of Business Relationships
- Continuing
Education
- Professional
GCM Client Relationships
Standard
1
Standard
While the primary
client usually is the older person whose care needs have instigated
the referral to a professional geriatric care manager, all others
affected by her/his care needs should be considered part of the client
system.
Rationale
In the area of
professional geriatric care management, the care needs of the older
persons often have significant consequences for others. The professional
geriatric care manager's goal is to assist the individual members
of the client system to understand fully the issues under consideration
and arrive at a solution that allows maximum decision-making autonomy
for the person receiving care and for the other persons involved with
or affected by these care needs.
Guidelines
- The "primary
client" may not be the person who makes the initial contact or the
person responsible for payment for services rendered.
- Members of the
"client system" may include:
- the older
person
- a family
member within or outside of the older person’s household
- a paid caregiver
- friends,
neighbors or community agencies
- a third
party with fiduciary responsibilities
- other professionals,
such as a physician, a nurse from a home health care agency,
an attorney, etc.
- the professional
geriatric care manager.
(See
Standard 6)
- In the event
of conflicting needs within the client system, the goal of professional
intervention should be to strive for resolution through a process
of review and discussion among the parties, facilitated by the professional
geriatric care manager.
- The professional
geriatric care manager should request assistance of appropriate
peers, as needed, to help the client system find an acceptable solution
to the conflicts it faces.
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Standard
2
Standard
To the greatest
extent possible, the professional geriatric care manager should foster
self-determination on the part of the older person.
Rationale
All too often,
the older person’s goals, values and voiced opinions are overlooked
by health care professionals and family members who feel that they
have the older person’s best interests at heart. Professional geriatric
care managers have a responsibility to respect the older person’s
right to make decisions regarding her/his care.
Guidelines
- The professional
geriatric care manager must attempt to involve the older person
in all decisions that impact her/his life regardless of the determination
of competence.
- As the older
person makes decisions on her/his own behalf, the professional geriatric
care manager (PGCM) should see that the following are understood
and discussed. In addition, the PGCM should encourage the older
person to communicate, verbally or non-verbally, her/his wishes.
- The specific
information needed to make a given decision.
- The consequences
of alternative decisions that could be made.
- Whether
or not the consequences of these decisions are in accord with
her/his personal values and goals.
- If the older
person has not comprehended the factors involved in the decision-making
process and, therefore, cannot make a responsible decision, then
the professional geriatric care manager should see that all decisions
concerning the older person are made by the person(s) with the legal
authority to do so.
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Standard
3
Standard
The professional
geriatric care manager should respect the older person’s and, when
applicable, the family’s right to privacy by protecting all information
that is given in confidence and all information of a confidential
nature. It should be made clear to the client the limits of confidentiality
as appropriate.
Rationale
The professional
geriatric care manager (PGCM) generally needs to share information
with others in order to fulfill her/his responsibilities. The PGCM
utilized knowledge of the older person’s physical and mental status,
financial and legal affairs, and family and community supports to
assist her/him to achieve maximum well-being. Due care must be exercised
at all times to protect the privacy of this information.
Guidelines
- The information
contained in case files is considered privileged and confidential.
- The professional
geriatric care manager should obtain a release of information that
covers all actions taken on the behalf of the client so that pertinent
information can be shared for the benefit of the older person.
- The professional
geriatric care manager should act judiciously when sharing information
within families and with other professionals.
- The professional
geriatric care manager should insure that all consultations and
interviews are held in locations which allow for the maximum amount
of privacy.
- Confidentiality
is waived when the PGCM has good reason to believe life is threatened
or the laws of the State, in which the PGCM practices, require the
reporting of suspected abuse or neglect.
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Standard
4
Standard
The professional
geriatric care manager should define her/his role clearly to other
professionals.
Rationale
Since the specialty
of professional geriatric care management is a relatively new one,
other professionals may not have worked with professional geriatric
care managers before. Thus, uncertainty may exist as to how each can
complement the other’s rule. It is of utmost importance for all professionals
involved in the care of the older person to have a clear understanding
of each others’ areas of expertise and responsibility.
Guidelines
- Professional
geriatric care managers should act only in the roles for which they
have the appropriate skills, knowledge and training. She/he should
not claim knowledge and skills in roles for which she/he does not
have adequate training and should recommend consultations with specialists
as needed.
- With proper
consent the professional geriatric care manager should share information
concerning the needs of the older person or client system with professional
colleagues in a forthright, clear and timely manner.
