Assessment & Care Plan

Home Visits

By evaluating the elderly adult in their present environment, we can best determine their functional abilities, medical condition, mental status, support available, and financial resources. We meet with the senior citizen and utilize a social services/nurse team approach to assure that all of their physical, mental, emotional, and environmental needs are addressed.

Our initial assessment includes:

Pre-conference phone interview to share information about our company, review client and family goals and get preliminary details of the client's needs.

Collection of medical information to include medical history, medications, care received to date, results of recent lab work or diagnostic tests, etc.

Evaluation of the mental and emotional status including, the individual's memory, ability to make appropriate decisions, and care for himself/herself on a daily basis.

Assessment of cognition including Alzheimer's and other dementia patients.  

Evaluation of the physical function including gait, determination of mobility, ability to transfer, and continence levels.

Determination of the elderly person's ability to manage his or her finances, to what degree and  if assistance would be helpful.

An analysis of living arrangements including the maintenance condition of house, condo or apartment and possible safety hazards or improvements that may be needed.

A review of the client's current advanced directives.
 
Referrals to Elder Law Attorneys and medical professionals for complex cases.

Recommendations / Care Plans are established to meet client needs and a family meeting, phone conference, or written summary of findings and recommendations from the assessment are reported.

Evaluating the senior's needs

• Medical Condition
• Mental Status
• Functional Ability
• Family Involvement
• Financial Resources
• Home & Safety Issues

At Senior Care Management Services, we make the wishes, values, and preferred environment of the older adult part of our recommendation. We evaluate the ability to live alone and provide resources and/or referrals that enable the older adult to stay at home as long as possible.

We examine the following:

• Ability to handle finances
• Safety of home environment
• Physical abilities and disabilities of aging adult
• Ability of Alzheimer's and other dementia patients
• Legal documents such as advanced directives or guardianship documents
• Needed referrals to elder law attorneys or other medical professionals

Summary Report

• Prepared and delivered to family promptly
• Written summary of assessment report
• Written recommendations and referrals