Care Co-ordination

Care Transition Coordination

A transition of care is when a patient moves between care settings, such as when a patient leaves the hospital and returns home or goes to a rehabilitation facility. Care transitions also occur when a patient’s condition or situation changes. We provide the coordination during care transitions that helps prevent problems such as medication errors or failure to transfer important information.

Coordinate Services With Other Members Of The Health Care Team

Research shows that patients who receive treatment under a coordinated care system such as the patient-centered care model our care managers use experience better outcomes across the full spectrum of aging issues. A few examples:

Emergency Room visits and hospital admissions are reduced by at least 50% among high-risk elderly patients.
The reduced functionality usually associated with hospital discharges of the elderly is mitigated.
Agitation in Alzheimer’s patients is reduced with a correlated reduction in caregiver stress.

Locate & Coordinate Community Resources

Families often contact Umbrella when the best course of action to take for an ill or injured senior adult is unapparent. One of our primary objectives is to ensure the best possible care for every patient while involving community resources to alleviate caregivers’ stress and financial burdens. These professional resources may include government, non-profit, and private programs. We often find that our fees are offset by the community resources and entitlement benefits we discover for our patients.

Coordination & Supervision Of In-Home Care & Companion Services

When home care is required for elderly or disabled persons, we are happy to refer families to trusted providers. Regardless of the referral source, however, home caregivers are entrusted to work otherwise unsupervised in patients’ homes. To ensure peace of mind, Umbrella care managers can conduct regular, unannounced visits to accurately review the quality of care being provided.

Regional Network Of Financial Experts

The reality that many older adults fail to plan for future declining health can be catastrophic to family assets. Our comprehensive assessment includes an evaluation of a patient’s legal and financial preparedness respective to their current medical condition. When appropriate, we are able to provide referrals to our regional network of attorneys who can advise clients on options to preserve assets and obviate legal disputes.

• • Mediation for difficult interpersonal issues
  • Compassionate listening
  • Elder coaching