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Health Care Home Care Coordination Toolkit for Working with Persons with Complex Needs and Older AdultsJANUARY2015VERSIONThis toolkit was created as a part of the Medicare Multiplayer Advanced Primary
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How to fill out complex needs and older:

01
Start by carefully assessing the specific needs of the individual. This includes their physical, emotional, and cognitive requirements.
02
Take into account any chronic illnesses or disabilities they may have and consider how these may affect their daily lives and overall well-being.
03
Connect with professionals such as doctors, therapists, and social workers who can provide guidance and support in meeting the complex needs of the individual.
04
Develop a comprehensive care plan that addresses all aspects of their needs, including medical care, personal care, mobility, nutrition, and emotional support.
05
Ensure clear and effective communication among all caregivers involved. This may include family members, healthcare providers, and any other individuals responsible for the individual's care.
06
Regularly review and adjust the care plan as needed to ensure it remains effective and meets the individual's evolving needs.

Who needs complex needs and older:

01
Older adults who have multiple chronic health conditions, such as heart disease, diabetes, or dementia, may require support in managing their complex needs.
02
Individuals with disabilities, both physical and cognitive, may also have complex needs that require specialized care and support.
03
Individuals who have experienced a significant life-altering event, such as a stroke or traumatic brain injury, may also have complex needs as they navigate their recovery and adjust to their new circumstances.
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Complex needs and older refers to individuals who require specialized care and support due to advanced age and multiple health or social needs.
Healthcare providers, social workers, and caregivers are required to file complex needs and older assessments for individuals in need of specialized care.
Complex needs and older assessments can be filled out by gathering information on the individual's medical history, current health condition, social support system, and any specific needs or challenges they may have.
The purpose of complex needs and older assessments is to ensure that individuals with advanced age and multiple health or social needs receive appropriate care and support tailored to their specific requirements.
Information such as medical history, current health conditions, social support system, specific needs or challenges, and any other relevant information must be reported on complex needs and older assessments.
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