|Senior Care Management||Home Orthopedics Rehabilitation|
|Polypharmacy Medication Management||Cardiocare|
|B.R.E.A.T.H.E||Transitional Care Program|
|Geropsych Program||Memory Care Alzheimer’s and Dementia|
When many age-related disease states and multiple medications complicate the coping ability of frail elders, Senior Care Management looks beyond the obvious needs of homebound seniors through a comprehensive assessment process. Our Geriatric Care Team specializes in evaluating, planning, directing and coordinating care to promote maximum health and functional well-being. Senior Care Management empowers seniors toward independence and aging in place.
Our orthopedic program delivers protocol-driven, physician-specific rehabilitation to orthopedic surgical patients. The therapy-led team admits patients within 24 hours upon hospital/facility discharge and will visit daily if needed. Our care delivery can begin pre-operatively so our patients know what to expect throughout recovery. We utilize in-home PT/INR technology.
Optimum Balance teams of nurses and therapists who have received advanced training carefully evaluate five key systems that contribute to balance dysfunctions.
Based on each patient’s unique assessment results, the specialty team implements an integrated treatment strategy proven to significantly reduce fall risk. This treatment approach helps to restore balance to keep patients independent longer. That’s what Optimum Balance is all about.
Our post-surgical urology program delivers care to patients recovering from prostate and bladder surgeries and other complex cases. Our urological-credentialed nursing team can begin to manage expectations pre-operatively and throughout recovery. Using point-of-care technology and assessment tools, patients recover at home with fewer complications.
Polypharmacy Management is our unique approach to teaching seniors about medications and how to manage them safely and effectively at home. Using large print teaching tools we assess, clarify and review medications at each skilled visit. Ongoing compliance and validation of effective medication management is our goal.
Cardiocare is delivering disease-specific education and self-management tools for newly diagnosed and chronic cardiovascular patients. Our credentialed clinical team utilizes "best practice" assessment tools and protocols for following patients newly diagnosed with cardiac disease, pre/post-operative cardiac surgical patients, or patients with chronic exacerbations of cardiac disease. Nurses and Therapists collaborate to achieve goals of increasing activity and endurance, medication compliance and knowledge to manage disease triggers.
B.R.E.A.T.H.E delivers disease specific education and self management tools for the pulmonary patient. Our credentialed clinical team utilizes "best practice" assessment tools and clinical protocols for the respiratory patient. Nurses and therapists collaborate to achieve goals of improving endurance, functional activity, medication compliance and knowledge to manage disease triggers.
The Transitional Care program provides caring solutions during stressful periods of change for seniors. It is designed to offer a safe environment to explore feelings of loss, depression and anxiety that accompany age-related change.
A new diagnosis or the exacerbation of an existing diagnosis, loss of a spouse or estrangement of a spouse due to memory disease, or a move into an assisted living facility may be overwhelming. Many of these life changes are accompanied by a sense of loss of control, frustration, anger, depression, and confusion.
Our goal: to help seniors age in place and transition successfully through loss or adjustment to new environments.
Physical, emotional and psychological needs are addressed in this clinical program led by an experienced psychiatric nurse. Our approach includes regular cognitive screening with standardized assessment tools to differentiate behavioral manifestations from cognitive decline. Promotion of aging in place through managing behavioral and psychiatric issues in combination with medical care management is our goal.
Palliative care provides specialized healthcare services designed to meet the needs of individuals with advanced illness and a limited life expectancy. Palliative care emphasizes dignity, comfort, choices and support for living life fully. Services include:
Skilled nursing for symptom and pain management
An on-call nurse available 24 hours a day, seven days a week
Trained care givers to provide support services such as staying with the patient when the family needs relief, offering companionship and running errands
Social workers to provide emotional support, and referrals to community resources
Bereavement care for family and friends through support groups and other resources