title: Filling the gaps. Systems offer two models of care management: community outreach and inpatient care.
abstract: The growing number of vulnerable people, such as the elderly and people with long-term disabilities, calls for healthcare providers to offer more programs to ensure a continuum of care. Client-focused care management programs offer access to such a continuum. Care managers understand services and reimbursement and can pull it all together for the client. The Sisters of Charity Health Care Systems, Cincinnati, have two models of care management. St. Joseph Coordinated Care provides extensive outreach to a large, culturally diverse New Mexico community, serving urban and rural clients. Penrose-St. Francis Healthcare System offers inpatient medical care management in Colorado. Coordinated Care at St. Joseph Healthcare System in Albuquerque is comprehensive, covering a wide spectrum of client needs--medical, social, and psychological. The program's central goal is to help individuals remain safely at home. Persistence and devotion to the client are the hallmarks of effective care management and the foundation of the new geriatric care management program at Penrose-St. Francis Healthcare System in Colorado Springs, CO. The program's goals are to improve inpatient geriatric care, smooth the patient's transition to alternative care settings, and ensure efficient and effective resource use during the patient's hospital stay.
authors.affiliation: St. Joseph Healthcare System, Albuquerque.
authors.forename: L
authors.initials: L
authors.lastname: Anker
authors.forename: R
authors.initials: R
authors.lastname: Rose
authors.forename: R F
authors.initials: RF
authors.lastname: Watson
mesh_terms: D000368:Aged; D002410:Catholicism; D003120:Colorado; D003153:Community Health Services; D003266:Continuity of Patient Care / Q000458:organization & administration*; D006233:Persons with Disabilities; D006760:Hospitalization; D006801:Humans; D008962:Models, Theoretical; D009096:Multi-Institutional Systems / Q000458:organization & administration*; D009516:New Mexico; D010347:Patient Care Planning / Q000458:organization & administration*; D010351:Patient Discharge