Once the plan of care is developed, the appropriate services are put into place in order to support the client. These services can include home care to provide personal care, cooking, cleaning, transportation and companionship. The care manager coordinates the use of these services while providing ongoing assessment and monitoring to determine that the services are always meeting the client's needs. This ongoing monitoring ensures that the client continues to receive the appropriate care and that any changes the client may have will be quickly addressed by the care manager. Senior Transitions has developed a wide network of individuals and agencies the provide high quality care. It is by using these agencies that Senior Transitions is able to meet the needs of their clients.
As nurses, the oversight and management of the client's medical problems provides the client and family with peace of mind that any acute changes will be quickly found and appropriate action undertaken. The nurse can set-up and monitor the medications to determine that they are taken as ordered and monitor for any unexpected reactions to medications. Having ongoing contact with the health care provider can reduce emergency room visits and hospitalizations as problems are found earlier and addressed quickly often before they become an emergency. Also, as a nurse the, care manager can help train the in-home caregiver as to the special needs of your family member.