Advanced Illness Management in NH

Specialized Support for Every Stage of Serious Illness

Led by expert nurses and social workers, our Advanced Illness Management program is built around one principle: you deserve a team with the time and experience to truly listen.

Our Advanced Illness Management (AIM) program provides specialized medical and emotional support for patients living with serious illness. Working alongside your existing care team, our AIM clinicians focus on improving quality of life, managing complex symptoms, and ensuring your care reflects what matters most to you—at every stage of your journey.

Our Services

• Navigating Symptom Challenges: Personalized support for patients facing new or worsening symptoms related to serious illness.
• Goals of Care Conversations: Taking the time to truly understand what matters most to you and your family—so your care reflects your values, not just your diagnosis.
• Care Coordination: Connecting you to the right resources and providers across every step of your healthcare journey.
• Advance Directive Support: Discussing, reviewing, and documenting your wishes so your voice is heard when it matters most.
• Support for Loved Ones: Guidance and resources for the family members and caregivers closest to you.
• Hospice Transition Support: Facilitating a smooth, compassionate transition to home hospice care when that appropriately reflects your goals.

When to Consider AIM Services

AIM may be right for you if you’re living with a serious diagnosis—such as heart failure, COPD, cancer, dementia, or another progressive condition—and you’re experiencing any of the following:

• Frequent hospitalizations
• Declining function or difficult-to-manage symptoms
• Uncertainty about your care goals or next steps
• You do not need a terminal diagnosis to benefit from AIM care. Many patients work with our team long before that stage.

Who We Serve

We support adults in our community living with serious or advanced illness who have complex or changing medical needs. Our team ensures a smooth, supportive transition from home health to hospice care when appropriate—but AIM is valuable at every point along that journey, not just at the end.

We Come to You

Our team meets patients wherever they call home—whether that’s a private residence, assisted living community, skilled nursing facility, or another healthcare setting.