Training › For Family Advocates › Coordinating care

You are the family's advocate. You are not a clinical care manager. You do not prescribe care; you coordinate it, communicate it, and stay with the family across years. The authorization level you carry on a case reflects the case itself, not the family's comfort with the word. This lesson is about the moment the case in front of you stops fitting the Coordination rhythm, and the care plan you write so the next hard week does not catch the family off guard.

The signals that move a case from Coordination to Delegated Authority

A Coordination case has a rhythm. A monthly check-in holds. The plan from last quarter still describes the home. The providers in place are the same providers as a month ago. When that stops being true, you are not on Coordination any more, even if nothing has been written down yet.

Four signals, in combination, are the practical line. One on its own is a hard week. Two or more, holding across two weeks, is the move.

Multiple active conditions, changing together

• The older adult is recovering from one thing and being newly worked up for another. Karim's pneumonia recovery and a new memory concern arriving in the same fortnight is the shape.
• A medication change has knocked the daily routine off, and the kitchen, the bathroom, and the morning are all moving at once.
• The hospital, a specialist clinic, and the home all want to schedule something this week, and nobody is holding the calendar.

Contested family decisions

• Two family members disagree on whether the older adult should stay at home or move, and the disagreement is not resolving.
• The daughter abroad and the son nearby are not speaking, and you are the only line between them on care.
• The older adult has stated a preference and at least one family member is overriding it in conversations with you.

Frequent service changes

• You have changed the provider mix twice in a month. Not by your choice, by the case asking for it.
• A booking pattern that held for a quarter has broken in the last fortnight, and the new pattern has not settled.
• You are adding a service type the family has not used before (transport on top of home help, or a partner program on top of both).

Repeated incident reports

• Two or more incident reports on the same family in the last sixty days. A fall, a missed medication window, a provider concern.
• A single incident that the family has reacted to in a way that needs follow-up beyond the report itself.
• A safeguarding concern surfacing alongside the case work. Safeguarding has its own path. Delegated Authority cases often run in parallel with it.

Writing the move into the file

The audit trail on an authorization-level move is the simplest test of whether you have done it well. A senior advocate, picking up your case in a year because you have moved on or are on leave, should be able to read your note and know why the authorization level changed, when it changed, and what you decided in the first week of the new tier.

What the note carries

• The date the move was decided, by you, as the family's named advocate.
• The signals you observed, named in your own words. Not a checkbox. A short paragraph that another advocate can read.
• The conversation you had with the family member who is the primary contact, and the date of that conversation.
• The first three things you changed in the week after the move: cadence, provider mix, or care plan section.
• The next review date you set for yourself on this case. Sooner than the old cadence.

A short paragraph beats a long one. Three plain sentences that name the signals and the conversation will be readable in a year. A long paragraph that lists every detail of the last month will not be. Write for the advocate who comes after you, not for the record.

The care plan that survives a contested family meeting

The care plan is yours to author. The family contributes; the older adult leads where they can. You write. A plan that pleases every family member in the room is rarely the right plan. A plan that reflects the older adult, names the people around them, and tells the next provider what to do on the first visit is the plan that holds.

Four sections matter most for Delegated Authority.

One named primary contact

One person, by name, with their phone number and the language they speak with you. Sylvie in Montreal Nord may have a daughter who is the primary contact on paper and a son who calls more often. The plan names the daughter. The son is documented as a secondary contact with a note on how he prefers to be reached. The provider arriving at the home reads one name and one number on the first page.

A documented substitute decision-maker

Who decides if the older adult cannot, on a given day. The legal arrangement (a power of attorney, a designated representative, whatever the local instrument is) is referenced by name. The advocate does not create the legal arrangement; the advocate documents it. If the family has not put one in place, the plan says so, and a line is added to your next family conversation.

Elder preferences, in their own words where possible

• The morning routine the older adult would choose if asked. Tea before the helper arrives. The window open. The radio quiet.
• Foods they will eat and foods they will not. People they want to see and people they do not.
• The small set of moments the older adult finds dignified, and the small set that they find difficult.

This is the section that prevents the most repeated stories. A new provider reading the plan should know how Karim takes his coffee without asking him on the doorstep on the first morning.

The small set of decisions reserved for the elder

Not every choice is a family decision. Some choices belong to the older adult, full stop, while they have the capacity to make them. The plan names which ones. What to wear. When to bathe. Whether to take the afternoon walk. Whether to see a particular relative this Sunday. The plan protects these choices from being negotiated away in a contested family meeting that the older adult is not in.

The audit trail the case file needs

A Delegated Authority case file is read by more people than a Coordination case file. Your replacement on leave. A second advocate covering a joint visit. An iCaria Support reviewing a break-glass escalation a quarter later. Maria in East Houston should be able to open the file and know, in five minutes, what is happening with this family.

What the file needs to carry

• The current tier and the date of the last authorization-level change, with the short note that explains it.
• The current care plan version, dated. Earlier versions are kept, not overwritten.
• The named primary contact, substitute decision-maker, and the elder's documented preferences.
• The current provider mix and the last two changes to it, with one line each on why.
• The last family conversation and the next one you have scheduled.
• Any open incident reports and any safeguarding referrals routed in parallel.

Lesson 2 is about holding the rhythm of a Delegated Authority caseload once the plan is in place. Weekly cadence, joint visits across multiple providers, escalation triggers, and the line between a hard week that needs your judgment and a break-glass moment that needs iCaria Support.

Finding this again Open Training from your advocate portal any time to come back to this module. This module is Advanced Practice, required for advocates handling Delegated Authority cases. A knowledge quiz follows. You pass it once before activating your caseload, and again each year when you renew your certification.