Case Management
This program assists frail clients with long-term, complex problems. Service includes:
- An in-depth, in-home assessment with a client, family members, and support network
- Development of a written care plan with input from client and family
- Implementation of the care plan through referrals, service arrangements, meetings with client and family, and case conferencing and coordination with appropriate services
- Ongoing monitoring and reassessment to be sure client's needs continue to be met and/or to implement additional services as client's needs change