Standards of Practice For Professional Geriatric Care Managers
The National Association of Professional Geriatric Care Managers adopted these Standards on October 20, 1990 at the 6th Annual Meeting held in Washington, DC. They were revised in June 1991, October 1992, June 1996, March 1997, October 1999, June 2002, August 2002, June 2003, December 2005, April 2007, November 2007, January 2008, April 2008, July 2008, January 2009, October 2009, and April 2010.
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, Geriatric Care Managers (GCMs) 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 GCMs 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 (NAPGCM) in the many complex situations presented by their practices. Members of NAPGCM are expected to abide by the standards of their respective professions, as well as to these Standards developed specifically for their practices in Geriatric Care Management.
Contents
STANDARDS AND PRACTICE GUIDELINES
Regarding the Client Relationship:
1. Identifying the Client
2. Promoting Self-Determination
3. Right to Privacy
4. Recognition of the GCM's Personal Values and Beliefs
5. Professionalism of the Relationship
Regarding the Professionalism of the Practice:
6. Definition of Role to Other Professionals
7. Development of Plans of Care
8. Knowledge of Employment Laws
9. Undertaking Fiduciary Responsibilities
10. Continuing Education
Regarding Business Policies:
11. Fees for Service
12. Advertising and Marketing
13. Disclosure of Business Relationships
Standard 1 – Identifying the Client
Standard
The primary client is the person whose care needs have initiated the referral to a geriatric care manager.
Rationale
The primary client’s care needs take place within the context of their family system and physical and social environments.
Guidelines
A. The primary client may not necessarily be the person who makes the initial contact or the person responsible for payment for services rendered.
B. All others affected by or have an impact on the client’s care needs should be considered part of the “client system” and may include:
-the primary client
-a family member within or outside of the primary client‘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 Geriatric Care Manager (See Standard 4)
C. 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 Geriatric Care Manager.
The Geriatric Care Manager should request assistance of peers, as needed, to help the client system find an acceptable solution when conflicts occur.
Standard 2 - Promoting Self-Determination
Standard
Geriatric Care Managers should promote self-determination of the primary client as appropriate within the context of their situation.
Rationale
The GCM has a responsibility to identify and articulate the client’s wishes, values and preferences so that these can be incorporated into the plan of care to the greatest extent possible, while identifying and clearly communicating risks to the client and/or designated decision maker.
Guidelines
A. The Geriatric Care Manager should involve the primary client and/or designated decision maker, to the greatest extent possible, in decisions that impact his/her life regardless of the client’s decisional capacity.
B. As the primary client is given the opportunity to make decisions on his/her own behalf, the Geriatric Care Manager should ensure that the following conditions are met:
1. The specific information needed to make decisions has been given to, discussed with, and understood by the primary client.
2. The primary client understands the risks and benefits of all options presented.
3. The primary client is able to communicate, verbally or non-verbally, his/her wishes.
C. If the primary client does not comprehend the factors involved in the decision-making process and, therefore, cannot make an informed decision, then the GCM should see that all decisions concerning the primary client are made by the person(s) with the legal authority to do so.
Standard 3 - Right to Privacy
Standard
The GCM should respect the client’s right to privacy and, when applicable, that of the client system. The limits of confidentiality should be clearly explained to the client or designated decision-maker.
Rationale
The GCM frequently needs to share information with others in order to fulfill his/her responsibilities. The GCM utilizes knowledge of the client’s physical and mental status, financial and legal affairs, and family and community supports to achieve maximum well-being for the client. Due diligence must be exercised at all times to protect the privacy of this information.
Guidelines
A. The GCM should consider all information in the client's records confidential.
B. The GCM has a responsibility to be knowledgeable of, and abide by, all applicable state and federal laws and regulations regarding confidentiality and the client’s right to privacy, including with respect to health information and electronic records.
C. The GCM should maintain a valid authorization to release information.
D. The GCM should act judiciously when sharing client information with others.
E. The GCM should ensure that all communications are conducted in a manner that allows for the maximum amount of privacy.
F. The obligation of confidentiality may be waived in circumstances when the care manager believes it is necessary to protect the client from harming him/herself or others.
G. The care manager has a responsibility to abide by the laws of their state relating to vulnerable adults including the reporting of abuse, neglect and exploitation as required in that state.
Standard 4 – Recognition of the GCM’s Personal Values and Beliefs
Standard:
The GCM should have a conscious awareness of their personal values and beliefs and the impact of these on their practice with clients.
