Caring for someone with a long-term disease like diabetes, Parkinson’s, or congestive heart failure requires more than good intentions—it demands expert coordination, reliable communication, and a proactive strategy. In Los Angeles, where care options are vast but disconnected, families often find themselves lost in the shuffle.
Our chronic care management services bring everything together: physicians, nurses, care coordinators, pharmacies, rehab providers, and—most importantly—peace of mind.
What Is Chronic Care Management?
Chronic care management involves overseeing and organizing the ongoing care of someone living with one or more chronic illnesses. Unlike short-term support, it’s focused on the long haul—making sure nothing slips through the cracks.
We help families by:
- Managing medication schedules and screening for side effects
- Coordinating primary care physician visits and therapy appointments
- Facilitating communication between providers and health professionals
- Monitoring for health risks, patient adherence, and medication compliance
- Planning for future care needs and emergencies
Whether your loved one lives at home, in assisted living, or is transitioning from the hospital, we provide the structure and support to keep their care stable and effective.
Who Benefits Most from Chronic Care Management?
These services are ideal for:
- Older adults with multiple chronic conditions like diabetes, COPD, or dementia
- Family caregivers who are burned out or managing care from another city
- Seniors at risk of hospital readmission after recent surgeries or ER visits
- Those navigating multiple providers without a central care plan
We often coordinate with primary care physicians, hospitals, and specialists across Los Angeles—including Cedars-Sinai, UCLA Health, and community-based clinics.
Our Chronic Care Management Services
We customize each plan to your loved one’s medical condition, living environment, and family situation. Services include:
✔️ Ongoing Care Coordination
We connect with hospitals, primary care teams, and nursing staff to manage care plans, electronic health records, and clinical updates.
✔️ Hospital-to-Home Transitions
Prevent readmissions by overseeing discharges, reconciling medications, and ensuring seamless transitions back to the home or nursing facility.
✔️ Medical Appointment Support
We attend key appointments, advocate for the patient, ask the right questions, and document care changes.
✔️ Home Safety & Accessibility Assessments
Identify fall risks, mobility challenges, and therapy needs through home evaluations.
✔️ Emergency Planning & Crisis Support
We help prepare for emergencies and act quickly when visits to the emergency department or urgent interventions are needed.
✔️ Family Updates & Decision Support
Keep families aligned on treatment goals, insurance coverage, and care workflows during stressful periods.
Why Los Angeles Families Trust Our Team
- Decades of experience in chronic and geriatric care coordination
- Trusted by families across Los Angeles and Southern California
- Deep knowledge of the local healthcare system, including electronic health record integration
- Patient-centered approach with flexible service plans
Get Help Managing Chronic Care
If you’re typing “chronic care management Los Angeles” into Google at 2 a.m., you’re likely feeling overwhelmed—and you’re not alone. We help families like yours every day.
Schedule a free consultation today and take the first step toward a calmer, more coordinated care plan.
Service Areas: Los Angeles, Santa Monica, Pasadena, Brentwood, West LA, and surrounding communities.
Virtual Support Available Nationwide
Frequently Asked Questions (FAQs)
What is included in chronic care management?
Chronic care management includes coordinating a loved one’s ongoing medical care, managing medications, scheduling appointments, monitoring for changes in condition, and keeping all providers informed. It’s comprehensive, proactive support designed to prevent emergencies and improve daily quality of life.
Do you provide chronic care management for specific conditions like Parkinson’s or Alzheimer’s?
Yes. We have experience supporting individuals with Parkinson’s, Alzheimer’s, COPD, congestive heart failure, and other complex conditions. Each care plan is tailored to the specific health needs of the client and the goals of the family.
How does chronic care management reduce hospital readmissions?
By monitoring health changes, ensuring medication compliance, and coordinating follow-ups, we help prevent complications that often lead to hospital visits. We also provide hospital-to-home transition planning to make recovery safer and smoother.
Can this service be used alongside home health or hospice care?
Absolutely. We often collaborate with home health, hospice, and palliative care teams. Our role is to act as the central coordinator—making sure nothing falls through the cracks and that everyone is aligned.
Do you offer chronic care management in specific parts of Los Angeles?
Yes. We serve clients in Los Angeles, Santa Monica, Pasadena, Brentwood, and surrounding communities. Virtual support is also available for families coordinating care from out of town.
How do I get started with chronic care management?
You can begin by scheduling a free consultation. We’ll talk through your loved one’s current needs and challenges, and outline how we can help create a more coordinated, less stressful care experience.
