Becky Tiller, owner of the geriatric care management service Tiller Care Strategies LLC, of Spokane, says clients most frequently ask how to decide when it’s time to move a loved one into a long-term care facility. 

Tiller suggests approaching the decision as a dialogue with the senior in making choices, but safety is the biggest issue leading up to placement at a facility. 

“Can the individual be left alone safely?” Tiller asks. “Would the senior know what to do in an emergency? Are they at risk because of falls, medication compliance, nutrition, or poor judgment?”

She adds, “If the individual has a poor memory, is it impairing his or her functioning? Are they at risk of exploitation?”

Tiller Care Strategies, which occupies a leased office at 2028 W. Northwest Blvd., provides case management services to plan for the care of mostly people ages 60 and older. 

The services include assessing clients’ physical and mental health, and how well they function in their current residence. It also provides the same service for some younger people who have mental or physical conditions. 

The company’s work includes helping clients find community services that can be provided in the home so they can stay there, or assisting seniors with a move to a retirement community or care facility, Tiller says.

“We provide comprehensive case management, everything from arranging a client’s move from Alaska to here, to arranging a burial, so it’s the whole gamut of geriatric care services,” she says.

Tiller says the company’s services also might include helping clients complete long-term care insurance claims or an application for Medicaid. The company has assisted people who have dementia, along with other health concerns that cause family to seek help, especially if the relatives live away from Spokane, she adds.

“Most of the time it’s the adult child who hires us for their parent,” Tiller says. “A lot of times, the adult child lives in another area, because we’re such a transient society now, and that person is concerned maybe after visiting during a holiday because of the parent’s health issues, or memory issues.” 

The business also sometimes hears about concerns that an elderly couple needs to consider downsizing to a retirement community, because they can’t maintain the home or keep up with daily chores.

She adds, “We rarely have the actual senior call. People don’t see it in themselves, the need for help. Maybe 10 percent do. We also get referrals from neurologists, physicians, and elder law attorneys.”

The business charges clients by the hour. For the initial assessments, the company charges $135 an hour, and Tiller says an assessment session usually requires about 1 1/2 to two hours. Following the assessment, all other case work is handled for a rate of $95 an hour.

The cost for an assessment and initial follow-up services can range from $200 to $500, she says, depending on how much time is required to stabilize the individual who needs the case management.

“For a couple hundred dollars, you have someone who has an objective standpoint and can make recommendations that can save you some grief,” she says.

Tiller estimates that the company has about 50 active cases, and about 50 inactive cases, which she says means the company is available to those clients they’ve recently assisted on an as-needed basis if concerns arise.

“Once someone is stabilized, we back off,” she says. “Some people need some ongoing care. We’ll take seniors to the doctors’ appointments, the dentist, because the adult child is away.”

Most of the company’s clients are in Spokane County, but it has served people who live in rural Eastern Washington towns as far away as Othello and Davenport and in parts of North Idaho, including Sandpoint.

A licensed mental-health counselor, Tiller began her career in 1985 doing geriatric case management for Elder Services, a Spokane-based information and referral service that is now a department of nonprofit Frontier Behavioral Health. She started Tiller Care Strategies in 2004 and works there full time. It has two employees, a registered nurse and a social worker, who work part time.

“They assist often with home assessments; we’ll go in pairs,” Tiller says about the two employees.

She  attends many of the assessments, either with the company’s nurse or with the social worker. The company typically does an in-home assessment in order to evaluate the needs of the clients and assist in developing a plan for care, Tiller says.

“We research what level of care they need, how independent they are,” she says. “Could someone stay in the home? Do we need to bring in services? We refer a lot of people to community services, such as to a neurologist or another specialist. There are a lot of resources in the community, and people don’t know about them.”

She adds, “We can also assess their judgment. They say they’re OK, but they have a bump on the head from falling. We have to look at safety. That’s one of the main things.”

If a person needs to move into a retirement community or assisted-living facility, the company researches the facilities that are specific to the needs of the client, Tiller says. However, she adds that Tiller Care Strategies provides a recommendation for a facility without receiving any compensation from that facility in return.

“We do not accept referrals fees from care facilities or retirement communities,” she says. “There are companies out there that do that, and the state had cracked down on them. They were getting kickbacks. They’d say they have no charge for the elderly person, and maybe talk to that person for five minutes.”

Tiller adds, “We’re advocates for the best level of care, the most appropriate facility, and we’re doing it without any influence from a facility. We research them.”

The types of facilities include retirement communities with independent-living arrangements, assisted-living facilities, and memory-care centers.

If an adult child of an elderly person receiving services lives outside of Spokane, the company often sets up conference calls to talk to all family members involved. The company’s work also can involve providing mediation between family members about the need for care, such as for an elderly couple.

“There can be a lot of family conflict,” Tiller says. “The son says they’re doing fine. The daughter says, ‘No, they need help,’ so a fight ensues.”  

She says the company is seeing more people in their 50s and 60s reaching out for services themselves in order to remain in their homes, or to move to a retirement community that still enables them to live independently. 

“With the boomers, I’m seeing more people who are saying I don’t want to deal with a home, a yard,” she adds. “They want to look at a retirement community where it’s all inclusive with all the amenities. The retirement industry is trying to accommodate that.”

She says an all-inclusive arrangement means that seniors can enter a retirement community and live in an independent home but still have access to services of a retirement community if needed.

“That way people can come and go, and travel,” she says.

 She says that while the company continues to research retirement facilities here, she has noticed a trend in the past year of many Spokane-area complexes changing hands.  

“There are huge transitions going on right now, maybe a national company buys them out.” she says. “We keep our fingers on the pulse of that to make sure placement is still right for a client. We can remain involved for a while afterward just to make sure.”

She says the company went through some lean years in terms of revenues in 2010 and 2011, but it has experienced gradual growth for the past two years.

“2012 is when we really started to recover,” she says. “I don’t know a percentage, but the last two years have built up gradually. It’s only going to increase because the boomers are getting older.”

She says about four other companies in Spokane provide geriatric care management.

“We’re seeing more and more adult children recognizing there are services like us out there,” Tiller adds. “They search and find geriatric care managers on the Internet.”

Tiller also says she’s noticing a change in attitude among more of the seniors helped by the company.

“People are much more willing to utilize services, whereas for the generation of the Great Depression, it was all about self-sufficiency and independence,” she says. “If they accepted help, it was a sign of weakness.”