Coordinated care is extremely important with an aging and geriatric population, especially when the individuals are dealing with complex and chronic conditions. This means the health care professionals (medical and mental) involved in developing treatment plans and overseeing their implementation must have integrated communication. This is important because there may be recommendations from one discipline that contradict or complicate the recommendations from a different discipline. Without the coordination of the professionals responsible for the care of the individual, there could be overlapping services, unmet needs, or contra-indications between treatments.
The professionals typically involved in coordinating care for elderly patients include: physician, geriatric nurse, pharmacists, physical therapists, psychiatrists, and social workers. The coordination of these services also be integrated with different facilities, such as hospitals, nursing homes, independent living apartments, rehabilitation centers, home healthcare, hospice, and senior centers.
The first step in a Coordinated Care Plan is to assess the individual’s mental and physical health, including aspects of activities of daily living and limitations to their independence and need for care. This is a central component to providing the necessary care to older adults. The assessment includes recommendations for the treatment of the patient based on the various disciplines, and making sure they are in sync with each other. For example, if the Coordinated Care Assessment determined that the individual would benefit from taking an anti-depressant to level their mood swings, the pharmacist, psychiatrist, and social worker should agree and work together to implement that medication.
When treatment professionals collaborate with each other for the good of the patient, less time and resources are spent on evaluation and ineffective treatment modalities. There is a greater focus on providing only what the patient wants and needs, because the coordinated care was done.
Families and care-givers are given better information and support when working with a team of professionals who are all on the same page. They spend less time and resources involved in activities that do not produce positive results for their family member. The feel like they have the support they need to provide the care for their loved one in their home, making them better care givers. The same is true for care-givers who are not family members, but still responsible for the care of an elderly person.
