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About IKOR International

IKOR International Founder &
CIO, Patricia Maisano

IKOR is not just care management, we are life management RE-DEFINED. It is not a question of if we will age, but how will we age. That question is answered differently for every one of us, and with changes to legislation, healthcare and technology, it is not always easy to navigate those changes. IKOR was created to help navigate these changing environments with compassion, wisdom and integrity. At IKOR, we take a holistic approach to the lives of our clients, looking at the medical, environmental, psychosocial, and vocational/educational aspects surrounding them.

IKOR’s Key Principles

  • 1

    To act in the best interest of our client only and always.

  • 2

    To help our clients live the most independent life possible within their physical and financial restrictions.


The IKOR Approach

  • 1

    Needs Assessment – IKOR will do an initial assessment to get an accurate picture of the current situation. This will create a baseline for where the person is right now so we can have a starting point. Assessments are given by trained, experienced Patient Advocates, or RN Patient Advocates. We can do Directed Assessments to address specific needs, or our Complete Assessment which looks at the major aspects of one’s life – medical, environmental and psychosocial.

  • 2

    Life Map – After the initial assessment, we will make recommendations for the short term and long term to navigate the future. The short-term plan will address immediate needs and concerns that can be resolved over a 60- to 90-day period. They can be as simple as a doctor’s appointment or as complex as home modification. Long-term plans cover a longer period of time, usually 6-12 months, and are often contingent on solving a short-term problem before they can be implemented successfully.

  • 3

    Coordination of Care Services – Once the life map is agreed upon, IKOR will work to coordinate the services. Because our offices are locally owned and operated, our professionals have a working knowledge of the different professionals needed for each situation. Here are a few examples:

  • Meal Preparation
  • Transportation
  • Handicap Equipment Providers
  • Telemedicine Providers
  • Lawn Services
  • Assisted Living Facilities
  • Home Care Providers
  • Rehabilitation Centers
  • Occupational Therapists
  • Mental Health Professionals
  • Attorneys

IKOR works independently of any referral networks, and will typically provide up to three options for any services required.

  • 4

    On-Site Quality Assurance – After we have coordinated services, IKOR will perform scheduled and unscheduled quality assurance monitoring. We make sure the professionals that are selected are providing the level of service our clients expect. IKOR monitors the progress of our clients and will continue to make recommendations as their situation changes.

Let us show you why IKOR is the right choice for you and your family!


What IKOR customers have to say about us.


"Over the last eight months your IKOR team in Charlottesville have provided guidance and care for my sister, Lee Arnett Young, and her husband (my brother in law), Robert Young, through their death and dying process. I write this letter to you on the same day as my brother-in-law died, succeeding my sister in death by a little over four months.

Katie Caverly, as a manager of her team and as court—appointed Guardian and Conservator, was not only thoughtful in every detail and decision (many very difficult to make) but she was also diligent about communicating to us and our family. I taught gerontology at San Diego State University for five years, having previously retired from service to the State of California as Director of the Department of Aging. Katie and her team not only lived up to my teachings but taught me "how it’s done” beyond the level of just giving lectures to nursing and social studies students.

Thus, this letter is a personal "thank you” to you and your concept for IKOR. But, even more important, it is to say that Katie is a blessing to the study of human aging and demonstrating the very best in the actual practice of caregiving, especially at a critical time."


"When my dad was diagnosed with Alzheimer’s, I wanted to understand what he needed and what I could do. Through your assessment, you found the place that could meet all of my dad’s physical and psychological needs. And you helped me as well. You educated me in the disease process, and gave me some instruction on how to communicate with him to make the time we had left have greater meaning. We could communicate again on his level, and I understood how and why. My last months with him were some of our best. I’ll never forget what IKOR did for us."


"My mother was in an auto accident at 70 years old and left a quadriplegic. I had one school-aged child and one on the way. She was seeing 10 different doctors and was, when we met IKOR, on 35 different medications. Mom was living with me, and I didn’t know what to do next. Your IKOR RN Advocate got us dependable home care and worked with the doctors to coordinate information during her hospital admissions. With your help, she decreased the number of doctors in her care and significantly decreased her medications. Things calmed down to such a point that we didn’t need your help any longer. But I know if I ever need you again, IKOR will be there."


