Patient advocacy

In-home care referrals: private duty caregivers, skilled nursing

Personalized and comprehensive care assessments

Educate clients about alternative living and care settings

Ensure legal, financial and end of life wishes/preparations are in place

Communication with physicians, practitioners and other parties

Benefits coordination including paperwork and gathering documentation

Assessment of need and eligibility for local and state programs or services including

• Veterans programs
• Older Americans Act
• Florida’s statewide Medicaid managed care program

Lead the transition of safe discharge to home, skilled nursing or assisted living including

• Transportation coordination
• Schedule follow-up appointments
• Private duty and skilled nursing therapy services referrals
• Ensure medical supplies, safety and support devices, medications and prescriptions are in place