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Why is care management critical to home care’s future?

A Q&A with Kate Granigan, MSW, LICSW, C-ASWCM, Vice President, Care Management, Overlook CARE

Where many fear obstacles, the entrepreneur seizes opportunities to make things better.

For more than 20 years, Kate Granigan has applied her passion for care management and her entrepreneurial drive to help families manage the complex and often-confusing array of care options for their elderly and disabled loved ones.

From 1999 to 2009, the agency Kate founded – Consulting Advocacy Resources for Elders, (CARE) – earned a reputation as an experienced, proactive private-pay counselor and advocate for seniors across the South Shore region of Massachusetts and the families responsible for their care.

In 2009, CARE was acquired by the Masonic Health System of Massachusetts (MHS) and renamed Overlook CARE. Kate’s organization became part of a MHS senior care portfolio that includes a continuum of care retirement community, a visiting nurse association, a hospice care organization and a free help line.

We met recently with Kate to talk about how she built her business, her role at Overlook CARE, and her vision for the future of senior care.

Q: Why and how did you choose to work in the field of care management?

A: Before I started in social work I earned my undergraduate degree in education and began working with families and troubled youth. As I began to raise my own family, I shifted my career focus and became a social worker for a visiting nurse association in 1995.

In the 1990s, social workers were included as part of an individual’s care team as long as there was a clinical need for our services. My frustration was that this was a very reactive model of care. Once the patient’s clinical issue had been addressed, there was no opportunity to continue with the social work component only.

I saw that our senior patients were not able to coordinate the outside services they needed on their own after the VNA’s services ended. Their situations would deteriorate, and they would end up back with the VNA. At that time, the concept of a private care manager was not widespread. I knew there had to be a better way.

Q: Why and how did you start Consulting Advocacy Resources for Elders (CARE)?

A: My goal was to be an advisor to caregiving families. I wanted to be able to take an objective look at a senior’s needs and recommend the best options to them and their families.

In addition to my master’s in social work, I’m a Licensed Independent Clinical Social Worker (LICSW) and a Certified Advanced Social Worker Case Manager (C-ASWCM). These credentials equipped me well to serve my new businesses’ clients and continue to serve me today.

In addition to counseling families on a private-pay basis, I also did in-home mental health counseling, working closely with Massachusetts’ Aging Services Access Point (ASAP) offices and Area Councils on Aging.

I ran CARE from my home office and began to receive more referrals than I could handle. I began to hire social work care managers and added a business partner to help meet the growing need. In 2009 the Masonic Health System of Massachusetts acquired my company: that’s how we became Overlook CARE.

Q: How does Overlook CARE operate today? How do you lead the organization?

A:  As they age, more people are becoming inundated with choices and decisions, many with significant consequences. Our clients are families – primarily daughters and sons – who are overwhelmed in making decisions for their parents or older relatives. Our care managers’ role is to be a consultant, an advocate and a quarterback.

Currently, Overlook CARE has a staff of 12. Our professionals have either a nursing or a social work background. Our Executive Director, Jennifer Warren, has a PhD in gerontology! Some of our staff members began their careers with the state’s Aging Services Access Points. We have significant interaction with other professionals on all levels that support our team, keep our families informed and in charge, and help guide their decisions. Especially in our business, it’s about hiring the right people.

Our services include the full spectrum of care management advice and counseling: from the initial assessment, to management of a sudden health crisis, to being an advocate for the client with his or her health care team, to ‘check in’ visits to clinical oversight. We coach family caregivers on how to reduce stress, communicate with their loved one and work with any contracted services such as homemakers, home health aides, skilled nursing staff, social workers, physical therapists and more.

Overlook CARE literally does whatever our clients need, whether it’s a one hour consult, an ongoing schedule of talks in person or over the phone, coordination of the next level of care for their loved one—or all of the above. We apply our clinical expertise, our knowledge of disease process and aging, and our knowledge about how people desperately try to hold onto their independence.

