How we start
Care management is a highly individualized experience. Each person is unique - each family is totally different then another. Therefore my work with each client is very personalized. For some clients they may need help with a single issue - insurance problem or housing or benefit counseling or a Medicaid application. Another client may need a much more comprehensive care management plan. But in all cases there are four main steps:
Assessment
Assess the client’s medical, psycho/social and living condition to identify care and safety needs.
Care Plan
Create a customized care plan designed to improve the client’s overall physical, mental, and emotional health
Implementation
Implement the care plan by arranging physician attorneys, home health agencies, and care companion agencies.Contact appropriate care companion agencies with client criteria and interview companions to find who best fits the client’s needs and behaviors
Follow Through
Serve as liaison and advocate between physicians, therapists, money managers, attorneys and family members to make certain the client’s overall needs are met. Visit clients onsite to supervise their continued care, set up and reorder medications, and support home care workers as needed. Coordinate the entire process and update families through emails and phone calls.