Care Coordination

Persons who are age 60 and older who have been in the hospital or experienced an illness or injury may benefit from services that will promote a safe recovery. Individuals are encouraged to participate forming their care plan. The

primary goals of this program are arranging the services, monitoring the progress, and ensuring the needs are met.

Availability of the services through this program will be given to individuals who:

Have suffered a health care crisis or recently been hospitalized

• Have a mild to moderate impairment or a temporary severe impairment

• Have a great economic or social need, with particular emphasis on low-income minority persons residing in a rural area and possess a  limited or no formal/informal support system

Direct services provided are:

• Homemaker Assistance as determined by assessment

• Emergency Response

• Personal Assistance as determined by assessment

• Limited Residential Repair when a health or safety issue is identified

• Limited Income Support to help with help with food, housing, prescriptions, rent, phone, or utilities

• Home Delivered Meals

• Minor Health Maintenance Equipment not provided through Medicare or Medicaid

• Respite Care

• Transportation

• Adult Day Care

• Chore Maintenance

Care coordination is based on a comprehensive care plan by a qualified care coordinator to fit the current needs of the individual. Referrals are accepted by an individual, a professional, a family member, or a friend.

All referrals can be made using our intake line or you can complete a Client Intake and mail to Area Agency on Aging, 1405 Kurth Drive, Lufkin, TX 75904. All services are short-term (up to 90 hours), temporary, and are provided at no charge. Contributions toward the cost of the service are accepted.

Click here to return to

2019 by Deep Texas Council of Governments