Care Navigation Help Desk

Personalized health care support

When you or a loved one has many medical needs, trying to determine how to get help and what services exist can be difficult.

Allina Care Navigation Help Desk is committed to going beyond your medical needs - making it easier to stay in control.

Our care navigators can identify and directly coordinate a wide variety of resources to meet your needs and wishes, including: Advanced illnesses Help with understanding illness and treatment choices, addressing financial and community resource options Advance care planning: Information others need to know if you become unable to make decisions Palliative care for those in any stage of chronic or advanced illness Complex chronic care management Specialty heart failure program Home oxygen and medical equipment Professional staff provides oxygen, respiratory, rehabilitation and mobility equipment, specialty beds as well as other equipment and supplies. 24-hour emergency services     Life care management Professional nurse or social worker provides initial and ongoing assessment and planning for: health and wellness cognition social support purpose, passion, identity home and safety finances Hospice Hospice is for anyone with a life-limiting illness and whose life expectancy is determined to be 6 months or less. Hospice care is provided at the patient's place of residence and is coordinated by an interdisciplinary team of nurses, social workers, home health aides, spiritual care coordinators, doctors and volunteers. Bereavement support is provided to family members. Home health care Professional at-home services including assessment, teaching, medication management and skilled procedures, as well as: skilled nursing care occupational, physical and speech therapy medical social work infusion therapy wound and ostomy dietitians Housing referral and placement Housing experts help seniors and their loved ones research, evaluate and choose from the more than 400 local options, including: independent living assisted living residential care homes skilled nursing facilities memory care adult day care Private care giving Home health aides, homemakers and companions. Insured, bonded and background tested. 4- to 24-hour and live-in options. Guaranteed staffing and satisfaction.

Patient names have been changed to protect their privacy.

Laura's story

People call Allina’s Care Navigation Help Desk with many different needs and health care situations. Laura, one of our social workers, provides these examples of how she and her colleagues help you navigate the complexities of care:

• A patient who has lung cancer was concerned that his children didn’t understand his health care goals and long-term wishes. The Care Navigation Help Desk arranged for an Advance Care Planning session and involved the patient’s family so everyone would be clear about the patient’s wishes.
• A daughter called the Care Navigation Help Desk because her mom was having trouble remembering to take her medications. The Care Navigator explained that a medication dispensing machine might be helpful and connected the family to a place they could purchase the device.
• A patient who had multiple wounds that were not healing was reluctant to be admitted to a transitional care unit for treatment. The Care Navigator was able to coordinate care with an Allina hospital outpatient wound center and Allina’s home care services so the patient could remain at his home.
• A social worker contacted the Care Navigation Help Desk on behalf of a patient who needed help with housing issues. A licensed care manager did a face to face assessment with the patient and helped connect him to services to complete paperwork, tour housing options, get on some housing waiting lists and prepare him to move in the near future.

Donna's story

People call Allina's Care Navigation Help Desk with many different needs and health care situations. Donna, the spouse of a patient, provides these examples of how she and her husband found help through the Care Navigation Help Desk:

Donna didn't know what to do. Her husband, Raymond, was diagnosed with lung cancer three years ago, and she was starting to see some changes in his behavior that concerned her. A recent MRI showed Ray may have had a "small stroke." He was sleeping a lot and didn’t want to shower or change his clothes.

After Raymond had lung surgery three years ago, he went to live in a transitional care center during his recovery. The couple decided that they would prefer to have Raymond at home in the future, and Donna has been caring for him at home ever since.

So Donna felt stuck. She didn't know what type of care their insurance would cover and she wasn't sure what to do about Raymond's change of behavior and attitude. So she made a call for help.

When Donna called the Allina Care Navigation Help Desk, the registered nurse she spoke to got Donna to open up about her concerns about Raymond.

Donna explained that Raymond had recently had home care, was no longer homebound and he was recently discharged from skilled intermittent home care support. The care navigator talked to Donna about other care options and checked the couple's insurance coverage to help determine what options they had for care. Donna knew she wanted Raymond to stay at home, but she was seeing changes in his condition and wanted him to open up to her. They agreed that it may be helpful for someone to come to their house to talk to the couple about what Raymond wanted to do about his health care.

A few days later, Allina social worker Maria went to visit the couple at home and completed an advance care planning session with Raymond. "Maria gave us a great deal of information," Donna said. She explained that Raymond decided that when his condition becomes terminal, he has chosen to stay at home with hospice care.

Advance care planning is an intentional and purposeful conversation about your wishes for medical care and identifying a health care agent to carry out your wishes. Planning ahead allows you to communicate the kind of care you want or do not want, leaving no questions.

Donna explained that part of the couple's concern was about their children not understanding their wishes. Maria suggested that maybe Donna would like to complete an advance care plan in the presence of the couple's son so they could talk things over together. That meeting took place a few weeks later. "It was a good thing to have our son included in my advance care planning session," Donna said. "I really felt it was needed and I'm glad that Maria suggested it."

Jane's story

People call Allina's Care Navigation Help Desk with many different needs and health care situations. Jane, the sister of a patient, provides these examples of how she and her sister found help through the Care Navigation Help Desk:

When Julie was diagnosed with stage 3 lung cancer last December, she and her sister Jane weren't sure what the future would hold. In subsequent months, Julie's health continued to decline and her doctor recommended she quit chemotherapy due to the side effects she had from the treatment. Jane thought Julie seemed depressed and that they both needed help figuring out what to do next.

That's when Jane went online to look for help. She found information about Allina's Care Navigation Help Desk, a place patients and their families can call when they need help finding health care resources and services. Jane called and talked to a registered nurse care navigator, who offered to work with Julie's doctor to get a referral for palliative care.

Palliative care is for patients living with a chronic illness who are not ready for hospice care (end-of-life care). Members of the palliative care team, including chaplains, nurses and social workers, focus on symptom management, education about disease progression, goals, concerns and nutrition.

Julie's palliative care nurse visited Julie at home three times over the summer to care for her and talk to her about her condition. When the time was right, the palliative care nurse recommended Julie begin hospice care. "Every since Julie went into the hospital, we’ve been glad we're hooked up with Allina," said Jane. "They’ve been able to help with home oxygen, palliative care and now hospice care. Not every health system has all those services."

Julie is still at home, receiving care from Jane and her nephew, in addition to many members of the Allina hospice care team. A hospice nurse visits twice a week and a social worker visits weekly. "She's been really helpful with information for the family," Jane said. Julie also receives massage therapy once per week and Julie and her family have talked to the hospice chaplain on the phone numerous times. "It's really comforting to me to talk with the chaplain," Jane said. "She and I had a nice long chat the other day." Jane hopes that sometime soon Julie will invite the chaplain to visit. "Julie is a person of great faith, but she kind of likes to keep her faith to herself," Jane explained.

Jane said that the hospice nurse said she saw a big change in Julie last week. The nurse visited over the weekend to check on Julie. "We had a lot of family members over last time, and the nurse spent time with us to explain what was happening and what to expect," Jane said.

"Having everything taken care of through Allina has just made things so much smoother for us, and better for Julie," Jane said.

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