• Elderly patients who have called EMS for help are screened for the following preventable conditions: falls, depression, and medication errors. Patients identified as at-risk are eligible for the transitional case management services. Patients are offered a free in-home visit from a transitional case manager.
• Prior to the home visit, and with the patient’s permission, a transitional case manager contacts the patient’s physician to determine any concerns they have for their patient and to obtain a current medication list.
• The transitional case manager visits the patient in their home to talk to them about a wide range of health, wellness and social support concerns. Based upon the findings from the home visit, the case manager works with each patient, their family members, their primary care physician, and elder care services to develop an individualized plan of care.
• The transitional case manager will assist the patient and their families to find resources and services to meet their needs
• After the home assessment, the patient’s physician receives a detailed summary of the needs and risks of their patient, as well any referrals made.

Livingston Help for Seniors is a Genesee Valley Health Partnership collaboration of:

• University of Rochester
• Tri-County Family Medicine
• Livingston County Office for the Aging
• Livingston County Department of Health

Related Documents:

• 08/05/05 - GVHP Awarded $586,000 Grant To Develop EMS Project for Preventing Illness & Injury Among Older Adults(36 kb).
• Brochure (pdf) - Livingston County Illness & Injury Prevention Project(303 kb).