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Care Coordination

What is care coordination? Care coordination is a person-centered, assessment-based, interdisciplinary approach to integrating health care and social support services that are tailored to individuals' needs and goals. Services are managed and monitored by a trained care coordinator or interdisciplinary team according to established standards of care.   As part of our mission, SWLI works to improve care coordination policy: National Coalition on Care Coordination (N3C) Inter-Professional Care Coordination State Level Care Coordination

Care coordination...

• Ensures those with multiple chronic conditions or disabilities achieve the highest level of functioning
• Improves communication among providers, individuals, their caregivers and payers
• Offers a range of services to meet needs including acute and post-acute health care services, and long-term care social support programs
• Helps individuals remain in the community, where they want to be
• Decreases the financial costs of unnecessary medical procedures and hospital visits
• Supports family caregivers

Center for Aging Policy Agenda

Improve the home and community based long-term care delivery system

• Advocate for federal and state policies that facilitate the shift towards home and community based services and reduce the long-term care system’s reliance on institutional care for frail older people.
• Support federal and state policies that facilitate further development and effective implementation of a patient-centered multidisciplinary care coordination component of long-term care in all systems of care, including Medicare, Medicaid, the Older Americans Act and other state administered long-term care programs.
• Support expansion of federal and state programs that provide services to caregivers.
• Advocate for federal and state policies that include care coordination services and caregiver assessments as part of the core menu of services provided under such programs.
• Support further development and expansion of "single point of entry" systems in states that open doors for older people and their caregivers to receive a comprehensive array of public/private home and community based services.

Ameliorate the shortage of qualified social workers who specialize in gerontology

• Advocate for federal and state policies that provide reduced or "no cost" loans for social work students who specialize in gerontology and who agree to work in the field of aging for a certain period of time following completion of a master's level social work program.
• Expand federal and state programs that provide stipends for students in the social work who specialize in gerontology while they conduct field work in aging.
• Develop and implement a comprehensive curriculum to educate students in social work (or mid-career social workers who could move into the aging field) on the aging network and the various opportunities to work in aging at the state or local level.