Care Coordination is a part of the Access and Assistance system offered through the Area Agency on Aging. It is a process that includes the assessment, effective planning, arranging, coordinating and follow-up on services that most appropriately meet the identified needs as mutually defined by Area Agency on Aging access and assistance staff, an older adult, and/or a family member or other caregiver. The aging network uses local, state, and federal funds to provide this service to as many as possible. Client referrals are accepted from any source.
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Care Coordination is a process, which includes assessing, arranging, and coordinating comprehensive services on a case-by-case basis with a goal of maintaining client independence.
Services are targeted to those eligible persons who will be able to regain their independence by receiving short-term support services.
Some of the services that may be available are: Homemaker, Personal Assistance, Residential Repair, Health Screening, Health Maintenance, and Utility Assistance. Care plans are generally no longer than three months. The programs goal is to promote independence.
Provision of services through the Care Coordination program is targeted to individuals who: have recently been hospitalized or suffered a health care crisis (recently has been defined as within the last 30 days); are in great economic or social need, with particular emphasis on low-income minority persons; have a limited or no formal/informal support system; reside in a rural area; and are waiting for Medicaid eligibility determination.