Recommendations for Academic Communities Developing Aging Life Care™ / Geriatric Care Management Programs

Download ALCA’s Recommendations

Approved by the ALCA Board of Directors January 2017

Introduction

With the influx of geriatric care management certificate programs, both online and provided by brick-and-mortar institutions of learning, the Aging Life Care Association (ALCA) believes that uniformity of purpose is vital to develop Aging Life Care Professionals™ / Geriatric Care Managers of tomorrow.

In response to requests by many academic communities for assistance with curricula development, in 2012 ALCA’s Educational Alliances Committee began to examine the recommended core competencies set forth by the Partnership for Health in Aging (PHA). The goal was to adapt those core competencies as recommendations for academic communities that are in the process of developing Aging Life Care / geriatric care management programs.

The committee adapted the PHA recommendations by adding additional core competencies that reflect what ALCA feels are the minimal requirements of an entry-level Aging Life Care Professional / geriatric care manager. The PHA Multidisciplinary Competencies include Domains 1 – 6. The Educational Alliances Committee and ALCA approved and recommended the addition of Domains 7, 8, 9 and an Addendum for Aging Life Care Professionals / Geriatric Care Managers.

Brief History on the Partnership for Health in Aging (PHA)

The PHA was conceived by the American Geriatric Society, and established to develop a set of core competencies in the care of older adults that are relevant to and can be endorsed by all health professional disciplines.

The PHA recommendations are the result of 21 organizations representing healthcare professionals who care for older adults advocating for ways to meet the healthcare needs of the nation’s rapidly growing older population. The PHA workgroup developed six domains that a healthcare professional in the following disciplines should have, and necessary approaches they should master, by the time they complete their entry-level degree, in order to provide quality care for older adults:

• Dentistry
• Medicine
• Nursing
• Nutrition
• Occupational Therapy
• Pharmacy
• Physical Therapy
• Physician Assistants
• Psychology
• Social Work

Domain 1: Health Promotion and Safety

1. Advocate to older adults and their caregivers interventions and behaviors that promote physical and mental health, nutrition, function, safety, social interactions, independence, and quality of life.
2. Identify and inform older adults and their caregivers about evidence based approaches to screening, immunizations, health promotion, and disease prevention.
3. Assess specific risks and barriers to older adult safety, including falls, elder mistreatment, and other risks in community, home, and care environments.
4. Recognize the principles and practices of safe, appropriate, and effective medication use in older adults.
5. Apply knowledge of the indications and contraindications for, risks of, and alternatives to the use of physical and pharmacological restraints with older adults.

Domain 2: Evaluation and Assessment

1. Define the purpose and components of an interdisciplinary, comprehensive geriatric assessment and the roles individual disciplines play in conducting and interpreting a comprehensive geriatric assessment.
2. Apply knowledge of the biological, physical, cognitive, psychological, and social changes commonly associated with aging.
3. Choose, administer, and interpret a validated and reliable tool/instrument appropriate for use with a given older adult to assess: a) cognition, b) mood, c) physical function, d) nutrition, and e) pain.
4. Demonstrate knowledge of the signs and symptoms of delirium and whom to notify if an older adult exhibits these signs and symptoms.
5. Develop verbal and nonverbal communication strategies to overcome potential sensory, language, and cognitive limitations in older adults.

Domain 3: Care Planning and Coordination across the Care Spectrum (Including End-of-Life Care)

1. Develop treatment plans based on best evidence and on person centered and directed care goals.
2. Evaluate clinical situations where standard treatment recommendations, based on best evidence, should be modified with regard to older adults’ preferences and treatment/care goals, life expectancy, co-morbid conditions, and/or functional status.
3. Develop advanced care plans based on older adults’ preferences and treatment/care goals, and their physical, psychological, social, and spiritual needs.
4. Recognize the need for continuity of treatment and communication across the spectrum of services and during transitions between care settings, utilizing information technology where appropriate and available.

Domain 4: Interdisciplinary and Team Care

1. Distinguish among, refer to, and/or consult with any of the multiple healthcare professionals who work with older adults, to achieve positive outcomes.
2. Communicate and collaborate with older adults, their caregivers, healthcare professionals, and direct-care workers to incorporate discipline-specific information into overall team care planning and implementation.

Domain 5: Caregiver Support

1. Assess caregiver knowledge and expectations of the impact of advanced age and disease on health needs, risks, and the unique manifestations and treatment of health conditions.
2. Assist caregivers to identify, access, and utilize specialized products, professional services, and support groups that can assist with caregiving responsibilities and reduce caregiver burden.
3. Know how to access and explain the availability and effectiveness of resources for older adults and caregivers that help them meet personal goals, maximize function, maintain independence, and live in their preferred and/or least restrictive environment.
4. Evaluate the continued appropriateness of care plans and services based on older adults’ and caregivers’ changes in age, health status, and function; assist caregivers in altering plans and actions as needed.

Domain 6: Healthcare Systems and Benefits

1. Serve as an advocate for older adults and caregivers within various healthcare systems and settings.
2. Know how to access, and share with older adults and their caregivers, information about the healthcare benefits of programs such as Medicare, Medicaid, Veterans’ Services, Social Security, and other public programs.
3. Provide information to older adults and their caregivers about the continuum of long-term care services and supports – such as community resources, home care, assisted living facilities, hospitals, nursing facilities, sub-acute care facilities, and hospice care.

