“…For instance, the success of Geriatric Teams at the John Hopkins Home Care Group (JHHCG), an American organization providing a full range of home health services throughout Maryland, demonstrates that regular and effective care coordination is achievable in the setting of home health care. 36 These teams, consisting of a physician, nurse, physical therapist, occupational therapist, speech and language pathologist, and social worker, are located in one location and meet daily to discuss patient progress, medical issues, rehabilitation, social and psychological issues, and family dynamics. The result of such meetings is that care is coordinated and seamless, with all providers communicating the same messages to the patient.…”