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Standard
5
Standard
The professional
geriatric care manager should strive to provide quality care using
a flexible care plan developed in conjunction with the older person
and other persons involved in her/his care.
Rationale
A plan of care
with the stated recommendations, goals and appropriate interventions
must be flexible enough to deal with the older person’s changing status.
The overall goal is to strive to assist the older person to attain
the highest level of health and quality of life that is possible within
her/his particular set of circumstances.
Guidelines
The care plan should:
- Have a systematic
and concise format.
- Be updated as
goals and recommendations are met and as needs change.
- Be acceptable
to the older person and the client system.
- Foster self-determination
of the older person while balanced with the person’s need
for safety. (See
Standard 2)
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Standard
6
Standard
The professional
geriatric care manager should act in a manner that insures her/his
own integrity as well as the integrity of the client system.
Rationale
One of the professional
geriatric care manager’s (PGCM) most important roles is to be an advocate
for the older person. At the same time, the PGCM’s own values and
beliefs must be taken into consideration when working with the older
person and client system.
Guidelines
- After careful
consideration of both her/his own values and those of the client
system, the professional geriatric care manager (PGCM) can appropriately
refuse to accept a new case or continue in a case in which she/he
is already involved if the PGCM believes that the situation would
require compromising her/his own values, beliefs or standards. The
PGCM can terminate her/his involvement in an ongoing case by providing
timely written notice to allow for alternate arrangements to be
made. She/he is obligated to make an effort to refer those cases
that she/he is unable to accept to an appropriate resource.
- If the professional
geriatric care manager finds her/himself in a circumstance in which
the integrity and safety of the older person is at risk (eg. abuse,
neglect or self-neglect) she/he must make a report to the appropriate
authority in accordance with national and state laws and regulations.
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Standard
7
Standard
All fees for professional
geriatric care management services are to be stated in written form
and discussed with the person accepting responsibility for payment
prior to the initiation of services.
Rationale
The older person
and the family often contact the geriatric care manager at a time
of great stress. To prevent any misunderstandings regarding fees it
is in the best interest of all parties to have information in written
form prior to the initiation of services. If time does not allow for
this then all information should be verbally presented and followed
in writing.
Guidelines
- Fees should
be charged for services rendered and presented in a clearly itemized
statement. These fees should not be based on a percentage of a person’s
assets.
- At intake, older
people or families determined to be unable to pay for care management
services can be referred to publicly supported agencies that can
provide the necessary services. An older person with an established
relationship with a professional geriatric care manager (PGCM),
but who can no longer pay for services, should not be abandoned.
The PGCM must make every effort to provide linkage with a community
agency suited to her/his needs.
- Professional
geriatric care managers are encouraged to provide free services
as a professional responsibility. Free services are to be of equal
quality as for person paying for services.
- To the extent
that the practices of fee splitting and receiving referral fees
from vendors/professionals who are providing services to the older
client are legal, they will not form the basis of any disciplinary
enforcement. Nevertheless, GCM does not support these practices,
and in the view of GCM, they may raise significant ethical and conflict
of interest issues.
- Professional
geriatric care managers, should not pay for her/his services through
direct access to client accounts without supervision by a third
party.
- Professional
geriatric care managers should not bill third party payers, including
Medicare, for geriatric care management services that are not covered
by the insurer.
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Standard
8
Standard
Advertising and
marketing of services should be conducted within all guidelines and
laws governing the advertising of professional management services
as they relate to the provision of professional geriatric care management.
Rationale
Families facing
the stresses of coping with complications of aging, dementia, chronic
illness or death are vulnerable to claims which suggest a rescue or
immediate relief of stressful circumstances. Older persons faced with
debilitating illnesses, decreased capacity for judgment and limited
financial resources are likewise vulnerable to specious claims.
Guidelines
- The responsibility
for truthful and non-deceptive advertising rests with the professional
geriatric care manager. All attempts should be made not to use advertising
that is deceptive, fraudulent, insincere of falsely disparaging
of competitors. Specific caution is urged in the area of misrepresentation
by omission or obfuscation of material fact.
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Standard
9
Standard
The professional
geriatric care manager who accepts a fiduciary responsibility should
act only within her/his knowledge and capabilities and should avoid
any activities which might comprise a conflict of interest.
Rationale
When, due to physical
frailties or cognitive losses, an older person is not able to handle
certain financial transactions, e.g. balancing a checkbook or paying
bills and there is no family member or other party to accept these
responsibilities the professional geriatric care manager can act as
a "pay agent." The older person may also need a conservator, guardian
or power of attorney.
