What should a social worker do as a care manager for persons with dementia?

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In the care management role, a social worker should:
(1) complete a comprehensive assessment of the situation;
(2) develop a care plan;
(3) implement the care plan by coordinating health and social service delivery from different providers and by providing services directly to both caregivers and informal caregivers;
(4) maintain regular and frequent contact with the person with dementia and informal caregivers to ensure that appropriate care is delivered in a timely fashion and that adjustments to changing circumstances are made on an ongoing basis; and
(5) advocate to close gaps and fill in needs that are not being fully met by the care plan.