This program may be appropriate for patients who:

Are experiencing memory loss or dementia (a formal diagnosis is not required)

Need assistance with activities of daily living such as bathing, dressing, toileting, eating, or medication management

Are enrolled in Medi-Cal through Health Net or L.A. Care and reside at home in Los Angeles County

Have a caregiver or support person who can participate in the program on an ongoing basis

The primary point of contact who collaborates with clients, caregivers, and an interdisciplinary team to develop person and family centered care plans. The Dementia Care Manager coordinates services and connects families to resources through Alzheimer’s Los Angeles and other community agencies.

Provides clinical support to the care team by advising on issues such as falls, sensory impairment, skin integrity, and incontinence. The Nurse Consultant offers guidance on managing complex medical conditions and assists with advanced care planning.

Collaborates with the care team to address psychosocial needs, support the individualized care plan, and close gaps in care. The LCSW provides caregiver support, education on behavioral management strategies, and guidance to help prevent caregiver burnout, abuse, or neglect.

Specializes in medication management for older adults. The Geriatric Pharmacist conducts comprehensive medication reviews to ensure safety, appropriateness, effectiveness, and provides recommendations to optimize medications. The Geriatric Pharmacist also educates caregivers and encourages communication with prescribing clinicians regarding any medication concerns.

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