top of page

Unexpected Hospitalization

Families are often caught off guard by a hospitalization. Regardless of diagnosis, our care managers are ready to meet you in the hospital, facilitate communication with medical professionals and help plan your next move.

Our goal is to maintain the client’s independence and well-being in the face of medical complexity, cognitive decline and end-of-life planning. We offer a palliative approach to guide families to understand options and make value-based decisions.

SERVICES

In Home Assessment

With a friendly and engaging interpersonal style, care managers create a comfortable interview format while assessing your loved one in their home environment. The following domains are assessed: physical and cognitive functioning, emotional and psychological status, social supports and community resources, as well as finances, benefits and advanced planning. Following the assessment, we provide an action plan for independent implementation or On Going Care Management. The assessment often results in referrals to geriatric specialists, local resources, Elder Law Attorneys, home care supports and other programs.

Care Management

Care Managers provide a comprehensive service which includes arranging all aspect of in-home care, ongoing monitoring of the client through routine visits, medical coordination, family support and 24/7 advocacy, support and crisis intervention. Ongoing care management services can extend a few months, to get you through a challenging period, or span many years. Our longest ongoing client has been with us for over 12 years.

Home Care Options

Hiring new home care staff or managing existing workers can be challenging. Our care managers present all home care options. We will also assess the strengths/weaknesses of existing staff and offer referrals to agencies, registries, and payroll services.

Transitions from Rehab to Home

The rehab stay never seems long enough and families are often suddenly faced with discharge planning. Our care managers will meet with you and your loved one at the rehab facility, review the medical chart, conduct an objective assessment, and talk with the professional staff. We will create a plan for a realistic discharge, manage home care arrangements/logistics, and advocate for essential community support.

Assistance for Attorneys

Care managers are available to provide in-person assessments of your older adult clients. We travel to any residential setting such as home, nursing home, or assisted living to conduct an assessment with a follow-up report. Additional services include: expert testimony, advocacy for MLTC assessments and care management for court appointed guardians.

See this document for more details.

Unexpected Hospitalization

Families are often caught off guard by a hospitalization. Regardless of diagnosis, our care managers are ready to meet you in the hospital, facilitate communication with medical professionals and help plan your next move.

Assistance for Financial Managers

Wealth management is not care management. If your older adult client—particularly one without children or family support—is using your time to meet all their needs, care management might be in order. With the support of a legal decision maker, we can provide assessment, planning and ongoing care management so you can get back to the work of managing your client’s money.

Caregiver Coaching

We offer telephone or in-person sessions from the convenience of your home or office to facilitate an understanding of caregiver stressors and the disease process itself, as well as provide emotional and moral support. During the session, we prioritize needs and create practical action steps to resolve stress. Referrals to support groups and other resources are also provided.

Moving to a Senior Residence

We provide consultation and support when and if someone has decided that they are ready to move to an adult community or skilled nursing facility or an assisted living facility.

Virtual Consultations

Let us help you address your concerns specific to the coronavirus, or more general concerns such as memory issues, home care, or the safety of a loved one’s living situation. We even assist with planning for future home care support and residential needs so you know what the options are and the likely costs.

bottom of page