It was the moment Joel Cohen most feared -- no one was answering at his father's house in Baltimore. His 87-year-old father was legally blind, almost deaf and increasingly senile. He also was almost 1,700 miles away.
But Dr. Cohen didn't have to catch a plane or drive madly for hours to find out whether his father was OK. The Denver math professor simply dialed the Baltimore firm he had hired to help care for his dad, and 20 minutes later, the answer came back: His father was outside on the porch with a radio, listening to the ballgame.
The elder Mr. Cohen, a retired city health inspector, refused to move with his son to Denver after his second wife died in 1986. So Joel hired a social worker to check in on him, first once a month, then once a week. Now a health aide is with him 24 hours a day.
A decade ago Mr. Cohen would have ended up in a nursing home. Today Joel, 50, and his brother, Daniel, 53, a physician in London, oversee their father's care long distance with the help of a care manager.
More and more adult children, bewildered by the array of services for the elderly and often living far away, are hiring firms with names like Senior Connections and ElderOptions to manage care for their loved ones. The companies are run by a geriatric care manager, a social worker or nurse who employs a host of aides to cook, clean and provide medical care for people like Mr. Cohen.
And the demand for geriatric care managers is growing rapidly. Last year the Tucson-based National Association of Professional Geriatric Care Managers had 400 members. This year there are 700.
In Maryland there are at least 13 care manager businesses and a dozen other solo practitioners, including gerontologists who work with lawyers or trust officers.
The profession is neither licensed nor certified, although a national exam for geriatric social workers is to start in January. Experts advise hiring social workers or nurses with experience in caring for the elderly.
"Geriatric care managers are in a sense a service broker or advocate. They cut through red tape. Like an attorney serves as a guide to the legal system, a geriatric care manager serves as a guide to elder services," says Helen Susik, an expert on the elderly at the University of South Florida in Tampa and author of "Hiring Home Caregivers."
They are priced like lawyers, too. Rates range from $50 to $175 an hour, with most around $90.
But many adult children struggling to care for aging parents consider the money well spent.
"I considered it mental health money, the best money I ever spent," says Joan Root, who paid $90 an hour for a geriatric care manager for her mother.
Services for the aging are complex and difficult to obtain. They vary by income and are sponsored by government, churches and private non-profits.
"Most families have never even heard of the Elder American Act or Meals on Wheels or anything that can keep elderly people in their homes," says Ms. Susik, a geriatric social worker.
Nonprofit care managers
Care managers are also available from private nonprofit groups such as Catholic Charities in Baltimore, which charges far less for the service. And they can be found through local offices on aging, through hospitals and other health services.
When Mrs. Root's mother, now 82, suffered a stroke in Yonkers, N.Y., in January 1992, the Washington, D.C., artist had only a few weeks to decide where her mom should live.
As she began sorting through the maze of aging facilities and nursing homes, she was completely confused.
"I thought to myself: 'There must be someone who is the equivalent of a high school guidance counselor,' " she recalls.
From a local office on aging in Alexandria, Va., she got the name of Pearlbea LaBler, a Rockville social worker who owns a geriatric care company called ElderOptions. After assessing Ms. Root's mother's health and financial situation, Ms. LaBler narrowed the possible assisted living facilities for her from 40 to two.
"I felt I had found my fairy godmother," Ms. Root says.
ElderOptions helped when her husband's mother needed to be moved south from New York, and again in April, when Ms. Root's mother needed to be moved to a nursing home. Now Ms. Root hires ElderOptions to serve as second-in-command when she travels or vacations.
"Any number of people of my age are facing similar problems," Ms. Root says. "We are all groping."
While geriatric case managers can help move elderly parents into assisted living facilities or nursing homes, most are being hired to help care for the elderly in their own homes.
Private services, when they include 24-hour home health aides, range from $3,000 to $4,500 a month -- similar to and sometimes more expensive than a nursing home. Neither option is covered by government health insurance except for the poor or, in the case of Medicare, when a person suffers from an acute medical condition and a doctor orders it.