Complex care for seniors

Our team becomes your primary care providers. We provide coordinated, comprehensive care for seniors at home. Services are designed to prevent unnecessary trips to the clinic or hospital while ensuring that you stay as healthy as possible. We focus on your whole being – mind, body, spirit and community – so you can safely maintain your independence.

If you or your loved one is eligible for complex care for seniors, our team will partner with you to:

• create a specialized care plan addressing your needs, values and goals
• provide health care in the comfort of your home
• support and help with your health care concerns and questions
• provide education to help you manage your condition and medications
• record all in-home visits within your medical record
• provide in-home lab and X-ray services, if needed 

Once you are enrolled, the Allina Health complex care for seniors team will become your primary care provider. Your personalized care team includes a:

• primary care provider to evaluate your needs and provide medical care
• nurse care coordinator to help create a health care plan based on your needs and wishes
• nurse triage service to provide telephone support 24 hours a day, seven days a week, for any late-night questions or concerns
• care guide to connect you with community and health care resources, and discuss advance care planning and spiritual support
• social worker to do a social assessment and connect you with community resources, as needed
• pharmacist to review your medications and work closely with your care team to make changes, if needed

Prior to starting care, we will review your benefits and verify eligibility for the program.