Compass Nurse Consulting
RN-Led Geriatric Care Management · CT
Interactive Scenario

Your toughest case
just got tougher.

Walk through a real-world scenario that home health agencies face every week — and see what changes when you have the right partner.

The Scenario

You're the Director of Patient Services at a home health agency. Your team just got a referral: 82-year-old Margaret, discharged after a hip fracture. Moderate dementia. Lives alone. Her daughter lives 2 hours away and is calling your office every day — frustrated, scared, and overwhelmed.

Your aide starts Monday. But there are problems your team can already see coming.

📋
Week 1 — The Referral Your aide reports: Margaret is confused about her meds, refusing PT exercises, and leaving the stove on. The daughter calls demanding answers you can't clinically give.
What does your team do?
Choose the path that matches your current reality.
A Handle it internally
Your aide and RN supervisor manage the situation within the existing care plan. You tell the daughter to call the PCP.
B Refer to a geriatric care consultant
You connect the family with an independent RN geriatric care manager who can assess the full picture and coordinate with everyone.
🔄
Now rewind. Same case. Same family. But this time, you have a geriatric care management partner.

An independent RN care consultant does a comprehensive home assessment within the first week. She reconciles 11 medications, flags two interactions the PCP missed, and identifies that Margaret's behavior isn't noncompliance — it's dementia progression that changes the entire safety plan.

She briefs your aide on dementia-specific approaches, gives the daughter a written plan with honest expectations, and communicates directly with the PCP — nurse to provider.

🟢
Outcome: Coordinated Care
Your agency delivers excellent care within scope. The family feels heard. No readmission. No complaints. Your staff isn't burning out on tasks outside their role.
0
Readmissions
On plan
Staff hours
5★
Family satisfaction

I don't replace your team.
I complete the picture.

Compass Nurse Consulting is an independent RN geriatric care management practice that partners with home health and VNA agencies across Connecticut.

🔍
Full-picture clinical assessment
Home safety, medication reconciliation, dementia staging, and care planning that goes beyond what a visit-based model can cover.
👨‍👩‍👧
Family communication & expectations
I become the single point of clinical clarity for overwhelmed families — so your team can focus on delivering care, not managing emotions.
🤝
Complement, never compete
I coordinate with your team, the PCP, specialists, and elder law attorneys. Your agency keeps the client. I fill the gaps that cause readmissions and complaints.
Jessica Kowal, RN, BSN, CDP
Concierge Geriatric Care Manager · Connecticut
860-367-8484
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