The Sourcewise Multipurpose Senior Services Program (MSSP)

The Sourcewise Care Management program is the home of the Multipurpose Senior Services Program (MSSP). MSSP is designed to work with frail older adults 65 years or older who are at risk of nursing home placement. We focus on helping you to remain living safely at home by providing supportive services and ongoing case management to avoid premature institutionalization. We also provide you help as you are returning home after a hospitalization, a stay in a skilled nursing facility, or intermediate care facility.

Who is this for?YourselfSomeone Else

For someone elseFamily MemberFriend / NeighborClient / Patient

Your Name, if this is for someone else

Phone Number, if for someone else

Please fill out the client Information below.

First Name *

Last Name *

Email

Phone Number *

Address *

Zip Code *

Date of Birth *

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What language do you feel most comfortable speaking? *

• English
• Mandarin
• Vietnamese
• Spanish
• Other

Other Language

Do you have Medi-Cal? *

• Yes
• No

Do you have a share of cost for your Medi-Cal? *YesNoDon't Know

Which of these activities are difficult for you or the prospective client to complete independently? (choose all that apply) *

• Eating
• Transferring
• Toileting
• Doing your laundry
• Managing your medications
• Walking home
• Dressing
• Bathing
• Cleaning your house
• Preparing meals and cleaning up
• Managing your money
• Walking in the community

What do you need help with? (choose all that apply) *

• Finding a caregiver
• Home safety/Getting safety equipment
• Managing money
• Getting incontinence supplies
• Legal advice
• Arranging transportation
• Getting enough food
• Managing medication
• Socialization
• Respite

Please check the services below where you would like to receive more information. (choose all that apply) *

• Information & Awareness (Find Older Adult Resources);
• Health Insurance Counseling (Medicare);
• Digital Inclusion (iPad Technology Program)
• Senior Employment Services;
• Caregivers Network;
• Meals on Wheels;
• Care Management;
• Public Authority Services;
• Senior Farmer's Market;
• Dignity at Home Fall Prevention
• Sourcewise Transit Services;
• Other;

Other Services

How did you find out about MSSP? *Postcard in MailEmail from SourcewiseCase ManagerFriend or Family MemberSocial Media

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