Care Management
Multipurpose Senior Services Program

The Sourcewise Care Management program is the home of the Multipurpose Senior Services Program (MSSP). MSSP is designed to work with frail older adults 60 years or older and have Medi-Cal 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. Our Care Management team will work with you and your loved ones to assess your situation and develop an individualized plan of care that fits your social, physical, and economic needs.

Please fill out the interest form to find out how you qualify.

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Who is this for? *YourselfSomeone Else

Your Name, if this is for someone else

Phone Number, if for someone else

Relationship to Client? *

Please fill out the client Information below.

First Name *

Last Name *

Email

Phone Number *

Address *

Zip Code *

Would you like to receive future updates and mailings from us? *

• Yes
• No

Date of Birth *

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Sex at Birth *MaleFemalePrefer not to respond

Sexual Orientation *Straight/HeterosexualBisexualGay/Lesbian/Same-Gender LovingQuestioning/UnsureNot listed, please specifyPrefer not to respond

Please Specify *

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

What is your current type of residence? *--- Select Choice ---Private home or apartmentAssisted living facilityNursing homeGroup homeOther

Other

Have you ever served in the US military? *

• Yes
• No
• Prefer not to respond

In affiliation with someone who is serving or has served in the US military? *

• Yes
• No
• Prefer not to respond

If affiliated, would you like us to share your contact details with VA for additional assistance? *

• Yes
• No
• Prefer not to respond

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);
• Caregivers Network;
• Digital Link (iPad Technology Program);
• Health Insurance Counseling & Advocacy Program (Medicare);
• Meals on Wheels;
• Public Authority Services;
• Senior Employment Services;
• South County 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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