This is assistance in the form of either access or care coordination in circumstances where the older person is experiencing diminished functioning capacities, medical conditions or other characteristics which require the provision of services by formal service providers or family caregivers. Typical services include assessing needs, developing care plans, authorize services, arranging services, coordinating the provision of services among providers, follow-up and reassessment as required.
How Service is provided
Case Management: The AAA staff provide this service. Case management is provided under Oregon Project Independence (OPI) program.
Services may include:
- Making home visits to clients and potential clients to assess needs. An assessment tool developed by the Department of Human Services is used to document medical conditions, medication regiments, treatment plans along with determining needs with any activities of daily living (i.e. bathing, behavior issues, bowel/bladder, etc.) and IADL’s (i.e. food preparation, house cleaning, shopping, etc.), which include issues with mobility, personal care, elimination (bladder/bowel), communication, mental status, household management, environmental concerns, and any other personal elements.
- Determining fees based on a sliding fee scale. Fees are based on gross income less all out of pocket medical deductions (medical deductions include medication costs, medical insurance costs, etc.).
- Assistance in gaining access to other program and services available. Services might include home delivered meals, energy assistance programs, etc.
Care Plans may include:
- Determining the amount of service to be provided based on the assessed needs, services provide by informal supports (family, friends, neighbors, etc.), services provided by other agencies (home delivered meals, visiting health services, etc.), and the local program’s budget.
- Assisting clients in accessing the in-home provider (Home Care Worker) registry by entering the client criteria and location. The registry then matches the top 10 home care workers who are qualified and available for work where the client lives.
- Complete necessary paperwork that authorizes the home care worker to provide the service for the client.