Question: My parents are in their mid-80's and live several hours away from my sister and me. Although my folks are in reasonably good health, during our visit over the holidays and when we talk by phone, my sister and I have both noticed a slow decline in their memories and abilities. My sister and I have discussed suggesting assisted living, but they want to continue living in their own home. They drive and socialize with friends and neighbors. My sister and I want to make sure their progress is monitored. We have looked into community services, but that seems so confusing. How can we find a trustworthy person to handle these things for our parents and us?

Answer: Because the health and other needs of aging parents is more than many people can handle on their own, especially when distance is thrown into the equation, more families are turning to a relatively new breed of professional: the geriatric care manager (GCM).

Generally, geriatric care managers have degrees in nursing or social work and act as personal health and care managers for elderly and disabled people. After assessing your parents' conditions and needs, the geriatric care manager will create a proposed plan that will include recommendations about your parents' care. Once everyone signs off on the plan, the geriatric care manager will be in a position to coordinate and oversee your parents' care.

Working in conjunction with elder law attorneys and medical doctors who specialize in elder issues, geriatric care managers will monitor your parents' conditions and coordinate various services for your parents in order to help them remain in the community for as long as possible. If and when necessary, the geriatric care manager can act as a referral source to a suitable assisted-living or long-term-care facility, in which case he or she will help your parents in the transition from home to the facility and will act as an advocate for your parents.

These professionals generally work on a fee schedule that can range from $60 to $150 per hour depending on the care manager's experience and where your parents live. Typically, an initial assessment will cost between $300 and $500. Since insurance does not cover these fees, the family is responsible for the charges; however, we have found that using geriatric care managers can often save the family money because they are very knowledgeable about the "ins and outs" of Medicare, Medicaid, and insurance issues. In addition, experienced GCMs can find free community services and help your parents receive the best care available.

The best way to seek out an experienced geriatric care manager is to contact an elder law attorney in your parents' area of the country who deals with GCMs on a regular basis, or call the National Association of Professional Geriatric Care Managers at 602-881-8008 in Tucson, Arizona. This group publishes a directory, and although there is a cost to purchase it, you can receive a referral for just one state at no cost.

Taking the NextStep: A few suggestions: Don't bring in a care manager without talking to your parents first, since a unilateral act like this will surely cause suspicion on the part of your parents. We suggest that you and your sister handle this conversation in person with your folks, not by telephone. We also suggest that you and your sister make sure your parents understand that you are working with them, not against them, and that the purpose of your suggestion is so that they can stay at home as long as possible. Finally, always interview the GCM either by phone or in person. And, make sure you receive and check out references.