AgeWise

 
 

Institutional Case Management

1660 Hotel Circle North, #320, 
San Diego, CA 92108
619-481-3850
619-481-3851 FAX

Strength-Based Case Management

6160 Mission Gorge Road, Suite #108
San Diego, California  92120
619-481-5200
619-481-5217 FAX


About AgeWise

 Click here to view PDF.

Click here to view PDF.

At Telecare’s AgeWise program, we are here to support you in taking positive steps towards independent living. 

We believe that integrated healthcare and care coordination are key components for your recovery journey. Our job is to do whatever it takes to help you get the proper care you need and feel empowered through your choices of care. We have a full staff of peer specialists, personal service coordinators, masters-level therapists or social workers, nurses, and psychiatrists, who are all here to help you on your path.

Your recovery plan is guided by your hopes and dreams. Our team will help you by providing personalized assessments where you can identify the kind of program assistance you will need. From there, we will collaborate primary care physicians and coordinate with home health agencies, senior centers, and other community resources  for older adults to make sure you get the most comprehensive care possible.

Opened in 2012, AgeWise was created to improve the quality of life and promote recovery for older adults. The program provides most supports in the community but includes two unique components: a strengths-based case management full-service partnership (FSP) and the institutional case management program. The strengths-based case management component provides comprehensive case management, crisis prevention and intervention, skill building and community integration services. The institutional case management program focuses on improving the quality of life and promoting recovery for older adults living in long-term care placements.

Just the Basics

Members: 704
Population served: Adults, aged 60 and older
Funded by: San Diego County, Medi-Cal, and MHSA

Recovery Model

The AgeWise program is founded on a strengths-based, person-centered model which aims to build trusting relationships, address immediate needs, and connect individuals to community resources so that they can reach their highest potential. We integrate Telecare’s Recovery-Centered Clinical System (RCCS), an innovative recovery framework that incorporates the latest research and evidence-based practices. RCCS emphasizes doing no harm and supporting and enlivening recovery. The recovery model incorporates such approaches as motivational interviewing, cognitive behavioral therapy, dialectical behavioral therapy (DBT), harm reduction, and other consumer-centered therapeutic interventions.

Services

Strength-Based Case Management Services: As a strength-based case management program and full-service partnership (FSP), we are a consumer-driven and highly collaborative program. We provide wraparound services to individuals with complex needs and support people in addressing mental health symptoms and conditions while building natural recovery supports and resources.

Teams work with members to identify needs and build a treatment plan that is collaborative and comprehensive. The goal is to assist people living in the community and ensure members are linked to housing, medical care, psychiatric care and natural supports.

Institutional Case Management Services: Institutional case management serves members who are conserved and placed in a long-term care facility. The program provides members with support in obtaining and maintaining benefits, care coordination, discharge planning, and advocacy. Members are assessed to ensure that they are placed in the least restrictive environment possible.

Referral Process

For strength-based case management, referrals come from a variety of places including hospitals, other providers, family members, and individuals. Referrals are coordinated through San Diego’s Department of Behavioral Health. Referrals can be made through the Department of Behavioral Health, or to the program directly.

For institutional case management, referrals come directly from the Public Conservator’s office and/or coordinated through San Diego’s Department of Behavioral Health. This program only serves those that are on conservatorship.

Admission Criteria

  • Adults, aged 60 and older

  • Residents of San Diego County

  • Diagnosed with a serious mental illness

  • For institutional case management, the person must also be conserved and placed in a locked, residential facility

Strength-Based Case Management

Eligibility Criteria: Client must meet two or more of the criteria below

  • Medical Necessity must be established (face to face) to determine the presence of a severe psychiatric disability and need for Strength-Based Case Management (SBCM) services per LOCUS (Level 3 – High Intensity Community Based Services)

  • Has current LPS Conservatorship (may be a designated County Conservator or family member (Private Conservator)

  • Client is not homeless but may be at-risk of homelessness

  • Minimum one hospitalization in the past year, OR multiple ER utilizations, PERT interventions, jail mental health service and/or long-term care hospitalization

  • Have major impairments in life functioning

  • Person is not connected to outpatient treatment

  • Person is experiencing an acute psychiatric episode that might require SBCM level services

  • Is at high risk of admission to an inpatient mental health facility

  • Has a substantial need for supportive services (including care coordination and outreach mental health services) to maintain current level of functioning in the community, as evidenced by missed appointments, medication non-adherence, or inability to coordinate services from multiple agencies

  • Does not have a case manager from another program who is able to address mental health needs

About Telecare

Telecare is a family- and employee-owned company that has been treating individuals with serious mental illness since 1965. We specialize in innovative, outcomes-driven services for high-risk individuals with complex needs. Our programs are recovery-focused and clinically effective and are designed in partnership with local, county, state and other behavioral health organizations.