Domain 7: Psychosocial and Family Systems

1. Exhibit ability to collect personal and family information without judgment or bias, to prepare a comprehensive psychosocial assessment of the older person.
2. Demonstrate awareness of traditional and non-traditional family structures, with sensitivity towards gender identity and designated family member roles.
3. Effectively identify and integrate cultural, religious and spiritual values / norms into the decision-making process.
4. Apply knowledge of interpersonal communication and family/group process to enhance clarity in the communication between the older adult, family member(s) and caregiving community.
5. Recognize signs or symptoms of possible elder abuse; including but not limited to: physical abuse, emotional abuse, neglect, and financial exploitation. Follow professional and state guidelines as a mandated reporter.

Domain 8: Substance Abuse

1. Be aware of the generally accepted definition of low risk, at-risk and problem and dependency issues related to alcohol and drug use in older adults and the societal stigma attached.
2. Be knowledgeable about the prevalence, signs and symptoms of alcohol and drug dependence in older adults, the characteristics of withdrawal, its effects on the individual and the family, and the characteristics of the stages of recovery.
3. Know the drinking guidelines for adults over age sixty-five.
4. Understand the neurological mechanisms and behavioral manifestations of alcohol and drug dependence and its effects on cognitive functioning.
5. Be aware that possible indicators of the disease may include: marital conflict, family violence (physical, emotional, and verbal), suicide, hospitalization, and encounters with the criminal justice system, poverty, unemployment, and homelessness, among others.
6. Be aware of the potential benefits of screening and intervention to the addicted person and family system especially during major life transitions or stressors.
7. Be able to communicate and sustain an appropriate level of concern with messages of hope and caring while maintaining dignity and respect for the older adult as an individual.
8. Be familiar with and utilize available community resources to ensure a continuum of care for the addicted person and the family system.
9. Have a general knowledge of and, where possible, exposure to the 12-step programs (AA, NA, Al-Anon/Alateen, Nar-Anon, ACOA, etc.) or other groups/programs.
10. Be able to acknowledge and address values, issues, and attitudes regarding alcohol and drug use and dependence in oneself and one’s own family.
11. Be familiar with motivational interviewing and assessing readiness for change.
12. Be aware of how prevention strategies can benefit the larger community.

Domain 9: Ethics

1. Understand the difference between a client and a client system and demonstrate the ability to strive for resolution when there are conflicting needs between the systems.
2. Foster client self-determination by providing information, education and evaluation of consequences and allowing the client to make decisions that impact his/her life. If the client is unable to comprehend the factors involved in the decision-making process, see that decisions concerning the primary client are made by an individual with the legal authority to do so.
3. Be knowledgeable of and abide by all state & federal regulations regarding privacy and confidentiality. Exercise due care regarding the client and client systems’ information through the proper use of release of information forms and judicious sharing of confidential information.
4. Understand/identify circumstances in which the personal integrity of the client or Aging Life Care Professional / geriatric care manager may be compromised and know how to act accordingly - either by providing timely written notice of a case termination that allows for alternative arrangements to be made or by making reports to the appropriate authorities in accordance with national and state laws.
5. Professional relationships with the client or client system should not be exploited for personal gain.
6. Fiduciary responsibilities should only be accepted in areas in which the Aging Life Care Professional / geriatric care manager is knowledgeable and capable and the Aging Life Care Professional / geriatric care manager should avoid any activities that might cause a conflict of interest including self-payment for services.
7. Participation in continuing education to enhance professional growth and maintain the highest quality of care management.
8. Fees for services should be stated in writing and discussed with the purchaser prior to the initiation of services. If it appears that services are no longer affordable, the Aging Life Care Professional / geriatric care manager should offer referrals to appropriate community services consistent with the client situation. The Aging Life Care Professional / geriatric care manager should make every effort to ensure that the client’s needs continue to be met.
9. Advertising and marketing of Aging Life Care / geriatric care manager services should honestly represent the background, affiliation, credentials and services that will be provided.
10. The Aging Life Care Professional / geriatric care manager should clarify/disclose any special business relationships that might exist with a referred business, agency or institution. If an Aging Life Care Professional / geriatric care manager practice is sold, the Aging Life Care Professional / geriatric care manager will notify the client in writing and offer them the choice of Aging Life Care Professional / geriatric care manager service options.

Addendum:

Individuals who receive a certificate in Aging Life Care / geriatric care management from an accredited educational institution and who aspire to be profession-recognized by the Aging Life Care Association (ALCA) at the Advanced level of membership must meet the following criteria:

Education and Experience:

1. An individual who holds a Baccalaureate, Master’s or Ph.D. degree with at least one degree held in a field related to care management, i.e. counseling, nursing, mental health, social work, psychology or gerontology;
   1. is primarily engaged in the direct practice, administration or supervision of client-centered services to the elderly and their families; and
   2. has two years of supervised experience in the field of Aging Life Care / care management following the completion of the degree.
OR
2. Non-degreed RNs and other individuals with a Baccalaureate, Masters or Ph.D. degree;
   1. are primarily engaged in the direct practice, administration or supervision of client-centered services to the elderly and their families; and
   2. have three years supervised experience in the field of Aging Life Care / care management.

Certification:

1. An individual who has received a Certification from at least one of the following Certifying Bodies:
   1. CMC from the National Academy of Certified Care Managers (NACCM)
   2. CCMC from the Commission for Case Manager Certification (CCMC)
   3. C-ASWCM or C-SWCM from the National Association of Social Workers (NASW)

© Aging Life Care Association™ 2015