Care Planning & Coordination Services

Comprehensive Care Planning

I work with individuals and families on proactive care planning. The kind that happens before crisis, and prevents it.

This includes:

• Building comprehensive care matrices that align your medical wishes, values, and personal characteristics with real healthcare decisions

• Gathering information and guidance on documents you need (POLST, living will, will)

• Reviewing and reconciling medications against the five rights of medication administration

• Coordinating conversations between family members and healthcare providers

• Developing actionable plans so everyone knows what matters and why

• Benefits navigation and applications (SSI, SSD, Medicaid programs)

• Provider coordination and transition planning (consolidating care, establishing relationships with integrated providers)

What this prevents:

• Family confusion and conflict when decisions need to be made

• Medical decisions that don't align with your actual values

• Crisis scrambling for documents and information

• Medication mismanagement due to lack of provider coordination

• Loss of autonomy and control

File Reviews for Guardians & Conservators

If you currently hold guardianship or conservatorship, I review your files for compliance, completeness, and alignment with best practices in fiduciary care. This includes documentation of medical decisions, financial management, court reporting requirements, and communication with healthcare providers and family.

Neutral Third-Party Visitor Reports

I provide objective assessments for families, providers, or court-related situations where an independent observer's perspective is needed. This includes evaluation of living situations, assessment of individual capacity and needs, and documentation of current functioning and care quality.

I am not a caregiver or case manager who will do the work for you. I do not hold fiduciary roles, make substituted judgements, or stand in as a guardian, healthcare representative, estate manager, payee, executor, or power of attorney.

What I CAN do:

• Help mediate family decisions around healthcare

• Find resources for estate services

• Explain the differences between documents and when you need them

• Guide you toward proactive selection of substituted judgment agents

• Help you think through who should hold which role before crisis hits

I am a consultant and coordinator. You and your family make the decisions. I help you make them clearly, together, and in alignment with your actual values.

You're a good fit if:

• You're a baby boomer thinking proactively about end-of-life planning

• You want to be clear about your healthcare wishes before crisis

• You're a family wanting to coordinate care for an aging or ill loved one

• You value clarity and organization

• You're willing to have difficult conversations and do the work

• You want to prevent future squabble and confusion

This might not be right if:

• You're looking for someone to make decisions for you

• You're in acute crisis and need immediate emergency support (you may need different services first)

• You're not ready to think about these topics

• You need ongoing caregiving (you'll need different support)

Private Hourly Coordination

$75/hour

For family consultations, coordination calls, and guidance. Includes:

• Family coordination meetings

• Provider communication and follow-up

• Questions about medications and care

• Meeting facilitation

• Document review and explanation

Flat-Fee Service Packages

For complete care planning projects, I offer flat-fee packages. Pricing varies based on complexity and scope. Examples include:

Comprehensive Care Matrix Development Building a complete care matrix organized by domain (medical, mental health, legal, financial, housing, social, ADLs, autonomy) and priority tier (emergent through long-term). Includes specific action items, responsible parties, timelines, and status tracking.

POLST Form Completion & Coordination Reviewing POLST requirements, gathering information about your wishes, helping complete the form accurately, and coordinating with your healthcare providers.

Living Will & Care Planning Consultation Guidance on advance directives and living will documents. Understanding what they mean and why they matter. Helping you articulate your actual wishes clearly.

Medication Review & Five-Rights Assessment Complete review of all current medications (working with your prescribers). Identifying overlaps, interactions, gaps in communication, and alignment with your care goals. Assessment of medications against the five rights of medication administration (right time, dose, medication, person, delivery).

Family Care Coordination & Meeting Facilitation Facilitating conversations between family members, healthcare providers, and you. Making sure everyone is on the same page about goals and wishes. Helping resolve disagreements and confusion.

File Review for Existing Guardians/Conservators Review of guardianship/conservatorship files for compliance and best practices.

Neutral Third-Party Visitor Report Objective assessment of living situation, capacity, and current functioning.

For detailed pricing on flat-fee packages, contact for consultation. Pricing depends on complexity and the work involved.

I am a retired nationally and state-certified guardian and fiduciary with nearly 20 years of professional experience. This means I have:

• Worked directly with vulnerable adults navigating health transitions, financial decisions, and end-of-life planning

• Managed complex cases involving medication mismanagement, provider coordination, and family dynamics

• Documented and reported on guardianship and conservatorship compliance

• Served as a decision-maker and advocate in crisis situations

• Held professional accountability for decisions affecting people's lives and wellbeing

I am also:

• Former President of the Guardianship and Conservatorship Association of Oregon

• Certificate holder in conflict resolution and mediation

• Someone with 19+ years of experience identifying dangerous medication combinations and systemic care failures

I have seen what families need to navigate transitions well. I have done this work for a long time. This new service offering brings everything I've learned into a proactive framework.

Initial Consultation (Free, 30 minutes)

We talk about your situation, what brought you here, and what you're hoping for. You understand what I offer and whether it's a good fit. No obligation.

Intake & Assessment

I gather information about your current situation, health status, medications, family dynamics, and goals. We discuss what matters most to you and why.

Strategy & Proposal

I create a clear scope of work: what's included, timeline, deliverables, and investment. You know exactly what you're getting.

Planning & Coordination

We work together on the care matrix, document review, family coordination, or whatever services you've chosen. This is active work—you participate.

Implementation & Handoff

When the planning is complete, you have clear systems, organized information, communication with providers, and confidence in your decisions. You're ready to maintain the systems we've created.

What if I'm not sure where to start? That's normal. We'll have an initial conversation and I'll help you figure out what's most important to address first.

How long does comprehensive care planning take? Typically 2-4 months depending on complexity and how quickly you gather information. Some families work faster, some slower. We'll set a pace that works for you.

Will you handle everything for me? No. This is collaborative work. I guide, coordinate, and help make things clear. You and your family make the decisions. You do the talking to your doctors. I support you through it.

What if my family disagrees about care wishes? That's exactly why we do this work proactively. We facilitate those conversations before crisis. I can help mediate and find common ground.

Do you work with people who have already had a health crisis? Yes. If you've already had a stroke, diagnosis, or other event, this work helps you get organized moving forward. But if you're in acute crisis right now, you may need immediate medical support first.

What if I don't have family members involved? That's fine. We work with whoever you have—friends, chosen family, church community, whoever matters to you.

How do you keep my information private and secure? All records are kept confidential and secure. I follow HIPAA principles even though I'm not a medical provider. Your medical and personal information is your protected information.

What if I change my mind about something after we're done? You can update documents and plans. I'm available for consultation support if you want to adjust things later.

Is this covered by insurance? Generally no. This is a direct-pay service. Check with your insurance, but most plans don't cover proactive care planning consultations.

This work matters to me because I have seen families paralyzed by confusion. I have seen people lose autonomy and control because their wishes were never documented. I have seen medications causing suffering because no one coordinated care.

But I have also seen families come through crisis with clarity, unity, and love. I have seen people live out their final chapters with dignity because the work was done. I have seen systems work because someone took time to build them.

That's why I do this work. Not because it's pleasant to think about endings. But because being clear about what matters allows you to actually live it.

Let me help you get clear.