Kristin Martinelli began her workday at 7:30 a.m. on a recent Monday, completing an online Medicaid re-certification form for a client in a nursing home in Austin, Texas.
Next, she drove to meet an 85-year-old and her daughter, who had come in from out of town. The older woman had “pretty advanced dementia” and was scheduled to move into the secure memory-care unit of a senior living facility that day, said Ms. Martinelli, who works as an aging life care manager with Mir Care Consultants in Central Texas. The three of them had a 9 a.m. meeting with the primary care doctor who would complete the paperwork for the move.
At the meeting, Ms. Martinelli explained the situation, and the doctor said he’d fill in the patient’s forms that afternoon. But later in the day, she got a call from a colleague saying that the doctor wouldn’t be able to complete the forms that day after all. That created a scramble because the woman wasn’t safe alone in her house. Ms. Martinelli ended up calling a home care agency she trusted. “I begged them to provide me with a caregiver in the next four hours,” she said.
If a combination of appointments, bureaucracy, vigilance and worry about a vulnerable older person — often interspersed with medical emergencies — sounds familiar, it might help to know about a service its providers ruefully call the best-kept secret in elder care.
Independent certified professionals like Ms. Martinelli used to be known as geriatric care managers. That’s what I called the people who helped my 88-year-old father make the 125-mile move from his apartment to a continuing care community near me, and later helped my disabled sister transition from her home to an assisted living facility.
I also used words like “godsend” and “indispensable.” After the moves, the care managers kept tabs on both my father and sister monthly and eased my fears that something urgent might strike the moment I left on a vacation or a work trip.
About a decade ago, these experts rebranded themselves as aging life care managers. It usually takes a couple of years to become one. Most enter the profession as nurses or social workers; some are physical or occupational therapists or gerontologists. They must attain a required combination of advanced education and supervised experience before they can take the certification exam.
The Aging Life Care Association, the nonprofit that represents these professionals, was founded in the 1980s and has grown to more than 2,000 members, but care managers still have a persistent public awareness problem.
“When we talk to someone, they say, ‘I wish I could have called you six months ago, but I didn’t know you existed,’” said Susy Elder Murphy, who owns Aging Well Eldercare, a large practice serving Washington and its Maryland suburbs.
The caller is typically an adult child, the Aging Life Care Association has reported. Ms. Martinelli described a common scenario: “Mom is in the hospital, or the children went to visit and hadn’t realized she was so sick. They’re in a crisis.”
Enter the aging life care manager. What distinguishes her (it is usually a woman) from people with confusingly similar names — senior care advisers, patient advocates, care navigators — is her independence.
Aging life care managers work for the client and the family paying them, not for hospitals or insurance companies. Moreover, the association’s extensive code of ethics specifically prohibits “accepting or giving referral fees, fee splitting, kickbacks or other similar arrangements in exchange for client referrals.”
Contrast that with companies that promise free advice on senior living, like A Place for Mom. Care facilities pay A Place for Mom fees for steering new residents their way, as the organization discloses on its website. Advisers for companies that receive fees may be unlikely to recommend places that don’t pay, or to recommend home care, unless the company also contracts with local agencies.
“They’re really marketers, salespeople,” Julie Wagner, chief executive of the Aging Life Care Association, said about the referral companies. Some companies are more transparent than others about these financial incentives.
“If you want to buy a car and you go to the Ford dealer, they will not say, ‘I really see you in a Subaru,’” Ms. Murphy said. “You should be talking to someone who’s objective, neutral and experienced.”
Care managers don’t come cheap. Ms. Wagner said association members’ hourly rates range from $150 to $350, with big geographic variations. In Texas, Mir’s standard rate is $185 an hour, billed in 15-minute increments. In Washington, Ms. Murphy’s practice charges $210 an hour. Sometimes families share the cost, as my sister and I did. And in some cities, social service agencies provide these specialists on a sliding scale.
Aging life care managers serve as coordinators, not hands-on caregivers, and the range of services they provide is quite broad.
They can, for example: Arrange and oversee a move to or within a senior living facility. Deal with insurers, including Medicare and Medicaid. Drive a client to the dentist. Recommend not only local residential communities and home care agencies but elder law lawyers, medical specialists, therapists, senior move managers and hospice organizations. Visit weekly or monthly to see that everything is going smoothly. Alert family members if it isn’t.
“A part of our job is mediating between family members, acting as a sounding board,” Ms. Martinelli said.
In fact, care managers like Ms. Murphy find their clients often seem more willing to listen to them than to their adult children — even if the advice is the same. “Your mom didn’t change our diapers or teach us to talk,” she said. “It’s a different relationship.”
In a 2025 survey of clients and families commissioned by the Aging Life Care Association, “the responses were overwhelmingly positive,” said Jullie Gray, a co-author of the study, who teaches at the University of Washington School of Social Work.
The nearly 200 respondents did not constitute a representative national sample, Dr. Gray said. But 93 percent said the benefits of hiring an aging life care manager outweighed the costs, and 99 percent said they would recommend such a manager to someone else. The survey’s findings were presented at the 2025 meeting of the Gerontological Society of America.
Jeffrey Bernstein, an engineer in Middleton, Mass., has for years relied on Aging Well Eldercare for help with his parents, two older siblings and an aunt, all in Maryland. Like many people who eventually learn about care managers, “I had no idea such a person existed,” he said, until his wife read about them in a magazine.
Mr. Bernstein, 65, was unable to relocate to care for his family directly. But with care managers, “when something came up, they were there, they stepped up,” he said. “More importantly, they knew what to do when I wouldn’t have. It was tremendously helpful for my peace of mind.”
The same was true with Ms. Martinelli’s 85-year-old client in Austin. She spent the night with temporary caregivers and moved into her new home in the memory care unit that Tuesday, after her doctor finally produced the necessary documentation. “She went in just before noon,” Ms. Martinelli reported. “She had lunch.”
How was the new resident adjusting? “It’s been OK,” Ms. Martinelli said, sounding relieved. “So far, so good.”
The New Old Age is produced through a partnership with KFF Health News.
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