Telephonic Geriatric & Aging Support
Phone-based geriatric health
and safety needs assessment
Aging-in-place planning
and resource navigation
Caregiver guidance
and burnout prevention support calls
Telephonic advocacy
and communication with providers
Support for families managing
dementia or cognitive changes
Assistance with advance care decisions and
preference planning
Education on senior programs,
benefits, and community resources
Remote Chronic Illness Case Management
Ongoing telephonic check-ins for symptom
monitoring and early intervention
Coordination of care between multiple
physicians and specialists
Medication education
and clarification calls
Lifestyle coaching related to diet, mobility,
and chronic condition management
Telehealth appointment preparation
and follow-up discussion
Support navigating durable medical equipment,
rehab, and outpatient services
Patient and family education on
disease progression and expectations
Virtual Hospital-to-Home Transition Support
Patient Screening for Healthcare Needs
Telephonic discharge plan review to
ensure understanding and safety
Virtual preparation support for what to expect
after returning home
Remote follow-up to identify complications
early and prevent readmission
Scheduling and coordination of follow-up
appointments and telehealth visits
Assistance understanding medications,
instructions, and red-flag symptoms
Guidance for families during surgical, cardiac,
or major illness recovery
Emotional support and reassurance
during the transition period