Geriatric Care Coordination

Geriatric Care Coordination

Geriatric Care Coordination (GCC) supports the independence and health of older adults. Services such as in-home assessments, phone consultations, and family meetings are provided to patients, families, and caregivers.

GCC also helps John Muir Health doctors and staff address their patients' aging and health concerns. GCC develops a care plan in keeping with the patient's individual needs and coordinates services with the primary care physician or referring department. The program also provides information and referrals to John Muir Health and community programs. Learn more about John Muir Health Senior Services

Participant Story

Ms. C. is a 47-year-old woman with advanced multiple sclerosis who receives $981 per month from Social Security Disability. She was at risk of institutionalization and was dependent on a nonfunctioning power wheelchair that did not meet her current physical limitations. GCC, in collaboration with case managers, arranged a complete repair of her wheelchair, provided referrals to several community services, and reduced the barriers to medical compliance. She is able to continue to live independently with assistance in her apartment.


  • In 2011, 1337 referrals were made to GCC.
  • 70 percent of patients receiving in-home assessments had incomes less than 350 percent of the Federal Poverty Guidelines.
  • 79 percent of patients reported being able to more effectively manage their activities of daily living.
  • As a result of the services provided by the GCC, 24 hospitalizations, 6 readmissions and 30 ED visits were avoided.