CMSA Today - Issue 1, 2013 - (Page 14)

AREA AGENCIES ON AGING Little Things, Big Coordination How Area Agencies on Aging are Coordinating the “Little Things” that Lead to Successful Care Transitions for Patients BY MARK FETTERHOFF AND MARY KASCHAK “Our AAA Care Transitions Program enables us to work with older adult clients at a very vulnerable point in their lives, who may not otherwise ask for support out of pride or who may not know that services exist that can help them. In my view, it is often the “little things” — just a few services that can provide someone with dignity, while fostering the independence that the Ar ea Agency on Aging strives to support,” said Derickson. That support comes in many different ways, depending on the challenges the older adult faces when they return home. Derickson shared examples of how her clients, who recently transitioned out of the hospital, have benefitted from this support: One of our clients, who is 88 years old and lives alone, returned home from the hospital with many new prescriptions in addition to the ones she was previously prescribed. Through the assessment process, we discovered that the client was low on some medications and out of others. She gets them through the mail and was expecting the delivery shortly. After following up a few days later, based on an estimated arrival date, I learned that the client had run out of additional medications and the package still had not arrived. Due to hearing issues, the client was reluctant to call the medication company. I helped contact the company and we discovered that overnight delivery did not necessarily mean next day. After learning this, we were able to create an appropriate F or older adults returning home from a hospital or stay in a rehab facility, the “little things” — such as managing medications, arranging a ride to a follow-up doctor’s appointment, receiving a home-delivered meal, getting help with personal care or cleaning along with bill paying assistance — quickly add up to one really “big thing” — independence, and the ability of that person to remain at home safely and successfully. Known to bridge the gap for patients through the health care continuum from acute care settings back home, care transition services and supports offer opportunities for people to maintain their independence, choice and functionality, while improving care and reducing costs. The national network of Area Agencies on Aging (AAAs) provides a range of services and supports that assist older adults to make these successful transitions. Diane Derickson, a case manager with the Northern Arizona Council of Governments Area Agency on Aging in Flagstaff, Ariz., helps older adult clients living in rural areas with the “little things.” 14 CMSA TODAY Issue 1 • 2013 • DIGITAL http://www.naylornetwork.com/cms-nxt/

Table of Contents for the Digital Edition of CMSA Today - Issue 1, 2013

Offering a Perfect Symphony of Caring
Promoting Accountability, Collaboration, and Engagement
Little Things, Big Coordination
Spotlight on CMSA’s Award of Service Excellence (AOSE)
Association News
Index of Advertisers
CMSA Corporate Partners

CMSA Today - Issue 1, 2013

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