When Hugh McGuire made a business trip to the Chicago area, he decided to visit his wife's 90-year-old aunt and 88-year-old uncle, who lived nearby in their own home.

What McGuire found alarmed him. While the couple was still ambulatory and proud of their independence, there was no food in the house and the formerly fastidious couple were no longer taking care of themselves or their home.

Like a growing number of Americans taking care of aging relatives from afar, McGuire responded to the situation by hiring a geriatric care manager, a relatively new type of professional who helps plan and organize care for disabled elderly people.

More and more people "are learning that geriatric care managers are out there and that they can help with these problems," says Erica Karp, who runs a geriatric care management firm in Evanston, Ill.

She was able to help McGuire's relatives by arranging meals for them, straightening out their legal affairs and eventually finding placement for the wife in a nursing home, where Karp continues to visit her regularly.

McGuire's situation is hardly unusual. At least one in every four American families provides care for an older relative. Many live hundreds of miles apart, compounding the stress and concerns of caregivers: How can they be sure their relative is not refusing to eat or misusing medications or mismanaging finances or feeling depressed?

Family members may also face tough decisions—such as choosing between assisted living, home care or a nursing home—which may be complicated by a limited knowledge of available options.

Geriatric care managers aim to help families in these circumstances. They may be hired either by family members or individuals needing care.

While care managers aren't regulated by state or federal government, they're usually licensed in a field of specialization, typically social work or nursing. That means most care managers are subject to disciplinary action by a state licensing board should a violation of standards occur. Technically, however, anyone can hang out a "geriatric care manager" shingle.

Even so, more care managers are joining groups like the National Association of Professional Geriatric Care Managers (NAPGCM), a voluntary organization with nearly 1,600 members. To qualify, the association says applicants must be licensed in their fields and trained in geriatrics, and they must adhere to professional guidelines and ethics.

NAPGCM has developed grievance procedures and will dismiss members who violate its requirements. (See When Hiring a Care Manager….)

THE ABCs OF MANAGING CARE

The first thing Pearlbea LaBier, a geriatric care manager in Bethesda, Md., who's the head of membership for NAPGCM, does for a new client is assess the older person's life—physical and mental health, family relationships, living conditions, finances and legal affairs.

She then draws up a "plan of care" based on her evaluation. Like her colleagues, LaBier says one of her most crucial tasks—and one that professionals sometimes do better than family members—is to convince the person to accept advice and help.

Competent care managers are able to find and hire needed help—home care workers, lawyers, nurses or even someone to mow the lawn. Many straighten out finances and kitchens. They may persuade clients that it's no longer safe for them to drive.

Erica Karp says that if a hard decision must be made—a move to a nursing home or hospitalization, for example—it may be easier for the care manager than a family member to be the "bad guy."

In some cases, the role of care managers is narrower. They simply evaluate the older person's needs and draw up a plan for the immediate future. If the situation changes, they may do subsequent "tuneups."

Not all geriatric care managers are created equal. Some may lack the necessary training or experience. Some may give poor advice.

A Silver Spring, Md., man discovered this to his dismay a few years ago. After his 94-year-old mother suffered a heart attack, he wondered what type of future living arrangement would be in her best interest: living alone in her Santa Ana, Calif., apartment? A nursing home? Or some other facility?

He hired a geriatric care manager suggested by a friend to evaluate his mother and make a recommendation.

By the time he arrived in California 10 days later, the care manager was waiting with her appraisal, which she said was based on a day of visiting the older woman and watching her in a rehab unit of an Orange County nursing home.

She concluded his mother could not live safely outside a nursing home. She charged $300 for this advice and offered to stay on the case.

Unconvinced by this assessment, the son hired a professional nurse and enlisted the support of the Orange County ombudsman program. A new evaluation came up with a different conclusion: His mother had the physical and mental prowess to live a quasi-independent life.

The man fired the geriatric care manager and moved his mother to an assisted living facility, where she lived successfully for several years.

WHAT'S THE COST OF CARE?

One potential downside of care management is the cost. Geriatric care managers charge between $80 and $150 an hour, so over time the costs can add up significantly.

Long-term care insurance policies often cover the costs of a geriatric care manager, but Medicare does not.

Despite the price, Jan Collins, a South Carolina attorney who specializes in elder law, frequently recommends geriatric care managers to his clients. "Dealing with the elderly is a multidiscipline event," he says.

He points out that a care manager may actually save money by connecting families to useful community resources, including free ones, and steering them away from expensive living arrangements where fees may quickly rise without warning.

"[Families] who have the least," Collins says, "have the most to lose."

EARNING TRUST IS KEY

For a geriatric care manager, "the most important job is to develop trust in the relationship," says NAPGCM's LaBier. As an example she cites a retired physician she cared for.

Accustomed to controlling every aspect of his life, the doctor had retreated at age 94 into a life of "sitting in his sunroom watching the grass grow," LaBier recalls.

He was also trying to care for his wife, who had dementia. Bills piled up on the dining room table, no one made meals and their home was a mess.

Furthermore, LaBier says, "stockbrokers were churning him left and right," talking him into buying and selling stocks at an alarming clip.

The couple had outlived their children and had no relatives nearby, but a nephew in Germany discovered their situation and hired LaBier.

Suspicious at first of LaBier, the physician eventually allowed her to bring in help to clean up the kitchen and cook some meals. She gradually persuaded him to deal with the bills and called the investment firm that was hounding the doctor to report the broker. The doctor was able to fulfill his wish of staying in his own home until he died.

Unfortunately, it's usually a crisis—a broken bone, a hospitalization—that prods families to plan for elder care. Care managers say they are having some success, however, in getting families to have a plan before a crisis develops.

The NAPGCM reports that even retirement-age people who are still healthy are arranging for their own eventual care needs so their younger relatives won't have to.