Standards of Practice

The Aging Life Care™ Association (formerly 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, and December 2011.

PREAMBLE

These Standards have been developed because Professional 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 professional care management services. Thus, Professional Care Managers (CMs) 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 CMs 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 Aging Life Care™ Association in the many complex situations presented by their practices. Members of ALC™ Association are expected to abide by the standards of their respective professions, as well as to these Standards developed specifically for their practices in Professional 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 Professional CM’s Personal Values and Beliefs
  5. Professionalism of the Relationship

Regarding the Professionalism of the Practice:

  1. Definition of Role
  2. Plan of Care
  3. Knowledge of Employment Laws
  4. Undertaking Fiduciary Responsibilities
  5. Continuing Education
  6. Certification

Regarding Business Policies:

  1. Fees for Service
  2. Advertising and Marketing
  3. Disclosure of Business Relationships

STANDARD 1 – IDENTIFYING THE CLIENT

Standard

The primary client is the person whose care needs have initiated the referral to an aging life care™ professional.

Rationale

The primary client’s care needs take place within the context of their family system and physical and social environments.

Guidelines

  1. The primary client may not necessarily be the person who makes the initial contact or the person responsible for payment for services rendered.
  2. 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 ALC™ Professional (See Standard 4)
  3. 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 ALC™ Professional.

The ALC™ Professional should request assistance of peers, as needed, to help the client system find an acceptable solution when conflicts occur.

BACK TO CONTENTS

STANDARD 2 – PROMOTING SELF-DETERMINATION

Standard

Aging Life Care™ Professional should promote self-determination of the primary client as appropriate within the context of their situation.

Rationale

The ALC™ Professional CM 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

  1. The ALC™ Professional should involve the primary client and/or designated decision maker, to the greatest extent possible.
  2. As the primary client and/or the designated decision maker is given the opportunity to make decisions, the Geriatric Care Manager should ensure that the following conditions are met:
    1. The specific information needed to make decisions is discussed and understood.
    2. The risks and benefits of all options are presented and understood.
    3. The ALC™ Professional encourages the client and/or decision maker to communicate, verbally or non-verbally, his/her wishes
    4. The client and/or designee consents to services, and the care manager respects the client’s right to discontinue services at any time.
    5. The client’s decisional capacity should be evaluated if there are questions regarding his/her capacity
  3. If the primary client does not comprehend the factors involved in the decision-making process and, therefore, cannot make an informed decision, then the ALC™ Professional should see that all decisions concerning the primary client are made by the person(s) with the legal authority to do so.

BACK TO CONTENTS

STANDARD 3 – RIGHT TO PRIVACY

Standard

The ALC™ Professional 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 ALC™ Professional frequently needs to share information with others in order to fulfill his/her responsibilities. The ALC™ Professional 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

  1. The ALC™ Professional should consider all information in the client’s records confidential. This pertains to active and inactive clients as well as closed cases.
  2. The ALC™ Professional 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.
  3. The ALC™ Professional should take precautions to ensure and 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.
  4. The ALC™ Professional should maintain a valid authorization to release information.
  5. The ALC™ Professional should act judiciously when sharing client information with others.
  6. The ALC™ Professional 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.
  7. The ALC™ Professional should ensure that all communications are conducted in a manner that allows for the maximum amount of privacy.
  8. 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.
  9. 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.
  10. The ALC™ Professional should take reasonable precautions to protect client confidentiality in the event of the ALC™ Professional’s termination of practice, incapacity, or death.

BACK TO CONTENTS

STANDARD 4 – RECOGNITION OF THE ALC™ Professional’S PERSONAL VALUES AND BELIEFS

Standard:

The ALC™ Professional 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 necessary to provide objective professional services.

Guidelines

  1. The ALC™ Professional should be cognizant of their personal and professional value system and beliefs through a continuous process of self-reflection and/or case consultation.
  2. If there is a circumstance in which the client’s wishes and preferences are in conflict with the professional judgment and values of the ALC™ Professional, there is an obligation to identify and address the disparity. The ALC™ Professional should make every effort to arrive at a mutually acceptable solution. If those disparities cannot be reconciled, the ALC™ Professional has an obligation to offer alternative services to the client.
  3. The ALC™ Professional may refuse to accept a new case or continue in a case if the ALC™ Professional believes that remaining in the situation would require compromising his/her own values or beliefs. The ALC™ Professional can terminate his/her involvement by providing reasonable written notice and recommend alternate services.

BACK TO CONTENTS

STANDARD 5 – PROFESSIONALISM OF THE RELATIONSHIP

Standard

The ALC™ Professional should not exploit professional relationships with the client and/or members of the client system and should maintain appropriate boundaries.

Rationale

The ALC™ Professional should be aware of and resist those influences and pressures that may interfere with the exercise of professional discretion and impartial judgment.

Guidelines

ALC™ Professionals:

  1. are sensitive to the power of the professional relationship.
  2. 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.
  3. should avoid the giving or receiving of any gifts that may impair their impartial judgement or might lead to exploitation.
  4. should never engage in sexual contact with the client and/or members of the client system.

BACK TO CONTENTS

STANDARD 6 – DEFINITION OF ROLE TO OTHER PROFESSIONALS

Standard

The ALC™ Professional should clearly define his/her role and scope of practice to clients and others involved with the client system.

Rationale

ALC™ Professionals are professionals with diverse educational backgrounds and skill sets. Therefore each ALC™ Professional 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.

Guidelines

  1. The ALC™ Professional should provide a clear, comprehensive explanation of his/her role and responsibilities to clients and the client system.
  2. The ALC™ Professional 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.

