Care Coordination
As a home and community care patient, you will be supported by a care coordinator or a direct care nurse depending on the services and supports arranged to meet your health care needs. These regulated health care professionals bring a range of expertise in areas such as nursing, social work, occupational therapy, physiotherapy and speech therapy. Acting as a liaison between patients and various health care professionals, they work directly with patients, their families and caregivers, whether it be in hospitals, doctors offices, communities, schools and in patients’ homes to facilitate a seamless, coordinated flow of information between patients, families and care team members.
They will develop an individualized care plan to help you achieve optimal health and independence, whether you need specialized nursing while healing after surgery, personal support services to assist with activities of daily living, or therapy sessions to help you regain your strength and mobility.
These professionals will work closely with your primary care provider and other health care providers to monitor your progress and adjust your care plan as needed. We will also connect you with support services and resources available in your community that could assist with your care.
