Ongoing Care Coordination, Advocacy and Follow Up of the Care Plan
- Accompany Elders to Physicians and Other Appointments, With Reports and Consultations With Family.
- Regular Visits With a Reassessment of Needs With Recommendations and Care Plan Updates, With Written Reports Monthly or More Frequently, and Telephone or E-mail Communication as Needed.
- Review of Care Delivery and Coaching for Care Partners in Handling New Care Needs and Difficult Behaviors and Assessing Any Developing Situation.
- Research Practical Solutions for Issues That May Arise for the Elder, Family, and Care Partners.
- Advocacy for Elders in a Hospital Stay, Emergency Room, Diagnostic Tests, or Clinical Trial Visits.
- Phone Availability to Care Partners, Family, and as Liaison With Physician and Other Providers.
- Arrangements for Attendance at Social Events, Visits From Friends, and Outside Activities.
- Continue to Creatively Explore Activities That Support Favorite Activities, Looking for Creative Solutions That Bring Interest and Enjoyment to the Elder Within the Home and With Possibilities for Outside Excursions and Visits.
- Coach Care Partners to Help Elders With Reading, Looking at Art and Film, Finding and Playing the Particular Music That the Elder Enjoys, Assisting With Arts, Crafts, and Other Home Activities.
- Household Cash Management for Care Partners and Housekeepers.
