Reasons for Case Management:
Out of pocket healthcare costs continue to escalate.
Limited Health Insurance benefits.
Multiple disease processes occurring.
A major diagnosis of stroke, diabetes, paralysis, cancer, etc
A decline in the client's medical condition.
A change in the clients' ability to care for themselves.
An increasing number of hospitalizations.
An extended hospitalization due to major illness or complications.
Anticipated continuing care needs, post hospitalization.
Multiple physicians being utilized.
A lack of communication between healthcare providers.
Multiple medications being prescribed from multiple physicians.
Confusion or concern about the current treatment plan.
An increasing number of falls (with or without injury).
Difficulty in obtaining healthcare information and resources.
Questionable compliance or lack of progress with treatment plans.
Family or caregivers have questions and have limited ability to assist with healthcare needs.
Experimental or investigational care.
Case Management Services Offered:
Senior Care Management:
An on-site assessment is done to identify the current health status, potential care needs, and recommendations are then made for the senior client. These may include home safety needs, utilization of community resources, or assistance in locating local experts i.e. Senior Real Estate Specialists (SRES), financial planners, elder law attorneys, asset managers etc., in order to meet the clients' needs. Ongoing follow-up will be done based on needs/requests.
Needs Assessment (Limited):
An on-site or telephonic meeting with the client and/or family is done to assess home safety and medication management, contacting applicable providers for current status reports, providing education and recommendations to manage and address client needs. Should ongoing follow-up be requested, full case management services will be implemented.
Full Case Management Services:
An on-site visit is done for assessment of current issues, treating physicians are contacted to obtain their treatment plans and goals, assistance for coordination of care is done as well as locating in network providers and/or local community resources. Additional tasks may include negotiating of costs if applicable, oversight of care being provided as well as ongoing assessment of progress towards goals in the plan of care, and confirming of inter-disciplinary communication.
Discharge Planning:
An on-site or telephonic meeting with the client and/or family is done to assess home safety and medication management, contacting applicable providers for current status reports, providing education and recommendations to manage and address client needs. Should ongoing follow-up be requested, full case management services will be implemented.
Special Services:
This may entail only limited involvement, such as negotiation of fees, performing on-site visits in facilities (assisted living, retirement, SNF) for potential utilization, general health insurance education and benefit reviews (note: specific carriers or policies will not be recommended). General consultation services and educational programs are offered based on requests.
Health and Wellness Coaching:
Education is provided related to health issues, lifestyle assessment with recommendations for modifications in order for each client to maintain their optimal health status.
Service Area and Locations:
Services may be provided on-site, telephonically, or a combination of both. Comprehensive Care Management, LLC primarily serves the North Texas population, however, Ms. Acres holds a Texas Compact Nursing License which allows practice in Arizona, Arkansas, Colorado, Delaware, Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin. (current compact states information is available at www.ncsbn.org).
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