Coordinates care to help older adults who are in need of long term in-home health care care to remain in their home and avoid frequent hospitalizations or nursing home placement. Works with the patient, their family, and medical service providers to meet the individual needs of the patient and help them to remain as independent as possible. Agency can provide in home nursing care as well as in home health aid services, but will work with outside agencies based on the client's preference. Transportation to adult day care is provided. Dental care, vision care, respite care, rehabilitation services and hospice care can be provided by the agency as needed. If a participant needs any Durable Medical Equipment, such as a wheelchair or a lift chair, that equipment is ordered, delivered, and installed free of charge.