How the Program Works
Refer older adults and adults with disabilities during regular business hours (Daily, 9 a.m. - 5 p.m.).
Referrals received during nonbusiness hours will be acknowledged by 9 a.m. the next business day.
Acknowledge
211 Care Coordinators will acknowledge your referral within 30 minutes of receipt. The Care Coordinator will follow-up with the patient and begin identifying available resources using 211's comprehensive database.
Connect
211 Care Coordinators will assess patients to understand their needs and resources and develop a plan of action.
Follow-Up
211 Care Coordinators will engage patients in providing preventative services for a follow-up period of 120 days.
Which Patients Should Be Referred?
Refer these patients:
1. Older adults and adults with disabilities who are at risk of institutionalization, nursing facility placement, Medicaid eligible, or in need of other community-based resources to reduce unnecessary repeat hospitalizations.
2. Assistance is needed in locating older adult or adult with disability resources.
3. The patient provided consent.
211 Case Consultation Services
Have a complex case? Let our 211 Care Coordinators help you solve complex patient cases.
"Case consultation services have proven to be a useful tool for engagement and collaboration."
Maria Manna
Northwest Hospital, Director of Care Management
211 Hospital Network
Connect with 26 other hospitals, state coordinators, the Behavioral Health Administration (BHA) staff and other state partners during the 211 Hospital Network monthly meetings.
Participants discuss best practices, identify gaps in service, and develop long-term, sustainable solutions. This collaborative initiative aims to navigate the dynamic healthcare delivery system and support a holistic approach to patient care. Together, we can identify and implement collective strategies to enhance population health.
Additional Resources
Additional 211 Support
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