Care Management Services

Berger's Care Management team works with patients to determine their individual healthcare needs and arrange appropriate care plans. The team uses a collaborative process that assesses, implements, plans, coordinates, monitors, evaluates and advocates options and services. They work with community and government resources to coordinate the services throughout the patient's continuum of care.

The Care Management staff consists of registered nurses, licensed social workers, and a case management assistant/secretary.

Services to Patients

Home Care

Arrange for home medical services and follow-up care, mother-infant referral, medical equipment use/leasing.

Extended Care Placement

Assist with decisions regarding nursing home care, placement, and making specific arrangements. Available to assist with other living arrangements, such as assisted living and group homes.

Specialty Hospital Transfer

Provide contact with other hospitals, rehabilitation facilities, and residential treatment centers.

Transportation

Coordinate transportation at discharge and for outpatient treatment.

Advocacy

Support a patient's right and responsibility to participate in decisions regarding treatment, Advanced Directives and DNR status. Care Management can provide information on Living Wills, Durable Power of Attorney for Healthcare (DPOAH), and discussion regarding end-of-life, life support, and related issues.

Information and Referral

Provide information and referral to appropriate community resources, such as support groups and financial assistance/aid.

Program Implementation

The registered nurses and care coordinators utilize a collaborative process to assess, plan, monitor, and evaluate options of care to meet an individual's healthcare needs. They work closely with the patient's providers throughout the continuum of care. They also work to provide information to the insurance companies and are able to answer questions regarding the patient's coverage, including Medicare and Medicaid.

The social workers are also available to assist with other complex issues such as emotional stress of illness and hospitalization, drug and/or psychiatric issues. Specific information and referrals can be made for support groups, chemical dependency treatment programs, psychiatric care, and new parent resources.