Care Management is a service designed to locate, mobilize and manage a variety of home care and other services needed by frail elderly persons age 60 and older, who, without services and support, would be in a nursing home.
After an individual is determined eligible for the program, based on a standardized and scored screening process, a comprehensive assessment is conducted by a registered nurse assessor. During this process, information is gathered about the person’s health finances, social needs, family supports, activities of daily living and ability to function independently in their home setting.
Following the assessment, a plan of care is developed with the active involvement of the participant. Care managers utilize all available community and individual resources (i.e., friends, family, or volunteers) prior to purchasing services needed for the person to remain at home.
The participant receives ongoing monitoring of care and an in-home comprehensive assessment every 90 days. Participation in Project CHOICE is voluntary and the participant is not required to accept the team’s recommendations and plans.
Eligibility Criteria
- Age 60 or older and resident of Detroit, Hamtramck, Highland Park, Harper Woods, or any of the five Grosse Pointes
- Medically eligible for nursing home placement, but financially ineligible for the Medicaid Waiver program
- Have multiple and complex needs and a high level of unmet needs
- Considering a move to a nursing home and wants to know if other options are available
- Currently living in an institution and no longer in need of all the services provided there, but needs help to return home
CostsServices provided by traditional sources such as Medicare, Medicaid, private insurance, etc., are arranged when appropriate. Care managers are experienced in coordinating these various funding options and can serve as an advocate to make sure that the participant receives the services and benefits that he/she is entitled to and needs. There may be some cost-sharing or co-pay involved.