CARE MANAGEMENT is defined as comprehensive assistance to seniors and person with complex chronic health needs and disabilities for attaining their maximum functional potential. It means that the Care Manager designs a set of activities based on a need assessment for managing and understanding the following critical aspects of care.

  • Medical conditions and effects on the lifestyle
  • Related psycho-social problems that interfere with recovery
  • Pathways to stabilizing health problems
  • Home safety changes necessary for reduction of injury
  • Means to reducing rehospitalization and emergency room visits’

    Our model of Care Management is a full package of services that address the many facets of skilled nursing care and intervention.  Choices may be made.

    Assessment – Defines needs and risk.

    Plan of Care – Client-driven in conjunction with client, caregiver and professional care manager input.

    Medical Management – Coordination and maintenance of accurate and comprehensive health information and records.

    Care Coordination – Coordination of services among health care providers.

    Disease Management and Education – Early detection and intervention “RED FLAGS” of chronic diseases that educate client and family.

    Patient Advocacy – Representation and intervention with the medical and family communities.

    Medication Management – Oversight and coordination of all prescribed medicines and support equipment.

    Mediation – Skillful intervention for family education and consensus.

    Care Plan Monitoring and Modification – Flexible adjustments responsive to progress.

    Placement & Relocation– Finding living care options for Seniors.

    Ivory House Plans of Care are Results-driven and contain Measurable Benchmarks.  Goals for seniors and disabled clients are drive by client needs and risks.  These GOALS are:

    IMPROVEMENT IN QUALITY OF LIFE

    IMPROVEMENT IN HEALTH STATUS

    IMPROVEMENT IN FUNCTIONAL ABILITIES