The scaffolding around medical care, built where families actually need it.
Licensed clinical social workers address the emotional and practical burdens that medical care alone cannot reach — advance directives, family coordination, benefits navigation, and the long conversations no clinician has time for.
LCSW-led
Licensed clinical social workers, bound by professional ethics and HIPAA.
A diagnosis rarely sits alone. It brings paperwork, meetings, worried adult children, insurance letters, and the quiet weight of decisions that nobody prepared to make. Medical social service is where a family gets a seat at the table with someone whose job is to read the room and the forms at the same time.
Our social workers help coordinate with hospital teams, file and renew benefits, prepare advance directives, and connect families to community resources, from respite programs to meal delivery to transportation. They run family meetings that surface the unspoken and land on a plan.
Coverage and payment options vary by state, plan, eligibility, and authorization. Medical social work may be covered by Medicaid, long-term care insurance, or other payment options depending on the circumstances. We can meet at home, on the phone, or in a hospital room during discharge planning.
Where our social workers step in.
- Advance directive preparation
- Family meeting facilitation
- Hospital discharge planning
- Benefits navigation
- Community resource referrals
- Caregiver burnout support
- Grief and bereavement
- Long-term care planning
How we deliver it
Named advocate
Families get one licensed social worker, by name, who knows the case before every call.
Benefits, plainly
Medicaid, VA, and long-term care insurance — we walk families through what applies, without jargon.
Rooms, not just forms
We show up in hospital rooms and at kitchen tables. Presence is often the missing piece.
A service record you can verify and trust.
The Joint Commission Gold Seal of Approval®, held continuously since 2013.
The Joint Commission is the most widely recognised standard for health-care quality and safety in the United States. Home health agencies that hold the Gold Seal have been surveyed on-site against hundreds of patient-safety, clinical-practice, and infection-control standards, and are re-surveyed every three years.
- On-site surveyed against hundreds of patient-safety standards
- Nurse-led care plans reviewed by our nursing team before they reach a family
- Independently verifiable via The Joint Commission's Quality Check
- First accredited
- 2013
- Review cadence
- Triennial
- Internal rounds
- Monthly
Initial on-site Joint Commission survey passed
On-site resurvey every three years
Medication, infection & family experience
Accreditation is the floor we operate above, not the ceiling we aspire to. Between surveys, our nursing leadership runs monthly internal rounds on medication accuracy, infection control, and family-reported experience, the measures families actually feel at the kitchen table.
From first call to 24/7 coverage. Eight steps.
The process is short on purpose. A care coordinator walks each family through the steps so first calls, assessments, and caregiver matches stay in one conversation.
- Step 01
First call
A 30-minute conversation with our care coordinators. No forms first, no phone tree.
- Step 02
Referral review
Hospital discharge notes, physician referrals, or case-manager introductions, we take them all.
- Step 03
Needs assessment
Free in-home assessment scheduled based on availability, location, and care needs. A licensed nurse meets the person and the household.
- Step 04
Benefits mapped
Coverage and payment options vary by state, plan, eligibility, and authorization. Families can speak with Axzons intake about care needs, service availability, and next steps.
- Step 05
Caregiver matched
We propose caregivers whose training, language, and temperament fit the household. Families interview, families choose.
- Step 06
Care plan written
A plan, not a schedule. Nurse-reviewed, measurable, and revisited on a real cadence.
- Step 07
Service begins
First shift, with the coordinator on standby. Small issues are addressed during business hours.
- Step 08
24/7 coverage
On-call care coordinator line for the whole family, every night and weekend. One number is always answered.
The things we walk through on the first call.
If your question is not here, the fastest way to get an answer is to call; intake is answered by care coordinators, not a scripted agent.
Ask a care coordinatorCall us for a short intake conversation. After a free in-home visit with a licensed nurse, we work to match a caregiver as quickly as availability allows. We continuously recruit and screen caregivers so families rarely wait long.
Absolutely. Caregiver fit is a conversation, not a contract, if the match isn't right, we reassign without awkwardness and without interrupting coverage. Our goal is a caregiver the family forgets is not part of the family.
Every Axzons caregiver is background-checked, credential-verified, and interviewed in person for compassion, reliability, and competence before they ever reach a household. Continuing education is required throughout their time with us.
We work with Medicaid (including MLTC plans), Medicare Advantage, long-term-care insurance, and private pay. Coverage and payment options vary by state, plan, eligibility, and authorization. Our care coordinators walk through the options that may apply on the first call, before services start.