Care Navigation for Older Adults

Care Navigation Basics
Celia K. Krichman EMBRACE Program

Care Navigation Basics

Care Navigation keeps you and your loved ones safe and independent for as long as possible.

Jewish Family Service’s Care Navigation Program helps to guide individuals and families through the health care maze and during transitional steps in the aging process. Care Navigators are JFS Geriatric Care Managers, Special Needs Care Managers, and nurses who are here to offer a holistic approach to your or your loved one’s care. The program is a four-step process:
Step 1: Consultation
Step 2: Assessment
Step 3: Plan of Care Emerges
Step 4: Continued Monitoring

Step 1: Consultation
• A JFS Care Navigator will meet either alone or with a family member present, depending upon the client’s needs
• Information will be provided on:
• Affordable care options
• Alternative living situations
• Community resources
• Legal and financial referrals
• Decision making
• Relationship changes
• Emotional Support

Step 2: Assessment
• Our in-home, multi-dimensional assessment includes, but is not limited to, evaluation of:
• Health status
• Physical capability
• Mental and emotional status
• Environmental conditions
• Social and financial support networks

Step 3: The Plan Emerges
• A Care Navigation Plan is created based on the assessment, and is a collaborative effort with the client and their family. Plan components include, but are not limited to:
• Skilled Services Home Health Care
• Private Care Services
• Coordination with Physicians
• Mental Health Counseling
• Nutrition: Meals on Wheels
• Transportation Services
• Social Activities
• Volunteer Assistance
• Bill Paying

• JFS will contact and arrange appropriate community resources, such as:
• Housing facilities or providers
• Eligibility for government programs
• Adult Day Care
• Transportation services
• Elder law attorney consultations
• Emergency response systems

Step 4: Monitoring Your Needs
• JFS provides regular monitoring for clients on a weekly, monthly, or as-needed basis, reevaluation the plan as the client’s needs change.
• JFS will also communicate with a client’s relatives near and far, by request.

Celia K. Krichman EMBRACE Program

The Celia K. Krichman EMBRACE program offers a pre-emptive approach to care navigation for adults 55 and over. EMBRACE provides adults in good mental and physical health with education and care plan navigation to avoid stress and confusion during an unexpected illness, hospitalization or transitional stage. A one-time $10 membership fee provides you with:
• An initial consultation with a Care Navigator
• Access to educational programs sponsored by JFS
• Information and referral to JFS and other community programs
• Free bimonthly JFS Connect Newsletter
• seamless care to ease a safe transition home
• liaison services with the medical and hospital communities
• communicating with out of town relatives
• “one-stop shopping” approach to care navigation services
• Access to JFS Medical Transportation (available only to JFS clients)

Contact Info:
Call: (757) 321 -2222