Central County Senior Services Enhanced Care Management
Holistic Care for Complex Health and Social Needs
Enhanced Care Management (ECM) program is a whole-person, interdisciplinary approach to care that addresses the clinical and non-clinical needs of members with the most complex medical and social needs.
In parternship with
Who We Serve
Older adults on Medi-Cal enrolled with CalOptima, who are high healthcare utilizers, at risk of institutionalization, or those transitioning from nursing facilities back into the community.
OUR SERVICES
- Outreach and engagement
- Health needs assessment and care planning
- Coordination of care
- Health Promotion
- Transitional care services
- Member and family support
- Coordination of and referral to community and social support services
BENEFITS
- Makes it easier for you to stay safe and independent at home
- Improves communication with your care team to meet your needs
- Provides a dedicate Care Manager who understands you and helps coordinates your care and services
- Support overall well-being by addressing everyday needs
- Connects you to community resources
- Helps improve health outcomes
ELIGIBILITY
The ECM Program is designed to help CalOptima members who meet at least one of the following and with to remain safely at home:
- Older adults who have been hospitalized 5 or more times in the last 6 months or have 3 or more hospital or skilled nursing facility stays
- Older adults who are at risk of being institutionalized in a nursing home or facility who are struggling with:
-
- Activities of daily living (ADLs)
- Communication
- Accessing food
- Stable housing
- Making decisions
- Older adults who are in nursing facilities and transitioning back into the community who
- Are interested in moving out of the institution AND
- Are likely candidates to do so successfully AND
- Are able to reside continuously in the community
Not sure if you’re eligible? Our team can help you check your eligibility at no cost. Call 844-373-4400 or fill out the contact form below.