"My parents were on the East Coast and I was on the West. The only support they had was a family member who needed more help than they did. As a doctor, I couldn’t continue to leave my practice for weeks at a time to fly home to take care of what they needed. IKOR not only got their health and care stabilized, but helped me move them both out to the West Coast to live with me. Please accept the flowers as a small token of our appreciation."


"My mother was on a downward spiral. I was told that she would never leave the nursing home. When I found IKOR, she weighed 85 pounds and we had given up hope. All she wanted to do was come home, and die there. With IKOR, she not only came home, she gained weight and got her strength back. You helped her fulfill a dream, to see her last New York City Christmas with some dear friends. I couldn’t have asked for more."


"When my mother became ill, I prayed for an angel to help me. God sent me IKOR. Thank you for all you did. I keep your sympathy card with the others from the family. IKOR will always be one of the family."


"IKOR gave my father a true quality for the last three years of his life. He regained his dignity and choices, and felt more in control until the end. With my extensive traveling for business, you were there for him and for me."


"As a guardian, IKOR has been a staunch supporter of my mother’s day-to-day needs, and has worked tirelessly to protect my mom’s legal rights. IKOR is a caring and comforting support for my mother, which has brought me peace of mind. I have great faith that IKOR serves all their customers like my mother with compassion and with the utmost professionalism."

Patricia G

"I had neither the time nor the training to handle my in-law’s failing health issues; IKOR was the perfect solution for me."


"Without IKOR’s guidance through the maze of medical choices presented, my husband and I would never have found this beautiful facility."


"One of the most comforting services that IKOR performs is the knowledge that our parents are being continuously monitored."


"Because of IKOR’s medical insight, my family feels confident that we made the best choices for our parents."


"IKOR’s talented, dedicated, intelligent advocates improved every aspect of my care!"


Our Customers

IKOR Advocates are fully independent professionals focusing solely on the needs of our clients. By being independent, the IKOR name is recognized as being a protective influence in our clients' lives. IKOR Advocates listen to the individual, address their needs and place their well-being above all other factors.

Whether you are a professional seeking IKOR's assistance for your clients, a family member seeking help for a loved one or an individual in need of our services, IKOR is here to help you.


IKOR simplifies the care management process of fiduciaries by providing unique solutions for the issues of seniors and the disabled. We orchestrate all aspects of client care, because we know what they should be, providing an unbiased, independent point of view that focuses on maximizing the quality of life within the parameters of a cost-conscious and time-efficient platform.

This means constantly working with our clients in conjunction with professionals, families and other care providers; we ensure that all medical, environmental and psychosocial needs are covered.

IKOR is passionate about you and your family’s needs and wishes. IKOR services are used extensively when families are separated by distance from a senior and/or disabled individual. In addition, when there is uncertainty or disagreements regarding what needs to be done, IKOR is here every step of the way to help you and your family navigate through these difficult situations.

Our mission is to help our clients and their loved ones live as an enriched and fulfilled life as possible. The IKOR Approach was developed so that together, we can create the best comprehensive short-term and long-term strategic plans for our clients. While working with our clients and their families, we will ensure that all medical, environmental and psychosocial needs are covered. We work in a coordinated, proactive fashion for the benefit of our client, and in consideration of our client’s wishes.

Life is unpredictable. We all accept that. Unfortunately when you are a busy, successful professional, personal life issues can be even more difficult to juggle. What do you do when you find out that your medical test came back with unexpected results?

Should you obtain a second opinion? What treatment options do you have? Can you rely solely on your current medical team? Would you like a team that is dedicated to ensuring that your desires and schedule are the primary considerations? At IKOR, we specialize in helping professionals just like you.

We will be your advocate, working with you through not only the medical issues, but your complex life schedule as well … aiming for the best life and balance possible.

Case Studies

Over the years, families, trust officers, attorneys and even the courts have turned to IKOR to help them navigate our country’s fragmented and complex medical system. At IKOR, we give a voice to those who need it and empower them with information from highly trained Registered Nurse Patient Advocates and Personal Needs Coordinators.

Take a moment to look at our case studies; then when you are ready, call your local IKOR office to visit with an IKOR Managing Director to discuss how IKOR can help your specific needs.

No Matter The Needs, IKOR Can Help

Aging In Place

Case Study: Aging in Place

Mr. and Mrs. Smith wanted to remain independent in their 55+ community, and their children called IKOR to learn what was possible. After our IKOR assessments of both parents, we determined that continuing in their current lifestyle was safe to do at this point without aide services.

