Advocating for the elderly

Stacey Maines has devoted the last 24 years of her career to elder care social work.

“Most people don’t know that geriatric care managers even exist,” she said. “For the elderly patient who doesn’t have an advocate in the emergency room, at the hospital bedside, or even in the physician’s office — who is asking questions on his behalf?”

Ms. Maines is the director of care management services at Generations Counseling and Care Management in Rochelle Park. Growing up in a Conservative Jewish home, she recalls hearing her elderly relatives and their contemporaries spit poo, poo, poo — a superstition to prevent something terrible from happening — when they talked about aging, illness, or death. “My parents and grandparents would rarely speak about illness or the need for help for fear they might tempt fate,” she said.

Ms. Maines earned a B.A. in psychology and criminology from the University of Maryland, and received her master’s degree in social work from NYU. Next, she passed her certification exam and became a licensed social worker.

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She began her career in 1998 by working for the Legal Aid Society in New York, serving inmates at Rikers Island and detainees held in Queens County by preparing presentencing reports on their behalf.

But her commute to Queens from her home in Hackensack was difficult and prompted her to consider a change. She recalls that during a visit to Washington, D.C., a family friend, who was writing a grant for the National Association of Social Workers, asked why more social workers weren’t passionate about working with the geriatric population. “That’s a good question!” she replied, accepting it as a personal and professional challenge. “By the following Monday, I was looking in The Star-Ledger for jobs that fit the bill,” she said.

In 1999, Ms. Maines accepted a position as director of social services at South Mountain Healthcare Center in the Vauxhall section of Union Township, a long-term care facility with a 25-bed subacute rehabilitation unit. “It was there that I learned so much about the interdisciplinary process,” she said.

With a constant turnover in the rehab facility’s patient base, Ms. Maines had the opportunity to get to know her patients quickly, while simultaneously learning the roles of each of the clinicians on the care team. “Collaborating with nurses and dietitians, speech, physical and occupational therapists, I participated in twice weekly team meetings,” she said. Since her role was to create a comprehensive discharge plan for each patient, she studied every clinician’s handwritten note, picking up on abbreviations and care plan nuances. “It was from my experience in the subacute setting that I learned ‘nurse speak.’ I began to understand medical terminology and could translate information clearly to the patients and families with whom I worked.”

Ms. Maines believes that what she learned at her first job was a template for meaningful patient and family interactions in similar roles at various facilities in New Jersey. But while she appreciated the opportunity to coordinate all the home care, prescription, and equipment needs for her patients just before they were discharged, she was frustrated because she would not be available to help them once they got home. “I’d work tirelessly to put together the care plan, but I’d often ask myself what might happen if it all unravels when my patient gets home. What if it was necessary for someone to convince patients that their plan of care required tweaking as their needs change?”

Ms. Maines thought about how she might use her 10 years of experience at subacute rehabilitation centers, hospices, nursing homes and assisted living facilities. “I didn’t realize it, but I’d been preparing for my dream career,” she said.

She talked to social worker Vicki Doueck, whom she knew to be a leader in the field of geriatrics. “There’s a high turnover in health care social work,” Ms. Maines said. “I was convinced that serving as an aging life care provider would fill the gap for all of the roles I wasn’t able to fill as a discharge planner.”

Knowing Ms. Doueck’s success in patient advocacy as president of Generations Counseling and Care Management, Ms. Maines, who now lives in West Orange, joined the company nine years ago as a professional liaison between patient, physician, hospital, and family.

“Clients are referred to me from many sources,” she said. “Hospital discharge planners, estate attorneys, elder care accountants, and home care agencies may be working with a family who can benefit from our services, and others contact us by word of mouth or find us on the Aging Life Care Association database.

“Most people don’t know they need a geriatric care manager until they actually work with one.”

Now, after more than two decades in the field of senior care, Ms. Maines sees herself as a professional liaison to families.

Her presentations to the Jewish community, which outline the services she and her colleagues provide, are titled L’Dor V’dor— from generation to generation. “I try to take the fear out of growing old and make conversing about it more openly something that’s not forbidden,” she said, reflecting on the elders in her family who superstitiously refused to say the word cancer or name other frightening illnesses.

Her clients often talk about their need for a professional sounding board — someone who can help them navigate the healthcare system and offer guidance. “Many of my clients don’t want all of their time to be absorbed by caring for an elderly parent, irrespective of where they live,” Ms. Maines said. “Sometimes they need to set boundaries, because they recognize they can’t be their best if they’re on call for Mom or Dad 24/7.”

Ms. Maines believes that each family member deserves to have a voice. “There’s no one right answer when caring for an elderly relative,” she said. “My job is to determine what will work best in the context of family roles that have been established years prior to the parent’s decline.

“I see myself as both a professional neutralizer and hand holder. Sometimes I provide the initial tools to help clients divide and conquer in supporting their parents; other times I remain in the thick of patient advocacy until the parent’s end of life.” She has learned that guiding clients with difficult conversations and emotional decision-making is different with every family.

“Adults with growing children and aging parents are pulled in so many directions,” she said. “They often need someone to triage on their behalf.”

For almost a decade, Ms. Maines has prided herself on her ability to support her clients at any point in the process. “In one day, I might see four clients in an assisted living community, two in a memory care unit, two in a rehab, and one at home.” She participates in family meetings held at live-in facilities, establishing ongoing relationships with the person needing care, their adult children, and the facility’s staff.

She also advocates for adults with disabilities.

“Some of my favorite geriatric cases are the difficult ones,” she said. “Sometimes it can be like walking through a minefield. You never know what might set someone off.” By establishing rapport and trust and giving each of her clients the time they need to consider how their relationships with children and other family members might factor into care planning and decision making, Ms. Maines believes her clients know she respects them.

“I am committed to meeting them where they are on any given day,” she said. “I give them space to explore how they feel about growing old.”

What Stacey Maines does, or more broadly, what care managers do, is help connect the generations during challenging times.

“The Ten Commandments teach us to honor our mother and father,” Ms. Maines said. She attributes her compassion for the elderly to her relationship with her grandfather.

“When I was 12, my grandmother died,” she said. “As an adult, I got to know my grandfather as a separate individual with specific needs. I spent time with him at a vulnerable time of his life. That relationship guides how I do what I do.”