BACK TO CONTENTS

STANDARD 7 – PLAN OF CARE

Standard

The ALC™ Professional should strive to provide quality care using a personalized care plan developed in consultation with the client and/or client system.

Rationale

The care plan guides the work of the professional 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.

Guidelines

The care plan should:

  1. be a result of collaboration between the professional care manager, the client, and the client system.
  2. be based on an assessment.
  3. be flexible in order to address the client’s changing status.
  4. address the need for the development of a contingency plan for circumstances such as
    1. Natural Disasters
    2. Illness or change in condition of client
    3. Change in client support system
  5. be reviewed by the client and/or responsible party and included in the client file.

BACK TO CONTENTS

STANDARD 8 – KNOWLEDGE OF EMPLOYMENT LAWS

Standard

The ALC™ Professional should be familiar with laws relating to employment practices and should not knowingly participate in practices that are inconsistent with these laws.

Rationale

The ALC™ Professional 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 ALC™ Professional may employ other professionals or service providers. In either case, they need to be aware of applicable employment and tax laws.

Guidelines

  1. The ALC™ Professional should recommend or employ only persons who are legally permitted to work. The ALC™ Professional should not condone non-payment of payroll taxes, or wages that do not meet minimum wage requirements.
  2. The ALC™ Professional should use, and recommend that the client system use, the appropriate legal and accounting professionals to ensure that applicable laws are followed.
  3. The ALC™ Professional may also want to be familiar with the appropriate State and Federal agencies that regulate employment practices.

BACK TO CONTENTS

STANDARD 9 – UNDERTAKING FIDUCIARY RESPONSIBILITIES

Standard

The ALC™ Professional 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 ALC™ Professional may act as a “pay agent.” The role of the ALC™ Professional in handling fiduciary issues will be further determined by the competence of the older person.

Guidelines

  1. When undertaking “pay agent” responsibilities, the ALC™ Professional should obtain written consent from the older person or a responsible third party.
  2. When asked to take responsibility for a purchase of goods or services not commonly within the “pay agent” agreement, the ALC™ Professional 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 ALC™ Professional is the financial POA, then the ALC™ Professional will assume bill-paying responsibilities. Third party oversight of self-payment should continue.
  3. The ALC™ Professional, in the role of “pay agent,” should not act as a financial advisor regarding the older person’s assets or investments, unless qualified to do so. (See Standard 11)
  4. The ALC™ Professional should avoid, where possible, self-payment. If the ALC™ Professional 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)
  5. If the client has been determined to be incompetent, the ALC™ Professional may be appointed as guardian or conservator. If so appointed, the ALC™ Professional will be required to follow all the legal requirements of this court-appointed role. It is also recommended that if a ALC™ Professional takes on such a role, the ALC™ Professional should be knowledgeable of and adhere to the National Guardianship Association’s Standards of Practice.
  6. 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.

BBACK TO CONTENTS

STANDARD 10 – CONTINUING EDUCATION

Standard

The ALC™ Professional should participate in continuing education programs to enhance professional growth and development.

Rationale

All ALC™ Professionals should remain current in best practices and domains pertinent to the discipline of geriatric care management.

Guidelines

The ALC™ Professional should:

  1. engage in continuing education programs
  2. participate in courses that relate to geriatric care management
  3. read professional publications

BACK TO CONTENTS

STANDARD 11 – 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.ALC™ Association 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 ALC™ Professional should:

  1. Be certified according to those certifications endorsed by ALC™ Association, and licensed, if required, in his/her area of expertise.
  2. Seek peer/other consultation, which meets the requirement of the appropriate certifying body.

BACK TO CONTENTS

STANDARD 12 – 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.

Rationale

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.

Guidelines

  1. Prior to the initial meeting, the ALC 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.
  2. 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:
    1. Fee structure and rates
      i. E.g., hourly, monthly package, etc.
      ii. Out of pocket expenses and purchases made on behalf of clients
      iii. Charges for written and verbal communication
      iv. Travel time and/or mileage expenses
      v. Fees for consultations, assessments and/or follow-up services
    2. Payment terms
      i. Retainers/Deposits
      ii. Frequency of invoicing
      iii. Late fee policy
  3. Invoices should be sent in a timely manner consistent with the terms of the service agreement and should be clearly itemized.
  4. 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.
  5. A client with an established relationship with a ALC™ Professional, 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. The ALC™ Professional should make every effort to ensure that the client’s needs continue to be met.
  6. The Professional 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.

BACK TO CONTENTS

STANDARD 13 – 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

  1. Marketing communication is any communication to the public or prospective clients.
  2. The ALC™ Professional 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.
  3. Only the individual who is the member of ALC™ Association may advertise that membership.
  4. Each ALC™ Professional has a responsibility to protect and enhance the reputation of the profession of geriatric care management.
  5. Any representation of backgrounds, affiliations, or credentials made by the ALC™ Professional should be accurate and kept up to date.
  6. Use of the ALC™ Association logo should be in accordance with the policy on file.

BACK TO CONTENTS

STANDARD 14 – DISCLOSURE OF BUSINESS RELATIONSHIPS

Standard

The ALC™ Professional 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 ALC™ Professional 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 ALC™ Professional 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

  1. When a referral is made, the ALC™ Professional should disclose to the client any special relationship that exists with the recommended business, agency or institution.
  2. When the ALC™ Professional 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.
  3. Referrals made by a ALC™ Professional, whether to outside providers or internally within a ALC™ Professional practice, must be based only on the best interests of the client. A ALC™ Professional should maintain a position of objectivity when making any recommendations for services to avoid any possibility of a conflict of interest.
  4. When a ALC™ Professional sells his or her practice, the client will be notified in writing of the opportunity to use the ALC™ Association services of the buying party or to use alternative services.

BACK TO CONTENTS