IKOR Approach

Our RN Advocate attends all important doctor appointments for each client to communicate any changes or identified issues, find out what other treating doctors have done, and obtain new orders. About every two weeks, the nurse also distributes medications for Mr. and Mrs. Smith into a secure telemedicine unit.

The nurse sets the parameters of the unit’s distribution by computer remotely. Now every time medications are needed; the couple does not forget their medications. The unit tells them verbally when it’s time and for whom (“Mr. Smith, it’s time to take your medicine”), and disburses the correct medications into a cup. Mr. Smith has 30 minutes to take his meds, and if he doesn’t, the medication unit automatically sends a text message to their IKOR RN Advocate’s cell phone and informs her that the meds have not been taken. She can then immediately follow up by phone and find out what’s happening.

Case Outcome

This system has not only improved our clients’ health, but it’s also allowed them to live the quality of life they want and to know that IKOR is there for them should a change occur.


Disabled Child

Case Study: Disabled Child

Nine-year-old Gary became a quadriplegic from an accident that occurred when he was 10 months old. IKOR was asked to be involved by the trust officer working with the family. Upon assessment, IKOR noted several issues that needed immediate attention despite having one of the finest children’s hospitals as the central treatment team. Gary needed new arm braces, a wheelchair that fits his growing size, and the removal of an undersized trachea tube. We also noted that Gary had never received any children immunizations, and had never attended school.

IKOR Approach

The IKOR RN Advocate began interfacing with the staff of caregivers and noted that they were untrained to perform such functions as auctioning the trachea tube or basic care of Gary’s special physical needs.

IKOR first began communicating with the treatment team. IKOR had the trachea tube safely removed from Gary, and he slowly began the process of learning to eat by mouth. IKOR replaced Gary’s caregivers with trained RNs and LVNs, obtained a new wheelchair and arm splints for Gary, started physical therapy for him, and got his required immunizations. With the immunizations in place, IKOR identified a nearby school program, paid for by the local school district, that could address Gary’s special needs and challenges. The IKOR RN got Gary a special computer, paid for by the school, which could be operated through his existing abilities, enabling Gary to communicate more effectively. Gary at last had the socialization of peers and didn’t feel quite alone in the world.

Case Outcome

Gary’s quality of health and life were greatly improved, not just for the present, but with possibilities for greater enhancement in the future.


Financial Advocacy

Case Study: Financial Advocacy

Alfred is an 83-year-old man who had lost connections with his family due to some mental health issues in his past. He was living in an assisted living facility and had stopped paying his bill, leaving the assisted living director no choice but to look for outside assistance. Alfred had a nephew that lived several states away, but was an established scientist who could not take time away from work. Alfred’s nephew had no idea what his uncle’s situation was or how to handle it. At the facility’s suggestion, the nephew contacted IKOR.

IKOR Approach

IKOR visited the facility and assessed Alfred’s situation and needs. The RN Advocate found a room overflowing with what looked like trash in boxes. The facility planned to back a truck up and throw away everything, but IKOR stopped them. Instead, we used the IKOR Approach for exploring everything in the room to learn what we could.

The Outcome

Through our light forensic accounting, we discovered more than $4 million and the existence of six different bank accounts in six different banks, as well as stocks, bonds and safety deposit boxes. Most of these assets were not recorded elsewhere, and if the contents had been thrown away, that wealth would have been lost. Do we always find money? Of course not. But we have had numerous situations of locating money, antiques and other valuables that added to the funds needed for care, and in each case no one knew those valuables existed.


Medical Advocacy

Case Study: Medical & Financial Advocacy

Mrs. M is an 85-year-old wealthy widow with one son who does not live nearby. Several years earlier, Mr. and Mrs. M moved into a private cottage inside a retirement community. Now that Mr. M has died, Mrs. M has expressed the desire to remain in her home.

The retirement community informed the widow and her trust officer that she had to move out of her cottage and into assisted living because of her inability to function independently. This case was referred to IKOR to assess Mrs. M’s potential to age in place.

