What is Care Coordination?
Care Coordination
Care Coordination program is designed to link home care services to those vulnerable older adults who are at risk of loosing their independence due to having multiple problems with daily living tasks and skills. Care Coordination consumers cannot be PASSPORT eligible. Each Care Coordination consumer is assigned a Case Manager that is either a Licensed Social Worker or Registered Nurse. The Case Manager will monitor the delivery of all services, periodically reevaluate the consumer's needs and assist the consumer in accessing other medical and social services. Case Management is provided at no charge. A "sliding fee scale", based on income, gives the consumer an opportunity to make a voluntary contribution towards the cost of their services.
Services currently offered in the Care Coordination program consist of the following:
| Homemaker | Definition: Homemaker (HMK) is a service designed to enable a consumer to achieve and maintain a clean, safe and healthy environment, assist the consumer to manage personal appointments and day-to-day household activities as authorized by the case manager, and ensure that the consumer maintains the consumer’s current living arrangement. HMK service consists of general household care when the individual regularly responsible for these activities is temporarily absent or unable to manage the home. HMK staff may act as travel attendants for a consumer. |
| Personal Care | Definition: Personal Care is a service designed to enable a consumer to achieve optimal functioning with ADLs and IADLs, and includes personal care services and homemaking tasks appropriate to a consumer’s needs. Personal care services must be provided in the consumer’s current place of residence. |
| Adult Day Care | Definition: Adult Day Service (ADS) is a non-residential, community-based service designed to meet the needs of functionally and/or cognitively impaired older adults through an individualized care plan that encourages optimal capacity for self-care and/or maximizes functional abilities. ADS consists of structured, comprehensive and continually supervised components that are provided in a protective setting. Consumers who receive ADS attend on a planned basis during specified hours. |
| Emergency Response Systems (ERS) | Definition: Emergency Response System (ERS) is a service designed to monitor consumer safety and provide consumers with access to emergency crisis intervention for medical or environmental emergencies through the provision of communication connection systems. A person may also wear a portable “help” button to allow for mobility. The system is connected to the person’s phone and programmed to signal a response center once a “help” button is activated. The response center is staffed by individuals trained to respond to emergencies. ERS services are limited to those individuals who live alone, or who are alone for significant parts of the day and have no regular caregiver for extended periods of time. |
| Independent Living Assistance (ILA) | Definition: Independent Living Assistance (ILA) is a service that consists of activities that assist consumers to manage their households, handle their personal affairs, self-administer medications, and help ensure that consumers retain their community living arrangements and avoid institutionalization due to loss of shelter or other essential environmental services. There are three types of ILA services: telephone support, in-person support activities and travel attendant activities. |
Care Coordination services are available on a first come, first serve basis; contingent upon program funding availability.
Care Coordination Case Management Provides the following:
A Care Coordination Case Manager will be either a Licensed Social Worker or a Registered Nurse. The Case Manager will monitor the delivery of all services; periodically re-evaluate the client’s needs and assist the client in accessing other medical and social services. Case Management is provided at no charge.
Locates, Activates, Coordinates a variety of home care and other services needed by persons who are at “high risk” of loosing their independence through nursing home placement or who are otherwise vulnerable.
The Goal of Case Management
To enable consumers to remain in the least restrictive environment while maintaining the greatest amount of independence and human dignity. These Goals are accomplished in a cost effective and service efficient manner with sensitivity to the consumer’s own personal preferences and Choice, and are based upon the strengths present in the consumer and/or caregiver.