Senior Health & Providence Brain and Spine Care Ecosystem Helps Navigate Dementia Journey

Providence - Portland, OR

In the United States, nearly 7 million people live with dementia and over 20 million people provide unpaid care to support them. In 2021, with individual donor support, Providence Senior Health Program and Providence Brain & Spine Institute in Oregon launched the Care Ecosystem model to support people with dementia and their family caregivers. The Care Ecosystem is modeled on an evidence-based program from the University of California San Francisco. This innovative, population health approach improves outcomes, costs, and the care experience.

The Care Ecosystem delivers care via nonclinical navigators who perform an initial patient intake and needs assessment followed by monthly telephone check-ins. Navigators provide customized resources to persons with dementia and their caregivers based on needs identified during the intake and monthly check-ins. Navigators are supported by a robust, interdisciplinary team of clinicians including nursing, social work, pharmacy, geriatrics, and cognitive neurology providers. With the Care Ecosystem, families no longer have to steer through the often confusing health care system. They have a single point of contact to help them at every step of the way.

After early success and positive feedback, it was clear the Care Ecosystem was an asset for individuals with dementia, their caregivers and Providence. In 2022, Providence needed additional funding to support and expand this successful program while seeking a joint NIH grant with the University of California San Francisco to ensure the program can thrive and expand to other institutions. The JTMF Foundation was able to meet this need with a grant of $406,044. JTMF is proud to support the Care Ecosystem and in turn help older adults and their caregivers as they navigate their personal journeys with dementia.

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