Older Adults, Healthy Results provides Public Health Nurse case management to vulnerable, low income Alameda County elders.  We conduct comprehensive assessments in the home and, based on the results, develop individualized care plans that prioritize client safety, goals and values, and medical treatment plan.  In addition to high intensity psychosocial case management, we provide care coordination, health education, client advocacy, healthcare system navigation, and social emotional support to our clients.  We launched 10/24/17 and are piloting an approach that is entirely new to ACPHD.  As a result, we are having to adapt and iterate as we learn and grow.

OAHR offers case management to eligible Alameda County residents 60 years of age or older.  We work with medically complex patients whose psychosocial challenges interfere with their ability to follow through on treatment plans, achieve optimal quality of life, and ultimately jeopardize their ability to remain living in their homes.  In addition to age 60+, clients must have at least one functional impairment that leads to an Activity of Daily Living (ADL) limitation.  They must also agree to a comprehensive assessment conducted in their home.

We aim to show the following outcomes:    

1. Improved access to medical, dental, and/or behavioral health services and adherence to health-related treatment plans.
2. Improved linkage and effective utilization of home and community-based services so that clients can remain safely living in their homes and communities.
4. Reduced risk of falling.
3. Improved quality-of-life.