Coordinating the Best Possible Care

Coordinating the Best Possible Care

One of the most daunting challenges for family members who are responsible for the care of an aging or ill loved one is coordinating care — from health care planning and medication management to home safety upgrades, nutritional assistance and emotional support.

As your loved one continues to age, or his or her illness worsens, it’s easy to be caught off-guard. Many will end up with a lack of proper care providers, a dangerous living situation, or worse, a medical emergency that could have been avoided. While professional services will never replace the care and emotional support of loved ones (whether you’re across the country or down the street), Client Care Coordinators can complement daily in-home care practices, including hospital discharge services and after surgery care services, and enhance the quality of life of your entire family.

What is a ClientCare Coordinator?

ClientCare Coordinators are qualified nurses, social workers or geriatric care managers who work closely with families to orchestrate the best possible home health care for loved ones who are living at home. Care Coordinators keep all parties informed of health conditions, and can be present in any health care facilities to oversee care — they’ll be there when you can’t be. “Our nurses followed a client from an acute hospital stay to rehab ,back to the hospital and home, then back to the hospital and home again. His daughter lived out-of town, and our nurses kept her aware of her father’s health situation daily — even down to his [diabetic] blood sugar readings,” shares Nancy Ford, RN Services Supervisor at Homewatch CareGivers of Charlotte.

ClientCare Coordination offers families the benefit of high-level management and home health support. ClientCare Coordinators conduct an initial evaluation of your loved one’s health needs and create a full care plan — complete with goals and expected outcomes of care and treatments. They then work closely with routine home care providers and a full-spectrum of health care referrals to monitor and manage established care plans — including physical therapists, hospice care, oxygen and medical equipment companies. ClientCare Coordinators can also conduct routine wellness checks and work with family members to ensure that key players understand the status of health conditions, and any necessary follow-up care instructions.

Avoiding Unnecessary Medical Interventions

Falls are the leading cause of death and injuries among Americans age 65 and older, according to the National Center for Injury Prevention and Control. More than one third of all seniors — or about 11 million people — fall each year, resulting in almost 12,000 deaths. Of the fall survivors, 50 percent lose their mobility, and 40 percent, their independence — forever. “Our nurses frequently encounter clients who are a fall risk, or who have mobility challenges, making it difficult to remain independent at home,” Ford noted.

A safe home health environment can help your loved one maintain autonomy and continue to live (and thrive) at home, however, finding the right team to implement home safety recommendations can present a challenge. ClientCare Coordinators will identify and manage qualified vendors to complete the necessary safety-related household repairs and modifications — such as wheelchair ramps and bathroom grab bars, so you’ll be assured that your loved one is protected.

Nutritional Assistance

Malnutrition is common among the elderly, with a prevalence of 12 percent to 50 percent of those hospitalized, and 23 percent to 60 percent of those in extended care facilities, according to “Principles of Geriatric Medicine and Gerontology (fourth edition).” Preventing malnutrition in your aging loved one is essential to maintaining their health and autonomy, but can be a challenge if you live remotely. “A regular part of our RN [ClientCare] assessment involves nutrition and dietary requirements,” Ford shared. “Our nurses and aides are taught to pay attention to the type of diet required for optimal home health, such as a low-salt or diabetic diet.”

ClientCare Coordinators will manage your loved one’s nutritional needs and directions from health care professionals by executing menu planning, grocery shopping, and meal preparation with important guidelines in mind. ClientCare Coordinators also track and record dietary intake, so that meal plans can be adjusted to ensure the best nutrition — and enjoyment — possible.

Medication Management

The elderly are two and one-half times more likely to visit the emergency room due to an adverse drug event. Medication mistakes can leave otherwise independent and relatively healthy individuals in long-term hospital stays, or afflicted with further health complications.

With ClientCare Coordination medication management, our staff will conduct an initial evaluation, and follow-up with ongoing tracking to ensure medication compliance and prevent contraindications. “A nurse will review the medications of our clients, and schedule a nurse’s aide to ensure that the client is taking medications at the proper time, and in the proper way for optimal home health benefits,” Ford noted. They are also qualified to verify physician medication orders, set up medication schedules on a weekly or monthly basis, re-order and pick up prescriptions, and also manage electronic medication dispensers.

Emotional Well-Being

A recent report from the Journal of Health and Social Behavior shows that social disconnectedness is associated with worse physical health in seniors. It also says that older adults who feel isolated show a deteriorating level of mental health. Oftentimes in the wake of aging and illness, physical care is the main focus — leaving emotional care on the back burner. While your loved one may be suffering the physical consequences of becoming older, or from certain conditions or diseases, they also may become lonely, isolated or depressed. “One client is a grieving widow, who our nurse and a social worker felt would benefit from the support of an ongoing grief support group,” Ford shared. “Our nurse, a former hospice nurse, recommended that the client contact hospice, and now a bereavement counselor visits her to help.”

ClientCare Coordinators go the extra mile by planning social activities, referring community resources that fit your loved one’s social needs, and supporting you and your family with bereavement assistance and company during the mourning process -- in addition to tending to more traditional home health needs.

Transitional Assistance

What happens if your loved one can no longer stay in their home? The prospect of moving, whether to another residential home or to a professional care facility, can be intimidating for the family and their aging loved one. Family may be unsure of the next best move — is it to the home of a family member, or to assisted living or a nursing home? While the senior may be fearful of such a large lifestyle change. “A client in a continuous care residential community declined in health, and went from his cottage home to the hospital, and then from the hospital to the community’s nursing center. Our nurse arranged for one of our aides to follow him through each of his transitions, and the nurse continued to monitor his condition and communicate with his wife,” Ford explained. “Extra care was taken by our nurse with the family, as well as with the facility staff, to ensure smooth transitions.”

Knowing where to turn in the midst of such a transition can be a struggle. If necessary, ClientCare Coordinators can help your loved one physically move from their home into a facility, a new home, or your home. We’ll continue care services at your loved one’s new location, or help the transition to a facility go smoothly in the event that home care is no longer an option.

All-Encompassing Care

According to the National Institute on Aging, creating a positive (all-encompassing) home health routine can help your loved one feel less chronic pain, achieve greater independence and mobility, and decrease their risk for depression, injury and other medical emergencies.

With a ClientCare Coordination program, you and your loved one will have access to continuous learning classes, senior community centers, support groups, financial advisers, accountants, elder law attorneys and funerary services — the right ClientCare Coordinator will recommend and put you in touch with the best home health practitioners and support team. Families with loved ones who are ill or elderly have enough to worry about — why not leave the details and planning to a qualified ClientCare Coordination specialist? Homewatch CareGivers considers total health wellness of both the body and the mind. We will ensure an all-encompassing care model for your loved one’s health and well-being, and make sure you are supported (and at peace), as well.

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