Navigating the highly complex and deeply fragmented systems of medical and long-term care is one of the biggest challenges family caregivers face. How do I find a reliable home care aide? Where is a good adult day center? How can I coordinate dad’s medical treatment with his personal care?
Now, new care navigation services are filling the gaps, many offered by commercial businesses and health systems rather than government.
Hospitals, insurance companies, employee benefit firms, and small start-ups all have recognized the desperate need for ongoing care navigation. Some are guiding families to vetted networks of providers.
Limited Options
Until now, access to navigation services has been limited.
Aging life care managers, also known as geriatric care managers, are an important resource. But they are costly and Medicare or Medicaid will not pay for them. Medicaid case managers are overworked and have little information about supports and services outside their program.
Area Agencies on Aging provide free information assistance as well as other services. But the nation’s 600 AAAs vary widely in quality and in the services they offer, and generally don’t provide ongoing care management.
Some non-profit community-based organizations can provide excellent information and referral services, and some offer ongoing navigation. But they are available only in some communities.
And there is the Internet, littered with websites that recommend aging services providers. But beware: Many are paid for referrals by the firms they suggest or will sell your contact information to providers to use for leads.
Now, the care navigation landscape is beginning to change in important ways. Here are just a few examples:
CareScout
One of the most ambitious is CareScout, a subsidiary of the long-term insurance carrier Genworth.
It provides a range of supports, including physical and cognitive assessments, ongoing assistance, recommendations for medical equipment, care services, medication management, and the like. Its basic fee is $249 but in 2026 it will price a range of options from $99 to $499.
CareScout refers customers to a curated network of home health agencies in hundreds of markets that a spokesman says covers 95 percent of the population. Network providers offer discounts.
While its product has focused on home-based care, CareScout recently acquired Seniorly, an online service that refers consumers to senior living facilities. Under its current business model, Seniorly receives referral fees from their operators.
While CareScout is a Genworth subsidiary, its navigation services are available directly to all consumers, and it also plans to partner with other long-term care insurers. Interestingly, CareScout has won approval in more than 30 states to sell its own long-term care insurance.
This model is a potential win/win for insurers and consumers. It can improve the well-being of older adults while potentially lowering claim costs for carriers by helping customers maintain their physical and cognitive function for longer.
Wellthy
Another commercial venture, Wellthy, is an employee benefits firm that has been expanding the model of old-school employee assistance programs for about a decade.
In the past, these EAPs mostly offered generic advice. But Wellthy gives employees of participating firms specific information about where they can find everything from home care to legal advice and even pet care in their communities. It also assists with the paperwork families need to access assistance. While aging services are a big part of its portfolio, Wellthy assists employees in all stages of life, such as parents of newborns.
Wellthy started as a consumer product, and still has a small retail business, but it quickly transitioned to an employer-based model. Firm officials say they currently serve more than 175 employers, ranging from mega-businesses to health systems and universities. While it does work with smaller firms, Wellthy says its average employer client has about 12,000 workers.
While Wellthy does not have a formal network of providers such as CareScout, its care navigators do rely on local knowledge and less formal relationships. Wellthy does not take referral fees, says a spokesman.
It too is a potential win/win: It may help employees by providing critical support and benefit employers by enhancing worker productivity and boosting employee retention.
In what may become a major step forward, the firm also is looking to provide care navigation for Medicare Advantage plans. While these managed care companies coordinate care by their network physicians, they fall far short in organizing social supports for their members.
Caring for Caregivers
A different navigation model is Caring for Caregivers (C4C), an initiative of the Center for Excellence in Aging at Rush University Medical Center in Chicago.
It provides a wide range of supports for older adults and their family members. Social workers help build and implement a care plan. Other staffers teach hands-on skills such as transferring patients from beds to chairs, managing medications, or enhancing diet or exercise. Family caregivers receive emotional support. And participants have access to home care and other services.
C4C originally was created for patients being discharged from Rush. However, it now includes patients at 40 CVS minute clinics in Chicago, as well as patients at eight health systems including Maimonides Hospital in New York, the University of Nebraska Medical Center, and hospitals in Buffalo, N.Y.
The program is succeeding, in part, thanks to Medicare’s 2024 decision to allow providers to bill for caregiver training. C4C also participates in the federal government’s GUIDE program for people with dementia. More on that in a minute.
This model too can be a win/win, improving the well-being of patients and their families while reducing hospital readmissions and lengths of stay for which hospitals can be penalized by Medicare.
I have written previously about GUIDE, the federal demonstration program that pays Medicare providers such as doctors, health systems, and home care agencies, extra money to provide care navigation and family support for people with dementia. Several commercial start-ups, such as Seattle-based Rippl Care, contract with Medicare providers to manage those navigation services.
Filling A Need
These models, and others like them, are very different. And it remains to be seen how they will work out. But the market is beginning to recognize a major need and taking steps to fill it.
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