Rationale
Personal awareness is neccesary to provide objective professional services.
Guidelines
A. The GCM should be cognizant of their personal and professional value system and beliefs through a continuous process of self-reflection and/or case consultation.
B. If there is a circumstance in which the client’s wishes and preferences are in conflict with the professional judgment and values of the GCM, there is an obligation to identify and address the disparity. The GCM should make every effort to arrive at a mutually acceptable solution. If those disparities cannot be reconciled, the GCM has an obligation to offer alternative services to the client.
C. The GCM may refuse to accept a new case or continue in a case if the GCM believes that remaining in the situation would require compromising his/her own values or beliefs. The GCM can terminate his/her involvement by providing reasonable written notice and recommend alternate services.
Standard 5 - Professionalism of the Relationship
Standard
The GCM should not exploit professional relationships with the older person and/or the client system for personal gain.
Rationale
The GCM 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. The best interests of the client are the focus of the GCM.
Guidelines
GCMs:
A. should avoid inappropriate personal relationships with the older person and/or the client system that may impair their impartialjudgment or lead to exploitation.
B. should under no circumstances engage in sexual contact with the client or family members.
Standard 6 - Definition of Role to Other Professionals
Standard
The GCMshould define his/her role clearly to other professionals.
Rationale
Since the specialty of geriatric care management is not uniformly known and understood, other professionals may not have worked with GCMs. Thus, uncertainty may exist as to how each can complement the other’s role. It is of utmost importance for all professionals involved in the care of the older person to have a clear understanding of each other's areas of expertise and responsibility.
Guidelines
A. The GCM should act only in the roles for which he/she has the appropriate skills, knowledge and training. He/she should recommend consultations with specialists as needed.
B. With written consent from the older person and/or client system, the GCM should share information concerning the needs of the older person or client system with professional colleagues in a forthright, clear and timely manner.
Standard 7 - Development of Plans of Care
Standard
The GCM should strive to provide quality care using a flexible care plan developed in conjunction with the older person and/or client system.
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 his/her particular set of circumstances.
Guidelines
The care plan should:
A. be documented and included in the client file
B. have a systematic and concise format
C. outlinespecific goals that arebased on the needs of the older person as determined during the assessment process
D. ensure that during on-going care management the goals of the care plan are agreed upon by the older person or the substituted decision maker acting on behalf of the older person
E. foster goals of self-determination for the older person with due consideration of the person’s need for safety
F. include an emergency plan to address client safety in a crisis or natural disaster
Standard 8 - Knowledge of Employment Laws
Standard
The GCM should be familiar with laws relating to employment practices and should not knowingly participate in practices that are inconsistent with these laws.
Rationale
The GCM is 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, the GCM may employ other professionals or service providers. In either case, they need to be aware of applicable employment and tax laws.
Guidelines
A. The GCM should recommend or employ only persons who are legally permitted to work. The GCM should not condone non-payment of payroll taxes, or wages that do not meet minimum wage requirements.
B. The GCM should use, and recommend that the client system use, the appropriate legal and accounting professionals to ensure that applicable laws are followed.
C. The GCMmay also want to be familiar with the appropriate State and Federal agencies that regulate employment practices.
Standard 9 - Undertaking Fiduciary Responsibilities
Standard
The GCM who accepts a fiduciary responsibility should act only within his/her knowledge and capabilities and avoid any activities that might suggest a conflict of interest.
Rationale
When an older person is not able to handle certain financial transactions (e.g. balancing a checkbook or paying bills) due to physical frailties or cognitive losses and there is no member of the client system to accept these responsibilities, the GCM may act as a “pay agent.” The role of the GCM in handling fiduciary issues will be further determined by the competence of the older person.
Guidelines
A. When undertaking “pay agent” responsibilities, the GCM should obtain written consent from the older person or a responsible third party.
B. When asked to take responsibility for a purchase of goods or services not commonly within the “pay agent” agreement, the GCM should conduct appropriate comparative pricing and make the purchase only with the agreement of the older person or a responsible third party. If the older person becomes incompetent and has appointed a financial power of attorney (POA), then all bill-paying responsibilities should be assumed by the POA. If the GCM is the financial POA, then the GCM will assume bill-paying responsibilities. Third party oversight of self-payment should continue.
C. The GCM, in the role of “pay agent,” should not act as a financial advisor regarding the older person’sassets or investments, unless qualified to do so. (See Standard 11.)