IKOR Approach

IKOR, offering Advocacy without CompromiseSM, was able to independently assess the situation and determine the facility had withheld private knowledge. If Mrs. M moved out of her cottage, along with losing her independence, Mrs. M would lose the greater portion, if not all, of the $200,000 she and her husband had paid for their home. The facility could then resell Mrs. M’s cottage, and the proceeds would go to the institutional community. If Mrs. M were able to safely remain in her home, she would have her wish to age in place. Her son, through her estate, would retain the entire value of the cottage.

Based upon the IKOR assessment, the RN Patient Advocate was able to determine that aging in place was possible. The Patient Advocate found that Mrs. M had a significant hearing loss which had not been addressed. The RN Patient Advocate coordinated a full hearing analysis and the implementation of hearing aids. The nurse also expedited the receipt of new eyeglasses that Mrs. M had ordered but had not received.

To address moment-to-moment care, the IKOR Registered Nurse coordinated 24-hour-a-day companion care in the home. IKOR secured services that would help Mrs. M with her physical care, preparation of meals, and transportation to meet friends and to doctor’s appointments.

Case Outcome

The companion care is currently being monitored by the case management RN. The IKOR nurse also maintains communication with Mrs. M’s treating physician with respect to medication and treatment. IKOR has implemented medication and disposable goods through a service which resulted in substantial savings for Mrs. M as compared to the pharmacy previously used.

Mrs. M continues to age in place at an average monthly cost of $4,000 including the costs of IKOR’s continuing intervention. If Mrs. M were to be placed into a skilled care facility to meet the same needs, she would be spending a minimum of $4,500 plus paying an additional fee (often at a 50% increase) for medication and disposable goods. The client and ultimately her son were able to also save the cottage investment of $200,000.


Medical Advocacy for a Senior Couple

Case Study: Medical Advocacy for a Senior Couple

Case Background

Mr. and Mrs. G are ages 72 and 70, respectfully. Mrs. G was diagnosed with a brain tumor and underwent brain surgery 30 years ago, which left her fully paralyzed on the right side. Her husband and children were her primary caregivers from that time on. Mr. G was an active executive until his retirement three years ago. Soon after his retirement, Mr. G began to experience cardiac and vascular difficulties. These medical conditions resulted in the need for numerous medications and subsequent surgery.

Following Mr. G’s surgery, the couple was placed in a skilled care facility at the doctor’s request for the purpose of rehabilitation for Mr. G, and because Mrs. G could not care for herself. Mr. and Mrs. G’s children, now grown and with careers and families of their own, did not have time to provide care within their homes. The children were left to search independently for several weeks for what they thought was the most appropriate placement.

IKOR was contacted by two of the four adult children who lived nearby. The children had recently been informed that it was no longer suitable for their father to stay at the skilled care facility because he had greatly improved. The facility recommended that the father be moved to an assisted living center owned by the same company some distance away.

The children were concerned about the financial effects the move would have on their parents. At the time of IKOR’s intervention, Mr. and Mrs. G were spending well over $10,000 a month to live in the skilled care facility. When the money and assets ran out, the family was resigned to total Medicaid dependence as an inevitable conclusion.

IKOR Approach

IKOR Advocacy with Wisdom and CompassionSM approaches these situations understanding that financial motivation of the care facility may not be consistent with the best needs of the clients. The family was completely unaware of the financial drivers affecting the facility’s motivation to move their father. Based upon the current criteria for Medicaid admission, Mr. G would bring the facility the lowest level of reimbursement possible. If the facility moved Mr. G to their own assisted living center, they would continue filling Mr. G’s skilled care bed with a client who could provide the facility with the maximum Medicaid reimbursement.

An IKOR Patient Advocate met with the family and assessed both parents in their skilled care room. Mr. and Mrs. G were adamant about remaining together, as they had been for over the last 46 years. Mr. G was so adamant about remaining together that he had hidden his full capabilities from the staff.

They discussed their wishes and hopes regarding a new environment. Among those wishes was that they could live in an apartment-style home instead of one small room. Their children had one specific request – that the facility be near a full medical center to address any potential crisis for their father.

The IKOR assessment clearly showed that Mr. G was mentally and physically far more independent than warranted a skilled care level. Mr. G was assessed by the IKOR RN to be appropriate for an assisted living level. Mrs. G, although needing more assistance than her husband, was in many respects beyond skilled care as well. Mrs. G’s capabilities placed her somewhere within the void between assisted living and skilled care.

The IKOR determination was that assisted living with limited additional care was the best response to the needs of both individuals.

