Geriatric Assessment and Care Plan

As an older person journeys through life, multiple issues can lead to critical change in physical, mental, emotional, spiritual and social functioning.

Gerontology in Action

Schedule your call to identify urgent care needs and uncover new challenges.

A comprehensive multidisciplinary evaluation to identify ways to treat and improve health problems, maintain one’s independence and lead to better overall wellness is essential to develop an action plan that promotes an integrated approach to care.

I assess basic day to day care needs to relieve stress and overwhelm for the care recipient and family members.

The assessment includes:

  • Connection and in-depth discussion by phone / zoom calls or in-person meetings with family members / loved ones.
  • Information gathering from health care professionals such as primary and neurological physicians, physical therapists, social workers and others deemed essential to gain insight on the care recipient’s challenges.
  • In-home meeting with the care recipient to evaluate and identify strengths and limitations with social, physical, mental, emotional function. Care recipients are encouraged to share their challenges and goals.
  • Questionnaires and screenings are implemented and, when possible, medical records are reviewed to gain valuable information for developing a solution based care plan.
  • Review of documents such as the durable power of attorney ( finance/ health), health care directive, physician order for life sustaining treatment (POLST)
  • An in-home safety assessment and recommendations for specific safety improvements to be made if necessary.

Geriatric Care Plan

After the initial assessment and information is gathered, I craft a written geriatric care plan with recommendations focused on objectives, action steps and solutions. This is an organized tool using the best approach for managing change and securing a safe environment. It includes recommendations for appropriate care services and resources to support a safe continuum of care and a healthy transition. I meet with the client to review the care plan for clarity. Should care management be needed, I can provide or recommend resources.