Home Care Coordination
Research shows that older adults are happier and healthier when they stay in their own homes. But to do so, most eventually need help. How much and what kind can vary, sometimes daily, and it can be an overwhelming challenge to know exactly what to do and where to get help.
We developed Comprehensive Care Coordination to give older adults immediate access to whatever help they need through a regular relationship with a designated geriatric care coordinator. Care coordinators assess needs, develop a care plan and arrange for necessary services. A key component of our Comprehensive Care Coordination program is our focus on prevention. Ongoing communication and regularly scheduled and comprehensive assessment puts into place services, programs and even cognitive enhancement exercises and helps to spot and address issues before they become severe.
JF&CS care coordinators are credentialed, experienced geriatric social workers. They combine compassionate care with the objectivity and expertise necessary to help you make informed decisions. JF&CS also offers immediate backup if the assigned care coordinator is unavailable.
JF&CS's older adult clients can continue to live independently with confidence, and their families are less anxious knowing that loved ones are in good hands.
How We Help
- The first step is a comprehensive, in-home evaluation. All aspects of the older adult client's life are reviewed, including general health, medical treatments and providers, medications, mood, cognitive ability, physical ability, nutrition, home safety, current benefits and relevant legal documents. From this review, a care plan—designed to assure safety and independence and to enhance overall well being (functional, cognitive and emotional)—is developed and implemented.
- Monthly home visits and frequent phone contact allow geriatric care coordinators to continuously track how well clients are doing, to judge whether current services are meeting needs and to make required changes in a timely manner.
- Relationships established with clients ensure that you have a professional available to monitor and address changing needs, as well as to immediately address any crisis that may occur.
- Coordination of doctor and other appointments, financial management assistance and more provide support for daily living.
- Twice a year, a medical professional will review all prescription and over-the-counter medications to ensure safety.
- Cognitive enhancement exercises (brain stimulation and enrichment activities), proven to reinforce mental agility, are an integral part of the program.
- If a client can no longer safely and comfortably live at home, we will present residential options that meet client needs, preferences and finances; help with arrangements to make the transition as smooth as possible; and provide ongoing care if desired.
- With approval of our client, ongoing communication with family members provides updates, an opportunity to answer questions and peace of mind.
- Additional elder care services are available to Care Coordination clients at discounted rates.
- Care coordination services also are available on an hourly basis.
Meet the People We Help
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A few years after the death of her husband, Belle* began having bouts of depression that kept her isolated from the rest of the world around her. The obvious solution to daughter Cheryl* (who lived in Europe) and son Jeff* was to relocate their mother to North Carolina where Jeff lived. However, like many older adults, Belle did not want to burden her children and did not want to release her independence. Pittsburgh was her home, and she wasn't leaving.
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When 90-year-old Leonard* was rushed to the hospital, his wife, Shirley*, was left home alone to fend for herself. Worried about how her physically disabled mother would cope in her husband's absence, Shirley's daughter called the Care Coordination staff at JF&CS.
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After undergoing back surgery, Jack's* doctor recommended that he stay in a nursing home rather than return to the assisted living facility that he loved. Faced with the prospect of living out the rest of his days in the nursing home, Jack began to suffer depression and other cognitive setbacks.
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The challenges brought on by aging made it even more difficult for Joan* to cope with her schizophrenia. Knowing when and how to seek out the care that she required for her chronic mental illness grew harder and harder.
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After a debilitating fall, Jake's* elderly father could no longer care for his mother, who suffers from bipolar disorder. Their son didn't know where to turn, especially because his parents were reluctant to seek outside help.
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*Name changed to protect client confidentiality.
