Standards of Practice
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 April 2010, September 2010, July 2011, December 2011, June 2012, July 2012, October 2012, January 2013, November 2013, and April 2014.
The National Association of Professional Geriatric Care Managers (NAPGCM) was founded in 1985 to advance the profession of geriatric care management. Geriatric Care Managers (GCMs) have varied educational and professional backgrounds with a specialized focus on issues associated with aging and disabilities. Through consultation, assessment, care coordination and advocacy, a GCM works with clients and families to address these challenges.
The Code of Ethics and Standards of Practice were developed to guide the GCM in his or her daily professional and business practices. The ethical principles at the core of the Code of Ethics are the foundation for the Standards of Practice.
STANDARDS AND PRACTICE GUIDELINES
Regarding the Client Relationship:
- Identifying the Client
- Promoting Self-Determination
- Right to Privacy
- Recognition of the GCM’s Personal Values and Beliefs
- Professionalism of the Relationship
- Continuity of Service
- Termination of Service
Regarding the Professionalism of the Practice:
- Definition of Role
- Plan of Care
- Knowledge of Employment Laws
- Undertaking Decision-Making Authority
- Continuing Education
Regarding Business Policies:
The primary client is the person whose care needs have initiated the referral to a geriatric care manager.
The primary client’s care needs take place within the context of their family system and physical and social environments.
- The primary client may not necessarily be the person who makes the initial contact or the person responsible for payment for services rendered.
- 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)
- 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.
Geriatric Care Managers should promote self-determination of the primary client as appropriate within the context of their situation.
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.
- 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.
- As the primary client and/or the designated decision maker is given the opportunity to make decisions, the Geriatric Care Manager should strive to achieve the following conditions:
- The specific information needed to make decisions is discussed and understood.
- The risks and benefits of all options are presented and understood.
- The care manager encourages the client and/or decision maker to communicate, verbally or non-verbally, his/her wishes
- The client and/or designee consents to services, and the care manager respects the client’s right to discontinue services at any time.
- The client’s decisional capacity should be evaluated if there are questions regarding his/her capacity
- 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.
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.
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.
- The GCM should consider all information in the client’s records confidential. This pertains to active and inactive clients as well as closed cases.
- 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.
- The GCM should take precautions to maintain the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology. Disclosure of identifying information should be avoided whenever possible.
- The GCM should maintain a valid authorization to release information.
- The GCM should act judiciously when sharing client information with others.
- The GCM should not disclose identifying information when discussing clients for teaching or training or consultation purposes unless the client has consented to disclosure of confidential information.
- The GCM should strive to conduct all communications in a manner that allows for the maximum amount of privacy.
- 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.
- 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.
- The GCM should take reasonable precautions to protect client confidentiality in the event of the GCM’s termination of practice, incapacity, or death.
The GCM should have a conscious awareness of their personal values and beliefs and the impact of these on their practice with clients.
Personal awareness is necessary to provide objective professional services.
- 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.
- 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.
- 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 consistent with Standard 7.
The GCM should not exploit professional relationships with the client and/or members of the client system and should maintain appropriate boundaries.
The GCM should be aware of and resist those influences and pressures that may interfere with the exercise of professional discretion and impartial judgment.
- are sensitive to the power of the professional relationship.
- should refrain from entering into a dual relationship if the relationship could reasonably be expected to impair the care manager’s competence or effectiveness or may put the client at risk of exploitation or harm.
- should avoid the giving or receiving of any gifts that may impair their impartial judgement or might lead to exploitation.
- should never engage in sexual contact with the client and/or members of the client system.
The GCM should develop plans to provide for continuity in the event of an interruption of services.
Clients and families rely on the availability of the GCM and his/her services. Contingency plans should be in place to address circumstances that may arise which interrupt the delivery of these services.
- The GCM should reasonably prepare for practice coverage in the event of an absence which may be temporary or permanent.
- Temporary absences may include vacation, personal medical situations, or family emergencies
- Permanent absences may include a change in employment status, disability, or death
- Each practice, no matter the size, should have a plan to address potential service disruptions (such as technology failure, power outages, and natural disasters).
- GCMs who anticipate the interruption of services should notify clients promptly and make arrangements for continuation of services in consultation with the client and client system.
Termination of the care management relationship should be handled in a professional and ethical manner with consideration given to the unique circumstances and situation of the client/client system.
Relationships between the GCM and clients are terminated for a variety of reasons. The termination process may pose emotional or practical challenges for the client, the client system, and/or the GCM.
- When there is a termination for any reason, the needs of the client are central to the process.
- GCMs should be sensitive to the impact of the termination and take reasonable steps to facilitate client access to needed support and services.
- Termination ideally should occur with the agreement of the client or decision maker. There are circumstances, however, when service may ethically be terminated without the agreement of the client or decision maker. Examples may include, but are not limited to:
- The client requires expertise different from that of the GCM.
- The GCM becomes ill or incapacitated, retires or changes jobs.
- The client violates a contractual agreement.
- The client files a lawsuit and/or an official complaint against the GCM or the GCM practice
- When a GCM closes, sells his/her practice or moves out of the area, the client should be notified in writing of available care management services.
- In complex situations, GCMs are encouraged to seek appropriate consultation and guidance regarding legal and/or clinical issues.
The GCM should clearly define his/her role and scope of practice to clients and others involved with the client system.
GCMs are professionals with diverse educational backgrounds and skill sets. Therefore each GCM should define his/her scope of practice and the particular roles he/she will accept in assisting clients and those involved in the client’s care.