Guidelines
- When undertaking
"pay agent" responsibilities the professional geriatric care manager
should obtain written consent from the older person or a responsible
third party with power of attorney.
- The professional
geriatric care manager, in the role of "pay agent," should not act
as a financial advisor regarding client’s assets or investments,
unless qualified to do so.
(See
Standard 7)
- The professional
geriatric care manager (PGCM) should avoid, where possible,
self payment or the undertaking of power of attorney, guardianship,
or conservatorship. If the PGCM has no alternative than to
pay for her/his services through direct access to client accounts
then this should be done with oversight by a third party.
(See
Standard 7)
- When asked to
take responsibility for a purchase (of goods or services) not commonly
within the "pay agent" agreement, the care manager should appropriate
comparative pricing and make the purchase only with the agreement
of the older person or a responsible third party.
- Records of all
transaction should be kept current in a format recognized by standard
accounting practices, and should be open to inspection by appropriate
parties.
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Standard
10
Standard
The professional
geriatric care manager should be familiar with laws relating to employment
practices and should not knowingly participate in practices that are
inconsistent with these laws.
Rationale
Professional geriatric
care managers (PGCM) are often concerned with private duty caregivers,
either in screening and recommending them to clients for hire, or
in coordinating and/or supervising their work. In addition, PGCM may
employ other professionals or service providers. In either case, they
need to be aware of applicable employment and tax laws.
Guidelines
- Professional
geriatric care managers should not knowingly participate in employment
practices that are not legal, i.e., recommending or employing persons
not legally permitted to work, condoning non-payment of wage taxes,
or wages that do not meet minimum wage requirements.
- Professional
geriatric care managers should use, and recommend that clients use
the appropriate legal and accounting professionals to ensure that
applicable laws are followed.
- Professional
geriatric care managers may also want to be familiar with the appropriate
State and Federal agencies which handle employment practices.
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Standard
11
Standard
The professional
geriatric care manager should provide full disclosure regarding business,
professional or personal relationships she/he has with each recommended
business, agency or institution.
Rationale
When developing
a plan of care, the professional geriatric care manager (PGCM) often
will need to make referrals to businesses, agencies or institutions
that can provide needed services. It is important for the older person
and his/her family to be informed if the PGCM has a relationship other
than objective third party with that agency, e.g. Board of Trustees,
ownership, investor, family member.
Guidelines
- When a referral
is made the professional geriatric care manager should clarify to
the client any special relationship that exists with the recommended
business, agency or institution.
- When the professional
geriatric care manager has a business, professional or personal
relationship with a recommended business, agency or institution,
she/he should provide to the client information regarding alternative
choices.
- When a professional
geriatric care manager sells his or her practice, the client will
be notified in writing of the opportunity to use the GCM services
of the buying party or to use alternative services.
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Standard
12
Standard
The professional
geriatric care manager should participate in continuing education
programs and be a member of her/his respective professional organization
in order to enhance professional growth and to provide the highest
quality care management.
Rationale
To remain up to
date with scientific, cultural, political, legal and social changes
in the area of gerontology it is incumbent upon the professional geriatric
care manager (PGCM) to continually take part in educational programs
that will enable her/him to provide the highest quality care management.
In addition, both the PGCM and those persons to whom she/he provides
services will benefit from the PGCM’s participation in her/his respective
professional organization. The PGCM thus will practice in accord with
that organization’s standards, in addition those specific to professional
geriatric care management.
Guidelines
Professional geriatric
care managers should:
- be certified,
if applicable, and/or licensed, as required, in her/his area of
expertise,
- seek peer supervision,
as needed,
- seek consultation
with other professions, as needed.
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Standard
13
Standard
The PGCM should
not exploit professional relationships with clients and families for
personal gain.
Rationale
The PGCM needs
to "be alert to and resist the influence and pressures that interfere
with the exercise of professional discretion and impartial judgment
required for the performance of professional functions" (NASW Code
of Ethics). The best interests of the client are the focus of the
PGCM.
Guidelines
Professional geriatric
care managers should:
- charge reasonable
fees as reimbursement for services rendered.
- avoid personal
relationships with clients and families that may impair judgment
or lead to exploitation.
- under no circumstances
engage in sexual contact with clients.
The mission of
the National Association of Professional Geriatric Care Managers is
to provide dynamic leadership, education and collaborative relationships,
to promote the development of clinical expertise, excellence in service
delivery and high ethical standards for the practice of care management.
Revised March,
1997
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