Support Services

The Alzheimer Society of PEI (ASPEI) is a non-profit organization committed to improving the lives of Islanders affected by Alzheimer’s disease and other dementias. Our mission is to alleviate the personal and social consequences of Alzheimer’s disease and other dementias and to promote research for a cause and a cure.

The Society offers programs and services to support persons living with dementia, caregivers, and other family members and friends so they have the help they need today and have hope for the future. We work in collaboration with other health and community support providers to ensure quality across the system of care for all affected.

**JOB SUMMARY**

The Support Services & Clinical Coordinator will strive to ensure that persons diagnosed with dementia, their caregivers, family members, and friends have timely access to information, supportive counselling, learning opportunities and special programs throughout the continuum of the disease.

In this direct client service role, they may assist in cognitive screening and assessment and caregiver assessment. They will be a central contact person for families after a diagnosis of dementia, with responsibility for assisting in the identification of needs, supporting client goals, and strengthening the communication and care planning linkages between providers and across sectors along the continuum of care.

Working as part of a team across PEI, The Support Services & Clinical Coordinator, through the delivery of the First Link program works to achieve the following outcomes:

- Assist in the earlier assessment and diagnosis of dementia
- Provide persons and families impacted by a diagnosis of dementia with support and system navigation assistance throughout the continuum of illness
- Improve quality of life, client experience, and health for the person living with dementia and their caregivers
- Help to build caregiver capacity and competency to effectively manage their role and reduce the incidence of crisis situations
- Raise awareness with health care provider partners and in the broader community about dementia related initiatives and best-practices.

**KEY RESPONSIBILITIES**

**General**
- Advance the vision, mission, and values of ASPEI
- Participate in Strategic and Operational Planning
- Assist in Society fundraising, and other events as needed
- Represent ASPEI on local and national committees and working groups
- Acts as spokesperson for media and other public engagement opportunities
- Project management and implementation of special projects, services, and pilots

**Programs and Services**

The Support Services & Clinical Coordinator implements ASPEI’s First Link program and other services to support persons and families living with dementia. They also participate in a clinical capacity within primary care memory clinics providing cognitive screening and assessment, caregiver assessment, and care planning in collaboration with a multi-disciplinary team.

**Intake, Assessment and Care Planning**:

- Act as a member of an interprofessional multi-disciplinary team working together to collaboratively diagnose and care for those living with dementia
- Conduct cognitive assessments for screening and to support diagnosis process
- Conduct caregiver assessments to determine well-being and identify needs
- Receive incoming referrals to ASPEI’s First Link program, gather information for client intake, and review or conduct assessments
- Facilitate early intervention (pre and post-diagnosis) and ensure that clients have a point of contact for support throughout their disease journey
- Work with clients to determine current and future needs, goals, level of risk, and establish appropriate intervention plans
- Assist in the coordination of care across service providers, and maintain strong partnerships within health and community care
- Maintain confidential and accurate client records in compliance with relevant privacy legislation and internal policies
- Ensure that client consents, privacy, and confidentiality are maintained in compliance with legislation, professional standards/regulations, and policies

**Navigation and Care Coordination**:

- Support clients in navigating the system of care to access appropriate services and supports based on their individualized care plans
- Proactively facilitate and advocate for referrals, connections, information exchange and coordination between clients and other service providers
- Facilitate care conferences between clients/caregivers and other members of the care team
- Collaborate with partners in health and community services to address/overcome barriers in effective coordination of supports and services
- Leverage and maintain working relationships with physicians, allied health and community service providers, and other partners through outreach activities

**Pro-active Follow-Up**:

- Provide proactive follow-up for clients and caregivers to ensure ongoing support, coordination of care, and respo