- The GCM should provide a clear, comprehensive explanation of his/her role and responsibilities to clients and the client system.
- The GCM should accept only those roles and responsibilities for which he/she has the skills, knowledge and training. He/she should recommend consultations with other experts as needed.
The GCM should strive to provide quality care using a personalized care plan developed in consultation with the client and/or client system.
The care plan guides the work of the care manager by addressing the immediate and long-term needs, wishes and preferences of the client and the client system, and clarifies the expectations of the care management role.
The care plan should:
- be a result of collaboration between the care manager, the client, and the client system.
- be based on an assessment.
- be flexible in order to address the client’s changing status.
- address the need for the development of a contingency plan for circumstances such as
- Natural Disasters
- Illness or change in condition of client
- Change in client support system
- be reviewed by the client and/or responsible party and included in the client file.
The GCM should be familiar with laws relating to employment practices and should not knowingly participate in practices that are inconsistent with these laws.
As Care Managers, we should strive to prevent abuse of clients who may be vulnerable to exploitation.
- The GCM should be familiar with the State and Federal agencies that regulate employment practices.
- The GCM should recommend or employ only persons who are legally permitted to work.
- The GCM should encourage payment of payroll taxes, or wages that meet minimum wage requirements.
The GCM who accepts decision-making authority with respect to the affairs of a client should act only within his/her knowledge and capabilities and avoid any activities that might suggest a conflict of interest.
In accepting the role of decision maker for the client, the GCM has the responsibility to protect the client.
- Decision-making authority may include responsibility for healthcare decisions and/or financial management.
- The GCM should establish safe guards to avoid impropriety or any possible appearance thereof.
- The GCM should obtain written documentation of this authority.
- The GCM should avoid, where possible, self-payment. If the GCM has no alternative than to assist the client to pay for his/her services, it is recommended that a third party provide oversight for these transactions.
- The GCM should know and comply with relevant laws and statutes.
- Documentation of all actions shall be maintained and made available to authorized parties.
The GCM should participate in continuing education programs.
Participation in relevant continuing education programs will enable GCMs to remain current in best practices and maintain a base of professional knowledge and skills in order to practice in a proficient and ethical manner.
- Continuing education is a self-directed process, which requires GCMs to assume responsibility for their own professional development.
- Continuing education can include:
- Attendance at conferences, workshops, and seminars;
- Participation in webinars and self-study programs; and
- Reading of professional literature.
Members in the Certified Care Manager or Fellow/Certified Care Manager categories are required to meet the membership criteria and to hold one of the NAPGCM approved certifications.
Due to the varied backgrounds of members, certification is an independent method of verifying a basic level of professional practice. Certification provides the public with an objective criterion to evaluate care managers before they engage their services.
- The GCM should be certified according to those certifications endorsed by NAPGCM.
All fees for geriatric care management services are to be stated in written form and discussed with the person accepting responsibility for payment.
Billing is as an integral part of the professional practice of care management. When billing issues arise, they may be an expression of our clients’ feeling that expectations were not met. To help manage expectations and prevent any misunderstandings regarding fees and services, billing practices should be provided and agreed to in writing.
- Prior to the initial meeting, the care manager should clearly explain, verbally and in writing, the terms and conditions of care management services to the responsible party. This should include the cost of services and billing practices. If time does not allow for this, then all information should be verbally presented and followed up in writing.
- The care manager should have a signed agreement for all services, even if it is for consultation only. The signed agreement should specify the scope of services to be provided. The signed agreement also should address and clearly communicate terms with respect to:
- Fee structure and rates
- E.g., hourly, monthly package, etc.
- Out of pocket expenses and purchases made on behalf of clients
- Charges for written and verbal communication
- Travel time and/or mileage expenses
- Fees for consultations, assessments and/or follow-up services
- Payment terms
- Frequency of invoicing
- Late fee policy
- Invoices should be sent in a timely manner consistent with the terms of the service agreement and should be clearly itemized.
- Service agreements should be reviewed and updated periodically or as client circumstances change. These may include changes in fees/rates; responsible parties; or capacity of the payer or responsible party.
- A client with an established relationship with a GCM, but who can no longer pay for services, should not be abandoned. If it appears that care management services are not affordable, the care manager should offer referrals to resources consistent with the client situation so that the client’s needs continue to be met.
- 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.
Advertising and marketing of services should be conducted with honesty, accuracy, and integrity.
The GCM has a responsibility to clearly communicate the nature of Care Management and his or her areas of expertise in order to establish realistic expectations.
- Advertising and marketing is any printed, verbal, or electronic communication to the public.
- Statements in advertising and marketing material regarding care manager qualifications, expertise, or agency business practices should be truthful and non-misleading.
- Any representation of backgrounds, affiliations, or credentials made by the GCM should be accurate and current.
- Only the individual who is the member of NAPGCM may advertise that membership.
- Use of the NAPGCM logo shall be in accordance with current policy.
The GCM should provide full disclosure regarding business, professional or personal relationships when making referrals or recommendations.
Clients rely on GCMs to provide them with reliable and objective information about resources. The GCM should act with transparency and maintain a position of objectivity when making any recommendations for services to avoid the possibility of a conflict of interest.
- 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.
- When the GCM has a relationship with a recommended entity, he/she should provide the client with specific information regarding the nature of the relationship and offer alternative choices.
Relationships to be disclosed might include but are not limited to:
- Business involvement as owner, investor, or Board Member,
- Personal relationships such as a relative or friend,
- Professional colleague or employee.