Care coordination (also known as care management) is a service that allows older adults to remain in the community as independently as possible. The service begins with an in-depth assessment by a licensed clinical social worker. The assessment leads to a plan of care for the client, which can include bill paying, medical management, assistance in the home, and other referrals to local resources. Ongoing monitoring of the client and continuing communication with family members occurs regularly, as needed or desired by the client and family. These services combine to help a senior attain maximum potential and give families peace of mind that their loved ones are safe and content.
The social worker will talk with the client and explore all aspects of life, including physical and mental health, cognitive function, social activities, family dynamics, and personal history. We look at what the person can or cannot do in his or her home and how we can help them stay where they want to stay.