Generations Home Care Referral/Intake Process

All skilled referrals are handled by trained intake nurses.

Intake numbers:

New Castle County – (302) 658-6731
Kent County – (302) 734-7005
Sussex County – (302) 856-7774 

The Plan of Care

A plan of care is implemented for each referral.

• The original physician’s orders are documented
• The patient is assigned a nurse case manager who schedules the patient admission
• The nurse completes a patient assessment on the first visit
• The nurse develops a plan of care and then confers with the physician regarding needed services and frequency of visits based on the home environment and the patient’s condition.
• The nurse compiles a teaching packet based on patient diagnosis and physician’s orders

Each patient’s plan of care may include (as appropriate):

• A description of medical condition and need for home health care
• The results of the assessments
• Long and short term goals of treatment and expected outcomes
• Clinical interventions for each team member involved in the patient's care
• A care plan for the family caregivers
• A list of medical equipment and supplies

Basic assessments include:

• Physical assessment
• Functional assessments
     —Activities of daily living
     —Instrumental activities of daily living
     —Sensory assessment
     —Neuro/Cognitive assessment
     —Psychosocial assessment
     —Nutritional assessment
     —Medication use and compliance
• Family caregiver assessment
• Environmental assessment
• Community assessment
• Financial assessment