Care Coordination

Care Coordination or Care Management helps a consumer or family understand and utilize the variety of non-medical supportive services and help that could be accessed during changing circumstances. Social work based care management works in concert with health care but is focused on the choices and help that are needed for you to have the assistance you need and want.

When could you benefit from a care coordinator also called a care manager? There may be difficult times in your life when a care manager can help you or your loved ones. The following are some examples:

• When understanding the confusing jumble of services is too much to handle.
• When family members are becoming exhausted from providing hands on help.
• After a serious injury or stay in the hospital, rehabilitation or nursing home.
• When a temporary or long-term condition requires securing supportive care or services.
• If you are unclear about the range of options available to you and need additional information and/or assistance in securing the care you desire.
• If you are unsatisfied with the care you are currently receiving and want to ensure that you are knowledgeable about the range of options available, how to secure the care you need and desire, and how to make changes or explore alternatives.

What a care manager can do for me:

• Help you to identify your needs by fully assessing the health status and living situation.
• Help you to figure out what you, your family or friends can do for you, and what you still need to have done through medical or other services.
• Give you good advice about your choices and how they will work out in your case, such as the following:
  • Counsel you on the extent and limitations of various government benefits.
  • Schedule in-home services for meal preparation, personal care, light housekeeping, grocery shopping, escort to medical appointments, medication reminders, etc.
  • Propose alternative forms of care—when a person cannot be left alone but needs some medical assistance—adult day services.
  • Assist you in considering the most appropriate and possible housing options, even in relocating to a different community during difficult times.
• Help you to develop your own personal care plan with clarity regarding the costs for services and how payment will be handled.
• Check on how your care plan is working for you and make any necessary changes.
• Be there for you when you need help right away especially when plans are disrupted.

How do I find a good care manager?

Ask a hospital or nursing home discharge social worker, your family doctor, or religious leader. Often attorneys, bank trust officers, senior centers or community human service agencies are able to make recommendations. The federal Administration on Aging’s Elder Locator 1-800/677-1116 www.eldercare.gov/ can connect you to the local Area Agency on Aging, which usually provides this service and/or can refer you to private geriatric care managers.

Care managers should have certain education and experience. You should ask a care manager about the following:

• In what areas of care do you have experience?
• Where did you get your training or education?
• How long have you been a care manager, and for whom have you worked?
• Do you have state and federal clearances?
• Can you give the names of people for whom you have worked and who I can call?
• What are your rates and payment methods?
• If you have a limited income, be sure to ask about free, reduced fee or sliding scale care management services.

Mildred E. Morrison, Administrator
Allegheny County Department of Human Services, Area Agency on Aging