Editor in Chief
Jennifer Lansing Pilcher, PhD, CMC | Needham, MA
Debbie Beatty, RN, ADN, CMC | Yorba Linda, CA
Cathy Cress, MSW | Santa Cruz, CA
Kim Evanoski, LMSW, CMC, CDP | Ithaca, NY
Phyllis Lindsay, BSN, RN | Plymouth, MA
Jean Llamas, MSN, RN, CCM, ACM | Algonquin, IL
Karla Lindeen, BS, MBA, CMC | Palm Harbor, FL
Dan Medina, BA, NCG, CDP, BCPA | Elk Grove Village, IL
Rebecca Montano, PhD, CRC, CMC, CCM | La Jolla, CA
Greetings! In this issue of the Journal of Aging Life Care, we tackle the issue of Substitute Decision Making for elder clients. This is an important discussion for Aging Life Care Managers who can be involved with our clients’ decision making in many different ways.
Every Aging Life Care Manager (ALCM) will be involved in determining whether a client has appointed appropriate substitute decision makers. As part of an assessment, an ALCM will assess what tools a client already has in place for decision making when they are no longer able to make decisions for themselves.
In addition, ALCMs are frequently faced with issues of whether or not a client has capacity or competence to make decisions on their own. An ALCM can be an essential part of helping families discuss issues of competence with their client’s physicians and guiding families through the process of invoking these documents, if appropriate. Often ALCMs are tasked with having conversations with adult children about the difference between a loved one making a decision they don’t like, or a loved one not having the capacity to make their own decisions.
ALCMs may also be involved in the process of determining whether a client needs a guardian. For clients who have not designated substitute decision makers, guardianship is sometimes an unfortunate outcome. For other clients, there are a variety of reasons guardianship may be necessary, including: revocation of the health care proxy or power of attorney, need for authority to place a person in a nursing home, e.g. This can often be a long, expensive, and arduous process.
One of the debates among our colleagues over the last few years has been whether an ALCM should or should not take on a formal decision-making role for their clients. Some ALCMs have agreed to serve as Health Care Proxy, Rep Payee, or even Guardian for their client(s). In their article “Aging Life Care Professionals ® Serving as a Client’s Decision Maker: The Pros, the Cons and What to Consider,” Fins and Swerdlow discuss the potential risks and benefits of this arrangement. Voorlas and Lorenz, In their article “Who Should Be Paying the Bills, and Managing the Finances?” grapple with issues around an ALCM managing finances for a client and what was learned from that experience.
It is clear that there are conflicts with ALCMs taking on decision-making roles for their clients. However, it is also clear that ALCMs can play an important role for clients in providing education, information, and guidance around health care, housing, and care decisions. Is there a way that ALCMs could be involved in decision making without having to be the formal substitute decision maker?
This issue presents the concept of Supportive Decision Making (SDM), an alternative that is gaining momentum across the country. First, we offer an in depth description of SDM and how it compares and contrasts to Substitute Decision Making. Second, we discuss how this model might work for elders and specifically people who have cognitive impairment or dementia. Third, Granigan and Cohen in their article “The are Committee: An Example of Supportive Decision Making” presents an example of SDM in action by detailing how an Aging Life Care anagement practice and a law practice have collaborated to make this possible. Most importantly, this issue discusses how SDM can provide ging Life Care Managers a way to support and participate in the decision-making process without having to be a formal decision maker for heir clients.
We hope that this issue will spark discussion and consideration of alternative ways for us as ALCMs to support our clients’ decision making in later life. We would like to thank the authors of this issue for their thoughtful contributions.
CORRECTION TO ALCA JOURNAL
The most recent print issue of the Journal of Aging Life Care (Volume 29, Issue 1, Summer 2019) failed to include an important reference to a source for an article. The following citation should have appeared as part of the article “The Care Committee: A Planning Tool for Clients Without Families,” by Steven M. Cohen, Esq. and Kate Granigan MSW, LICSW, CASWCM:
Cohen, Steven (2014). “The Care Committee™: A Planning Tool for Clients Without Families,” The Elder Law Report, Volume XXVI, Number 5, page 1.
In addition, “Care Committee™” and the sample form included in this article are under trademark; however, the article outlines a general concept that is available for use.
These omissions have been remedied with the issuance of a revised version of this publication (PDF format), which is available on the ALCA website and to anyone who requests a copy.
The Editor and Editorial Board of The Journal send their deepest apologies to the authors and to Harry S. Margolis, Esq. and Kenneth M. Coughlin, editors of The Elder Law Report, for this oversight. We thank them for their generosity in sharing their valuable knowledge and insights with us.
Jennifer Lansing Pilcher, Editor