D. The GCM should avoid, where possible, self-payment. If the GCM has no alternative than to assist the competent client to pay for his/her services, it is recommended that a third party provide oversight for these transactions. (See Standard 11.)
E. If the client has been determined to be incompetent, the GCM may be appointed as guardian or conservator. If so appointed, the GCM will be required to follow all the legal requirements of this court-appointed role. It is also recommended that if a GCM takes on such a role, the GCM should be knowledgeable of and adhere to the National Guardianship Association’s Standards of Practice.
F. Records of all transaction should be kept current in a format recognized by generally accepted accounting practices and should be open to inspection by appropriate parties.
Standard 10 - Continuing Education
Standard
The GCM should participate in continuing education programs to enhance professional growth and development.
Rationale
All GCMs should remain current in best practices and domains pertinent to the discipline of geriatric care management.
Guidelines
The GCM should:
A. engage in continuing education programs
B. participate in courses that relate to geriatric care management
C. read professional publications
Regarding Business Policies:
Standard 11 - Fees for Service
Standard
All fees for 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/or the client systemoften contact the GCM 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 up in writing.
Guidelines
A. 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.
B. At intake, the older person and/or the client system determined to be unable to pay for care management services shouldbe referred to publicly supported agencies that can provide the necessary services. An older person with an established relationship with a GCM, but who can no longer pay for services, should not be abandoned. The GCM must make every effort to provide linkage with a community agency suited to his/her client’s needs, or continue to provide services pro bono.
C. The Care Manager should not participate in practices of fee splitting, accepting or giving referral fees or other similar arrangements with any other party providing services to the client. These practices may compromise the objectivity of the care manager and/or create the appearance of impropriety
D. The GCM should only bill third party payers who are known to cover geriatric care management services.
Standard 12 - Advertising and Marketing
Standard
Advertising and marketing of services should be conducted with honesty, accuracy, and integrity.
Rationale
Older persons and client systems facing the stresses of coping with complications of aging, dementia, chronic illness or death are vulnerable to claims that suggest a rescue or immediate relief from stressful circumstances. Older persons faced with debilitating illnesses, decreased capacity for judgment and limited financial resources are likewise vulnerable to unrealistic claims.
Guidelines
A. Marketing communication is any communication to the public or prospective clients.
B. The GCM has a responsibility to educate clients and the public about the nature of care management as a specialization in order to establish realistic expectations of the service.
C. Only the individual who is the member of NAPGCM may advertise that membership.
D. Each GCM has a responsibility to protect and enhance the reputation of the profession of geriatric care management.
E. Any representation of backgrounds, affiliations, or credentials made by the GCM should be accurate and kept up to date.
F. Use of the NAPGCM logo should be in accordance with the policy on file.
Standard 13 - Disclosure of Business Relationships
Standard
The GCM 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 GCM often will need to make referrals to businesses, agencies or institutions. It is important for the older person and/or the client system to be informed if the GCM has a relationship other than that of an objective third party with that entity, e.g. Board of Trustee, owner, investor, family member, or employee.
Guidelines
A. When a referral is made, the GCM should disclose to the client any special relationship that exists with the recommended business, agency or institution.
B. When the GCM has a business, professional or personal relationship with a recommended business, agency or institution, he/she should offer to provide to the client information regarding alternative choices.
C. Referrals made by a GCM, whether to outside providers or internally within a GCM practice, must be based only on the best interests of the client. A GCM should maintain a position of objectivity when making any recommendations for services to avoid any possibility of a conflict of interest.
D. When a GCM sells his or her practice, the client will be notified in writing of the opportunity to use the NAPGCM services of the buying party or to use alternative services.
Standard 14 - Certification
Standard
New members in the CARE MANAGER category will be required to hold one of the approved certifications starting in January 2008. Any continuing CARE MANAGER member will have until January 2010 to become certified. On January 1, 2010 all CARE MANAGER members without certification will be moved into a new membership category, entitled ASSOCIATE.
Rationale
Certification is an independent way of confirming a basic professional level of practice. NAPGCM supports providing the public with ways to evaluate care managers before they engage their services. The association recognizes the need to determine a basis for establishing geriatric care management as a unique profession and believe that certification is at the core of this process.
Guidelines
The GCM should:
A. Be certified according to those certifications endorsed by NAPGCM, and licensed, if required, in his/her area of expertise.
B. Seek peer/other consultation, which meets the requirement of the appropriate certifying body.
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