Our Services:

Care Management

  • Find and coordinate service delivery
  • Healthcare advocacy
  • Crisis intervention
  • Relocation service coordination
  • Educate family regarding entitlement and insurance benefits
  • Evaluate the client's long term care insurance for activation or alternatives prior to activation

Special interest in geriatrics, dementia, brain disease & injury, complex/high risk medical and mental health populations, developmental delay.

Care Transitions and Safe Landing

We navigate your progress throughout your hospitalization or rehabilitation facility and land you safely at home.

  • Conduct a home safety evaluation

  • Coordinate home modification needs
  • Hand select personal care workers, home health and hospice agency
  • Attend discharge planning meetings to reconcile medications and medical instructions
  • Arrange post hospital physician appointments, escort and interpret findings
  • Monitor vital signs, lung sounds, weight, blood sugars, etc. 

Healthy Senior Stand By Program

For independent seniors who want stand by assistance and intermittent home visits.

  • Institute enabling stay-at-home technologies for remote monitoringMonitor health and home care needs monthly

  • Stay abreast of medical appointments
  • Manage medications
  • Arrange community supports 
  • Attend medical appointments
  • Be available for emergencies

Advanced Care Planning 

  • Facilitate end of life conversations & planning to avoid a medical crisis. Stimulate conversation about your values and what matters most to you in deciding what care you want now and into the future

  • Discuss Advance Directives so your wishes will be honored
  • Coach your surrogate decision maker (guardian or health care proxy) how to represent your values

Nurse Life Care Plans

Development of Life Plans with community resources and associated care costs for life changing circumstances and personal injury cases

Social Work Geriatric Care Managers

Our social worker Care Managers counsel clients and families who feel overly stressed by mental health challenges and help clients learn positive coping strategies and build a support system

Rehabilitation Geriatric Care Manager

Our Occupational Therapists instruct and coach clients to build physical function, improve strength, balance, prevent falls and enjoy hobbies more fully.

Dementia Certified Care Managers

We teach families and facilities how to work with a client with memory loss, agitation and behaviors so the client and family can live a calm, happy, purposeful life.

Move to Retirement Community or Nursing Home

  • Identify a housing match
  • Tour you and your family through the community
  • Arrange the move
  • Create a transition plan 
  • Advocate long or short term to ensure success