Dear Ms. Bishop,

This letter is intended to provide prospective clients with one point of view from among your recent engagements. The letter is structured in two parts: (1) I want people (like me) who are looking for geriatric care management services to know a little bit about how and why I chose Elder Care Consultants, (ECC); and (2) I want those people to know what I now think about that choice. If I’m successful, the letter will also provide ECC with useful feedback on its performance. I don’t do “gushy testimonials.”

Part I: Assessing the Candidates

Background: My brother, sister and I were looking for a geriatric case manager (GCM) company to advise, manage, and provide hands on assistance in caring for our mother. Our Dad died many years ago; my mother raised all of us on her own. We are a close and supportive bunch, and we’ve always been united in our love and devotion to Mom. All of us were born, raised and currently living in Northern Virginia.

We researched the market, we sought recommendations from people we trusted, and we conducted short telephone interviews to narrow the field to a manageable number of promising companies. We had personal interviews with a half dozen. We found lots of similarities among them; but it was the unexpected differences that drove our decision to hire ECC. Here are some impressions we got — I hope they will be of benefit to you.

(1) First Impressions Count: Most companies talked to us for thirty to forty-five minutes at their office about what they could do for us. By comparison, our first meeting with ECC was around my dining room table. The company principal, Ms. Bishop, spent ten minutes talking about ECC and the better part of an hour asking about my mother. Her “listen vs. talk” ratio was 80% – 20%, and by the end of our first meeting, ECC had a basic, appreciative, and accurate understanding of Mom’s medical conditions, her life situation, and how we as a family were managing. It was a very good first impression.

(2) Professional Expertise: All of the ECC case managers have “genuine credentials.” They’ve completed academic degree programs in related fields; many of them have post-baccalaureate degrees. The occupations (social worker, registered nurse, clinical social worker) are regulated and licensed by state professional practice boards; they require a demonstrated level of competence, and continuing education to maintain a license.

GCM’s have a strong, national professional code of ethics and play an important advocacy role at the federal, state and local levels. I can personally attest that she is recognized and respected by GCM’s coast-to-coast — she taps into this network for the occasional tricky situation and then brings that collective expertise into her portfolio. Like the Verizon guy on TV who is always followed by thousands of Verizon team members. It really works.

Many, perhaps most of the other companies’ principal officers and staff that we interviewed also belonged to professional associations — all are completely respectable groups. I make a keen distinction between evaluating professional affiliations and connecting the dots to assess proven achievements.

(3) Opportunities for Increased Effectiveness: In our particular case, Mom was residing at a well-regarded nursing and rehabilitation center where ECC had already established constructive relationships with the professional, administrative, and allied caregiver staffs. These “insider – outsider” boundaries create delicate relationships that need to be carefully nurtured. I found that ECC had current clients at this location, and as I would later learn, most of the facility employees “on the floor” welcomed the ECC staff as colleagues, not interlopers.

Unlike insurance companies, physicians, and even many allied health and caring professionals, GCMs often establish extended relationships with their clients and the families. I venture to say that those relationships typically are founded at times of crises and despair and are managed to an inevitable conclusion. The sheer strength of heart and the power of purpose it takes to do that job are genuinely heroic. How anybody can do it — and do it well, and raise a family, and run a business, and get up and do it all again the next day escapes me.

(4) Cost: Let’s face it. It’s big. A lot of people believe they can or should do it all — why hire somebody — we’re family. Sometimes they crash and burn and their own health is affected. The actual cost incurred can’t be determined or evaluated until after the ubiquitous “comprehensive assessment and care plan.” Those are critical. Be involved. If your loved one can participate, include them. Don’t underestimate their contributions, or shield them from the situation. It’s hard — especially at this step in the process. If you are a long-distance caregiver – double that advice. A good GCM will help you.

