My Aged Care Providers: Coordinating Multiple Services Seamlessly

Coordinating multiple aged care services can feel like juggling too many balls—personal care aides, skilled nursing visits, therapy appointments, insurance paperwork, and family check‑ins. Without a unified plan, gaps emerge: missed medications, overlapping visits, or critical needs slipping through the cracks. At Maxona Care, our mission is to orchestrate every provider—home care, Medicare‑funded nursing, and Medicaid waiver programs—into a single, seamless care experience. Here’s how we do it, and how your family can benefit.

1. Conducting a Comprehensive Assessment

Start with a 360° View

• Medical Review: Gather discharge summaries, medication lists, and therapy orders.

• Functional Evaluation: Assess ADLs (bathing, dressing), mobility, nutrition, and cognitive status.

• Social & Environmental Scan: Identify home safety hazards, family support networks, and community resources (adult day programs, Meals on Wheels).

This holistic snapshot ensures we match each service to real needs—preventing duplication and filling any care gaps.

2. Assigning a Dedicated Care Coordinator

One Point of Contact
Rather than calling multiple agencies, you’ll work directly with your Maxona Care coordinator. Their responsibilities include:

• Scheduling visits across home care aides, RNs, therapists, and Medicaid waiver attendants.

• Managing paperwork for Medicare home health eligibility and CDPAP enrollment.

• Fielding emergent needs and adjusting plans on‑the‑fly.

You’ll always know exactly who to call—no more bouncing between voicemail trees.

3. Crafting a Unified Care Plan

Single Source of Truth
Our coordinator synthesizes inputs from physicians, therapists, and family into a living document that outlines:

• Daily Tasks: Bathing, meal prep, medication reminders, mobility exercises.

• Skilled Visits: Wound care schedules, physical therapy routines, telehealth check‑ins.

• Funding Sources: Hours covered by Medicare home health vs. Medicaid waiver (CDPAP) vs. private pay.

This plan guides every caregiver—regardless of their agency—so everyone works toward the same goals.

4. Leveraging Technology for Seamless Communication

Digital Care Dashboard

• Real‑Time Visit Logs: Caregivers upload notes after each shift—medications given, vitals recorded, unusual observations.

• Family Portal: Relatives can view schedules, care summaries, and upcoming appointments from any device.

• Telehealth Integration: Virtual nurse visits and specialist consults plug directly into the care calendar, keeping clinical inputs in one place.

Technology reduces paperwork, eliminates transcription errors, and keeps everyone on the same page—even when miles apart.

5. Integrating Home Care & Medicare‑Funded Services

Blending Non‑Medical & Skilled Care

• Home Care Aides: Handle ADLs, homemaking, and companionship under private‑pay or Medicaid waiver.

• Medicare Home Health Nurses/Therapists: Deliver wound care, IV infusions, or rehabilitation visits as prescribed—billing Medicare directly.

Maxona Care coordinates those hand‑offs seamlessly. For example, an aide might remind a client to weigh themselves each morning, instantly flagging weight changes to the RN during that week’s skilled visit.

6. Maximizing Medicaid Waiver Benefits (CDPAP)

Empowering Families
Under CDPAP, clients (or their representatives) can hire trusted neighbors or family members as paid caregivers. Maxona Care helps with:

• Application Assistance: Navigating forms and eligibility criteria.

• Payroll & Compliance: Ensuring timesheets, background checks, and training meet regulations.

• Clinical Oversight: Our RNs conduct monthly reviews and refresher training.

This program expands your caregiver options while leveraging Medicaid funding to the fullest.

7. Continuous Monitoring & Plan Evolution

Monthly Care Conferences
We convene a brief review—either virtually or in person—bringing together all stakeholders to:

• Review progress against goals (e.g., regain safe transfers, improve nutrition).

• Reallocate hours between home health and personal care as needs shift.

• Address new issues: hospital readmissions, changes in family availability, or emerging health concerns.

By treating the care plan as a dynamic blueprint, we keep it responsive, not static.

8. A Real‑World Success Story

Mr. Johnson’s Recovery
After a hospitalization for heart failure, Mr. Johnson needed both skilled nursing and daily homemaker support. Maxona Care:

1. Coordinated his Medicare‑approved nursing visits for medication adjustment and fluid monitoring.

2. Scheduled Medicaid waiver aides (CDPAP) for morning bathing and meal prep.

3. Integrated telehealth check‑ins to catch early signs of weight gain.

Within six weeks, Mr. Johnson avoided a second readmission and regained confidence to enjoy his garden again—without his daughter sacrificing work hours.

Partner with Maxona Care for Effortless Coordination

Stop managing multiple providers alone. With Maxona Care, your aged care providers—home care services, Medicare home health, and Medicaid waivers—work in concert, backed by a single care coordinator and robust technology.

Ready to streamline care for your loved one?
Call (470) 756‑1751 or visit www.maxonacare.com to schedule a free consultation. Our office is at Cedar Falls, IA 50613—let us bring harmony to your home‑based care plan.