Resource coordination service

Eligibility

Minnesota Aging Pathways provides free help to older adults who may need support remaining in, or returning to, their home. Providers can submit a referral, or a person can self-refer for help, by using the Help-for-older-adults referral form. When Minnesota Aging Pathways receives the referral, they will work with the person and/or caregiver to understand the person's needs and preferences. They'll help them connect with services in their community and follow up to support their long-term success.

If Medical Assistance (MA) pays for their long-term care, they should contact their county case manager or health plan care coordinator for help moving out of the nursing home or setting up services in their home.

Services

This work involves:

• Supporting people as they explore their needs and preferences
• Creating a comprehensive support plan with the person and/or caregiver
• Following up to increase long-term success in the community
• Building and maintaining professional relationships with provider partners

After a person returns to a community setting or gets services set up to remain in the community, Minnesota Aging Pathways provides follow up in-person and over the phone for up to five years. This ensures that the person remains successful for as long as possible in the home of their choice. The information also will be used to evaluate the service and the effectiveness of ongoing follow-up.

There is no cost for this service.

Learn more

To learn more about Resource coordination, call Minnesota Aging Pathways at 800-333-2433.