We coach people on common situations, for example, how to appropriately vet any strangers who come into the home. We help caregiving families understand that it’s OK to set limits. That it’s ok to balance your needs with your elder loved one’s needs. We give our clients both permission and strategies to introduce professional care into the home. We give people real-time info about the elder care landscape because families often lose the forest for the trees.

Our referrals come from family members, or other supportive people, but typically not the client themselves. And when family members come to us with a perceived crisis, it is also our role to be objective. We may actually see that Mom and Dad ARE OK and are able to make their own decisions even though their living situation may not be perfect.

My role is to oversee how our services are provided and how our people work; to what resources, services and community partners we refer our clients. While I no longer do the day-to-day clinical work, my 20 years of clinical experience gives me a deep appreciation for what our team does and accomplishes.

Overlook CARE’s clients pay for our services from their private funds. Our clients are not just older individuals, but also people challenged with chronic mental illness, which is an area of specialty for us as well as people with developmental challenges.  If a family doesn’t have the resources to pay for our counseling and advocacy services, we will give them the support we can on the phone but then refer them to one of our state’s Area Agencies on Aging and/or Aging Service Access Points or other resources to which they may be entitled, because that’s their right. The good news is that the ASAPs also offer case management services.

Q: How do you go about referring your clients to outside services: home health care, nursing, senior living, physical therapy, hospice, and more?

A: When making service referrals, and in keeping with our role as objective care managers, we look at every client as an individual with unique needs. As part of our code of ethics, Outlook CARE receives no financial benefit for the referrals we make. This sets us apart in our industry.

In joining the Masonic Health System, I needed to uphold my professional integrity and that of the company I created. Part of my role in integrating Outlook CARE with MHS was to help the parent organization understand that it is not always appropriate to refer clients to options within its system. So even though we are affiliated with Masonic Health Care and Overlook VNA, those entities are not always the right choice for our clients. And our organization is respected for this.

Q:  What industry groups support professional care managers, and how?

A: We are members of the Aging Life Care Association (formerly the National Association of Geriatric Care Managers).  This association’s goal is to define and promote the highest standard of practice by professionals who assist elders and their families.

This national organization is raising public awareness that highly trained professional care managers exist. I give talks and people come up to me and say, “I wish I knew about your services six months ago.” Others will learn about what we offer, and say “we’re not yet sure if we need your services and don’t want to pay the costs.” Our response is always “call again if you need us.”  Then the family calls back in six months to report that they are in a world of trouble with their elder loved one and need immediate help in navigating their options. We wonder how different the outcomes could be if we helped more people in a proactive, ongoing way.

Q: How do you see the future of the home care industry evolving over the next few years as our aging population continues to increase?

A: Our biggest challenge is to help people become educated consumers. Many head into their retirement with health insurance and believe they’re all set. But until they get to the point where they need to access care, they really don’t understand the costs or the process.

The future of care depends on our understanding the future of aging. It means understanding our right to make informed decisions and the importance of having important documents in place. Not just having conversations over the dinner table, but drawing up guidelines that help others understand and follow through on our care.

I want to recognize the work of Honoring Choices Massachusetts, a non-profit organization that helps people make a health care plan and connect to care that honors their choices throughout their lives. Led by Ellen DiPaola and Kathy Hankel, this network is improving people’s access to healthcare planning and care around the state.

Talking with families and seniors — regardless of where they are on the care spectrum — has been really valuable to me. There is such a gap in services for middle-income people who are trying to make health care work for them. If we can just provide consultation to help families separate their thoughts and consider their options, that’s valuable.

Healthcare is only as good as we let it be. Older generations tend to not question their healthcare providers, but that is changing with the younger population. We should pause, understand what our goals are and what we want from healthcare. We need to be creative about caregiving. We need to find ways to maximize the billions of dollars of unpaid care that family caregivers provide to their loved ones every year. Finally, we need to figure out how to not compete, but collaborate with non-paid family caregivers and other health care providers.


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