Dementia care education

• Complete cognitive assessments/plan of care development

• Assess client's need for memory care placement through one-on-one home visit and serve as a liaison among family members and health care professionals/clinicians

• Provide education to families regarding psychotropic medication, particularly related to client's who have a diagnosis of Dementia and/or other related disease processes

Availability

Monday - Friday 9am-6pm

Saturday 10am-3pm

COORDINATION OF ELDER CARE

• Assisting families in crisis intervention and counseling patients and their respective family members as it pertains to the transition to long term care placement to nursing homes. Assisting family members with the Medicaid Assistance applications in order to facilitate eligibility

• Assisting families with coordinating needed outpatient services in the home setting (i.e. referrals to homecare agencies, lifelines services, meals on wheels, home adaptive services, and other supportive services)

• 1 on 1 psycho social assessments in home and/or care facility setting

• Geriatric Case Management (home setting through assisted living and/or nursing facility placement)

Availability

Monday – Friday 9am-6pm

Saturday 10am-3pm

ASSISTED LIVING PLACEMENT

• Assess client in the comfort of their own home and/or acute/skilled rehab setting and assist client/family with the transition/admission process to an assisted living facility

• Serve as liaison and work collaboratively with administrative and clinical staff of client's preferred assisted living residency so as to ensure a smooth and seamless transition

Availability

Monday – Friday 9am-6pm

Saturday 10am-3pm

NURSING HOME PLACEMENT

• Assess client in home setting and complete an overall comprehensive assessment

• Provide education/guidance to families as to the transitional steps to take when placing a loved one in a nursing facility and make recommendations accordingly

• Provide case management with client and assist families with the admission process of their loved one to a nursing facility

• Accompany families when touring nursing homes, assist with application process, provide education on financial/insurance needs, including Medicaid guidance, and assist families with completion of required admission paperwork

• Consultative work in nursing homes

Availability

Monday – Friday 9am-6pm
Saturday 10am-3pm

end of life care

• Provide education to client and/or family member regarding Advance Directive planning (i.e. Living Will, MOLST, Durable Power of Attorney for Healthcare/Health Care Proxi)

• Provide recommendations to client/family member regarding hospice agency options and work in a collaborative effort with hospice staff of client or family member's preference

• Assist families with the transition process to a healthcare setting when appropriate as their loved one's condition declines

Availability

Monday – Friday 9am-6pm

Saturday 10am-3pm