Intended to be flexible and broad, the program is a collaborative effort between the patient and our CARES team. The team can coordinate primary and specialty care appointments, assist with medical transportation, help patients understand and manage their medications, and provide education on complex medical conditions.  Patients are also eligible to receive an in-home safety assessment with a focus on preventing falls.   

Although every patient requires a different approach, the guiding premise remains constant; help our patients navigate the healthcare system and find the most appropriate solutions to their healthcare needs. 

The program has shown success both in creating a healthier community and reducing the burden on responding EMS crews and area hospitals.  On average, patients show a 39% reduction in 911 calls after enrollment in the program.  Partially funded by The North Sound ACH and The Olson Foundation, the program is free to citizens of NCRFA and completely voluntary.

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Care coordination services include:  

Coordinating primary and specialty care appointments. CARES team members can attend these appointments as an advocate and improve communication with providers. 

• Coordinating primary and specialty care appointments. CARES team members can attend these appointments as an advocate and improve communication with providers.
• Facilitating or providing medical transportation 
• Assisting with understanding and managing medications 
• Help following and understanding discharge instructions from the hospital
• Providing fall-risk assessments with recommendations for fall prevention tailored to the client  
• Connecting to behavioral health services including counseling and substance use programs  
• Accessing and applying for community and social programs that address basic needs such as housing, food, and long-term care for older adults.