How All-Around Home Health Works
Step 1: Assessment
Upon request, one of our experienced Supervisors will evaluate any senior or disabled adult for service and care needs free of charge. The evaluation is done at the person’s home or place of residence including health care facilities. We guarantee to conduct an assessment within 48 hours. This assessment may include the following:
- Home or environmental safety
- Client mobility and independence
- Medical history
- Assisted devices used/needed
- Performance for activities of daily living (ADL)
Step 2: Individual Service Plan
Our Agency will utilize the information from the assessment in the care planning process which identifies the activities of daily living needed such as personal and home management services. Personal services include services such as bathing, dressing, grooming, hair/skin care, toileting needs, feeding, exercising, transferring/ambulating, positioning, and medication reminders. Home management services include services such as meal preparation, light house cleaning, changing bed linens, laundry, shopping, washing dishes, and home organization. After the needs are individually determined, they are then personalized to the person’s own preferences as to frequency and method of delivery.
Step 3: First two Weeks of Care
During the first two weeks of care a Care Manager will make calls and visits to ensure complete satisfaction with the caregiver and the services provided. The ISP is reviewed to make sure that the client’s needs are being met, or if other services need to be added.
Step 4: Provision of Services
Our Agency uses telephony to record client visits and to record notes about visits. Alerts are provided to the Scheduler and staff to ensure schedules are being kept as requested. If a caregiver is not available to give services on a particular day a call will be given to see if the visit should be rescheduled or if a different caregiver should be assigned for the visit. If a client is not pleased with a caregiver, the agency will make a different assignment as soon as possible. The Care Manager will continue to monitor and support the client and family on a regular basis for the duration of services.
Step 5: Coordination of Care
Coordination of care is of the upmost importance in our Agency. Coordination of care is a client and family-centered, team-based activity that is designed to assess and meet the needs of clients by closing gaps in communication between doctors, nurses, and other medical professionals especially during transition times or significant changes in condition. This strengthens accountability and responsibility among all those involved in the care of a person. Coordination of care is key to reducing risk and fostering optimal outcomes.
Step 4: Reassessment
Assessments are repeated at least every 6 months and a new Individual Service Plan (ISP) is written. A significant change in a client’s health or after hospitalization also may require a new ISP. Reassessments are done to identify new needs and assess both decline and progress in service needs. Care Managers and caregivers are continually updated on changes needed.
Step 5: Discharge Planning
Because there is no time contract for services a client may request discharge with our Agency at any time. If the Agency can no longer meet a client’s needs, a Care Manager will assist the client and/or family in planning for future needs, coordinating care as needed, and providing resources for continuity of care. AAHH’s goal is always to enable the client to become as independent as possible and to promote continuity of care.