Care Management & Coordination
Care management is the work of running someone's care rather than delivering it: assessing what they need, writing and revising the plan, keeping physicians, therapists, caregivers and family working from the same information, and noticing when the arrangement no longer fits.
Reviewed by Valerie VanBooven, RN, BSN
What's Included
- An assessment of the person's needs, home and support network
- A written care plan, revised as the situation changes
- A named care manager, often a nurse or social worker, who owns it
- Coordination between physicians, specialists and therapists
- Attending medical appointments and reporting back to the family
- Oversight of medications and of what the clinical team has ordered
- Managing transitions between hospital, rehab and home
- Regular updates to family, including family living elsewhere
- Help finding and vetting the other services the person needs
Who It's For
Families coordinating care from another city, situations complex enough that nobody has the whole picture, and anyone who has realized that the unpaid job of managing a parent's care has quietly become larger than the care itself.
Understanding Care Management & Coordination
Care management is a distinct discipline rather than a feature of home care, and it is also sold on its own, usually as geriatric care management or aging life care management. Some home care agencies include it, some charge for it separately, and some do not offer it at all.
What a family is buying is someone accountable. A care manager assesses the situation, writes the plan, revises it when the condition changes, sits in on appointments, and keeps everyone working from the same information. Families who have tried to do this themselves across a hospital stay, a rehab stay and a discharge usually recognize the value immediately.
Long-distance families are the clearest fit. When the adult child is three time zones away, the practical problem is not finding someone to help with a shower. It is having a professional locally who answers the phone and can say what actually happened this week.
Care managers hold different credentials. Some are registered nurses, some are licensed social workers, and some hold a specific aging life care certification. Which one suits depends on whether the hardest part of the situation is clinical, or financial and family dynamics.
It is almost always private pay. Medicare does not cover care management as a standalone service, and long-term care policies that pay for caregiving hours often exclude the management layer, so the two get billed differently.
Worth asking before engaging one: what are their credentials, how often do they reassess, what is included in the fee against billed separately, and who covers when they are away. Agencies and independent care managers vary a great deal on all four.
Frequently Asked Questions
What is care management & coordination?
Care management is the work of running someone's care rather than delivering it: assessing what they need, writing and revising the plan, keeping physicians, therapists, caregivers and family working from the same information, and noticing when the arrangement no longer fits.
Who is care management & coordination for?
Families coordinating care from another city, situations complex enough that nobody has the whole picture, and anyone who has realized that the unpaid job of managing a parent's care has quietly become larger than the care itself.
Other Services
How to Get Care Management & Coordination
Enter a city and state below to find home care providers in the Care Across America directory who serve that area. Contact them directly to ask whether they offer care management & coordination and to get pricing for your situation.