For the nuts and bolts beyond that, clients will learn that many companies have minimum hours per day or minimum days per week, plus mileage, plus weekend surcharges, plus evening surcharges, ad nauseum. These charges are not objectionable per se, but they bear very little correlation to the quality of service delivered to your loved one. ECC was able and willing to piggyback on frequent visits to multiple clients, so they actually spread the mileage charges across multiple accounts. That’s just makes too much common sense.

(5) I will insert a cost anomaly here. During our introductory visit with Ms. Bishop, I received a call indicating that my Mom’s insurance company was wavering on whether or not skilled care was necessary. Nevertheless Ms. Bishop (with our quickly prepared written permission) asked the ECC Registered Nurse to look at Mom’s chart and help the facility staff strengthen the chart language to justify skilled rather than unskilled needs. As a result of the supplemental documentation, the insurance company approved several additional skilled days, saving Mom a few thousand dollars of her own money.

Part II: That Special Intangible Something (TSIS)

You and I probably have something in common — an elder person that we love, and we want the best care possible. Here are a few of the distinguishing things that I remember the most:

(1) Ms. Bishop (by now Vanessa to us) the company founder, president, and heart and soul, was involved in all the ECC client cases; her management approach includes an internal “peer review” — routine cross checking across the professional disciplines on staff for the best collective perspective on individual cases where necessary. I believe internal peer review to be a compelling “est practice” for the industry and a truly distinguishing element of ECC’s value.

(2) My mother didn’t warm up to strangers easily. The people she saw every day were perpetually poking, prodding, or generally pestering her. By contrast, after one or two visits, Vanessa was casually polishing Mom’s fingernails while building client rapport and collecting valuable client data via this “stealth” interview. Later, I learned that Mom asked Vanessa if she had any clear polish, and whether she could bring some next time. It was a singular magic moment.

(3) The three adult children always shared the same goal, but sometimes we differed on how to achieve that goal. Vanessa never failed to steer the discussion to focus on Mom’s needs and not on which kid had the best idea. To risk stating the obvious, Vanessa was typically right. She is simply client-focused and fearlessly makes sure we don’t forget it. It makes a real difference.

(4) Tidbits:

• Access to ECC staff: We never had to wait long for a call back. We also used e-mail group codes to ensure consistent and accurate flow of information across the care team simultaneously.

• ECC nurse encouraged Mom to “do a little bit more” than Mom thought she could do; she accurately assessed the self-limiting hesitance and uncertainty Mom experienced. By comparison, the regular facility staff would regrettably just check a box indicating, “Resident refused.” It was the easy way, and it was pervasive. Soon the family became more vigilant and raised the issue whenever necessary. Before long the regular staff stepped up.

• Similarly, ECC enjoys the respect of the physicians and nursing staff. Some doctors just don’t like talking to inquisitive family members – but allied professionals get their attention and cooperation.

PART III (O.K., So I Lied) Closing Remarks

If you’ve gotten this far, I’m grateful. But I just gotta stop somewhere!

My family eventually gave Vanessa Bishop the first and only “Honorary Sibling” award. She has a depth of character, an incredible commitment to her calling, and an uncanny read on interpersonal dynamics. I remember giving an unqualified and enthusiastic endorsement only one other time. You can guess if you like.

I also want to share something special with Vanessa Bishop — the first time anywhere this story has ever been told.

At the end of a telephone update one day, Vanessa closed the conversation with the phrase “That’s the story, morning glory.” When I was six or seven years old my back yard fence was covered with crawling vines. I stood on my tippy toes to look out the window in the kitchen door each spring morning to see if the vines had those big blue and white blossoms. If they did, I got to wear my nifty baseball jacket to school. If not, I had to wear my clunky warm coat. It was an established house rule; my mother’s house. If ever challenged she replied, “That’s the story, morning glory.”

Separated by fifty years, bookends on a son’s memories of his mother’s life.

M. Duda

PS: I lied about the gushy testimonials, too.

“The value in any personal endorsement depends on the integrity and candor of the writer, and on the wisdom and courage of the person endorsed.” James Madison in the Federalist Papers.