Managing Your Medical Team

Managing Your Medical TeamIt’s a fact of life that as we grow older chances increase that we will need to interact more with health and wellness professionals for both preventative care and medical treatment. That means more appointments and more scheduling and management concerns.

If you’re facing this challenge as a senior or someone providing care to an elder, there are a number of options for managing your medical team. If you’re lucky, you may have all the doctors and therapists you need under one care “umbrella.” If not, programs such as Senior Care Options (SCO) here in Massachusetts is a valuable solution.

The MassHealth Senior Care Options program is a comprehensive health plan that covers all of the services reimbursable under Medicare and MassHealth through a senior care organization and its network of providers. The SCO program offers MassHealth Standard members aged 65 or older quality health care that combines health services with social support services. By coordinating care and specialized geriatric support services, along with respite care for families and caregivers, SCO offers advantages for eligible MassHealth members over traditional fee-for-service care.

Members enrolled in SCO have 24-hour access to care and active involvement in decisions about their health care. SCO members have a primary care physician (PCP) who is affiliated with the senior care organization. The member’s PCP and a team of nurses, specialists, and a geriatric support services coordinator work with the member (and family members or caregivers, if applicable) to develop a plan of care to specifically address the needs of the member.

Enrollment in this managed care program is voluntary and open to MassHealth Standard members who meet the following criteria:

  • are aged 65 or older
  • reside in a geographic area serviced by a senior care organization;
  • live at home or in a long-term-care facility (The member cannot be an inpatient at a chronic or
  • rehabilitation hospital or reside in an intermediate care facility for the mentally retarded.)
  • are not subject to a six-month deductible period under MassHealth regulations at 130 CMR 520.028
  • are not diagnosed with end-stage renal disease (ESRD)

The MassHealth member must choose to enroll in SCO voluntarily and:

  • live in the geographic area served by the senior care organization
  • agree to receive all services from the senior care organization, except in the case of an emergency or when traveling temporarily out of the service area
  • select a primary care physician
  • agree to assist his/her primary care physician or primary care team in developing an individualized plan of care

The MassHealth member is not eligible to enroll in SCO if:

  • diagnosed with end-stage renal disease (ESRD)
  • subject to a six-month deductible period under 130 CMR 520.028 (spenddown)
  • residents of an intermediate care facility for the mentally retarded
  • inpatient in a chronic disease or rehabilitation hospital

If SCO is not a viable option for you or your loved one and you are concerned about managing care and coordinating all the activities and requirements around it, another option is a geriatric care manager.

Usually a registered nurse or social worker, a geriatric care manager assesses individual needs and provides services that can include physical and mental health counseling, crisis intervention, care management and coordination, medication management, and assistance with benefits enrollment or other financial resources.

Geriatric care managers coordinate and oversee a team of home care professionals who provide services according to a customized Plan of Care that might include skilled nurses, licensed rehabilitation therapists, nutritionists, social workers, physical therapists, behavioral health counselors, elder care attorneys and licensed home health aides. GCMs are responsible for creating individualized care plans for each client while keeping their lifestyle, physician orders and goals in mind.

Every individual is different and so are their needs and desires. Often the best place to start considering how to manage care is with a family physician who knows well the senior, their condition, and their concerns. Your local hospital is another great source of information and referrals, especially if you or your loved one has been recently hospitalized and a dialog has been started about care management.

Also, community resources can be valuable information sources, such as your local Council on Aging Center.

If you’d like to learn more about managing your medical team and the assistance we can provide, please contact our homecare specialists here at Metropolitan Home Health Services.

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