Case Outcome

IKOR successfully found and recommended two possible facilities. Both were able to meet all the clients’ desired objectives. Mr. and Mrs. G would have a one-bedroom apartment living environment with cable television and a full kitchen where Mr. G could keep his favorite snacks. The couple would have the option either to take their meals in their apartment, or to eat in the restaurant-style environment, personally selecting what they would eat. Mr. and Mrs. G would have the opportunity to participate in activities both inside and outside of the facility. Both options were geographically situated within an easy driving distance from the nearby children and within a mile of a full medical center. In both options, IKOR assured 24-hour nursing service and more than four hours of direct care for Mrs. G every day.

IKOR presented a plan meeting all of the requested options and all of the identified needs. This solution also saved the family over $6,000 a month in costs.


Medical Advocacy for a Teenage Boy

Case Study: Medical Advocacy for a Teenage Boy

The High School Football Player

IKOR was contacted by the parents of an otherwise healthy teenage son. Their son was playing football for his high school team when one of his lungs collapsed.

Their son, Sam, was admitted to a local hospital five days before and was still suffering. The doctor wasn’t communicating with them, and continued to do testing but would not explain to them why or what the results were. They felt totally in the dark. These parents were educated and involved parents who felt completely lost as to how to help their son. They had heard of IKOR and wanted to see if we could help.

The IKOR Approach

Our RN Patient Advocate (RNPA) went directly to the hospital even though it was after hours for her. The staff told our nurse that the doctor had left for the day. The RN met with the parents and Sam, and found a young man who was no better than when he was first admitted. As the nurse was talking to the family, the doctor reappeared, and the IKOR RN began asking direct questions and expecting answers.

The doctor refused to answer, and the IKOR RNPA, being properly trained, acted professionally but demonstrated to the doctor her knowledge of the patient’s condition. When they discussed the errors the doctor had made and the jeopardy he had placed the client in, the doctor clearly understood the role of the IKOR Advocate.

Case Outcome

The RN Patient Advocate worked with the family and coordinated the patient’s move to another hospital. In getting the patient a specialist for his condition and the necessary surgery, Sam was once again himself. He was well enough to return to football before the end of the season, and IKOR completed its advocacy.


Advocacy for a Disabled Young Man

Case Study: Assistance for Disabled Young Man

IKOR received a call from a mother about her college-age son. Silvia told us that her son Brian had gone on a spring break vacation to Florida. While on vacation, he rented a motorcycle, and was subsequently involved in an accident resulting in a brain injury.

By the time Silvia called IKOR, Brian had been in a hospital in Florida for six months. During that time husband, Silvia’s husband George had remained in Florida by their son’s side, which seriously impacted their marriage. Silvia told us that her husband had seen steady improvement in their son, but the doctors wanted Brian to be placed in a nursing home because the doctor considered Brian “a vegetable.” She asked if there was any way IKOR could help.

The IKOR Approach

Our goal is this case was to prevent this 20-year-old man from being institutionalized and to get him a thorough, independent medical evaluation, ideally somewhere in Delaware or Pennsylvania closer to his home. In this way, should the evaluation turn out poorly, he would be placed closer to his parents.

To begin, we needed to find a way to prevent Brian’s discharge from the hospital until we could get him a lateral transfer to a hospital near his home. We knew it would be extremely difficult to have insurance cover an admission to another hospital, once he had been considered a discharge. We learned from Silvia that Brian had a tube in place to breathe (a vent), and we knew (based on our experience) that it is very rare that a long-term facility can admit a person on a vent. So we suggested that the parents refuse the procedure, thereby impeding a “safe discharge,” The hospital could not transfer Brian in this condition.

Then we asked for medical records to explore what was possible. We noted that the father and the doctor were both right on paper. The records showed that Brian was progressing in therapy every day. The records showed that the doctor only saw Brian between 1 and 2 a.m. The doctor never read the therapy notes, and forgot that it’s historically difficult to wake a head-injured patient especially after they have worked hard all day.

Case Outcome

We identified a head-injury program close to home that agreed to look over the records and discuss the possibilities with us. We forwarded the records and pointed out the failings of the doctor’s evaluation. They agreed to take Brian as a patient. Now we had to get him back home.

IKOR identified a medical air transport company, and together with the family’s church, we coordinated his transport.

Brian was treated in the program for head injury and was discharged fully able to function and return to school.


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