Ongoing Care Management

When the initial plan is carried out, families often arrange for us to coordinate and monitor services that have been put in place, and to look in on the client. The value of such oversight increases in proportion to the complexity of the care needs and the number of medical and other service providers as well as family members who are involved in the care.

If the client is hospitalized or otherwise experiences significant changes in needs and capabilities, we may do a reassessment. As always, we adjust the plan of care accordingly with the client’s and family’s input.