The Care Coordination Program, offered in partnership with the Memory and Aging Care Clinic at the UVA Health System, provides care partners with the additional support of a dedicated Clinical Care Coordinator (CCC). The goal of the program is to provide exceptional person-centered care to both persons living with dementia and their care partners.

This program aims to provide a more effective coordination of services that will help care partners improve their quality of life, decrease symptoms of depression, and reduce care partner burden. Our goal is to offer increased support, reduce stress, and help care partners identify areas where they need assistance through care coordination. The dedicated CCC will work with the care partner to develop goals and plans, aimed at providing the best support possible, specific to the partners' needs. 


Examples of services include: 

  • Providing education about dementia and what to expect after receiving a diagnosis
  • Understanding behavioral changes that can occur with dementia and strategies for managing them
  • Assistance with scheduling neurology appointments and accessing MyChart
  • Sharing information and strategies to promote Aging in Place
  • Helping to navigate difficult conversations (i.e., driving, bringing additional care into the home, etc.)
  • Connecting patients and care partners to relevant community resources
  • Accessing clinical trials
  • Providing support and information around accessing programs such as Veteran's Benefits, Medicaid, etc.
  • Researching and connecting with additional supportive programs such as counseling or support groups
  • Creating plans for future care needs or long term care
How to Access Dementia Care Coordination Services

Please speak to your UVA Neurologist to learn more about the Dementia Care Coordination program and to find out if it might be right for you and your family.

About Us

UVA Care Coordinators Group Photo

Liz Boyd is a Dementia Clinical Care Coordinator. She received her master's degree in Clinical Psychology from Western Carolina University in North Carolina and completed her undergraduate degrees at Albion College in Michigan. Elizabeth's interests include helping people living with dementia and their care partners with future planning, minimizing care partner burnout, and improving overall quality of life. Elizabeth is proud to be one of three dementia CCCs in a program recognized at the state and national level for their contributions to aging best practices and innovations.


Samantha Fields is a Dementia Clinical Care Coordinator. She received her bachelor's degree in Social Work from Virginia Commonwealth University and has been working in the field of human services ever since. Samantha's professional interests include learning more about public health and advocating for the care and wellbeing of older adults and their families - especially those that are living alone and are otherwise on their own navigating the healthcare system. 


Jessica Samet is a Dementia Clinical Care Coordinator. She received her master's degree in Social Work and an additional certificate in Aging Studies from Virginia Commonwealth University. She has spent the majority of her career working with caregivers and those living with dementia by providing needed resources, education, and support. Jessica is especially interested in how dementia impacts the lives of all family members, especially when the diagnosis is a younger onset illness. When not working, Jess enjoys traveling, spending time with her family and pets, and digging in her garden.


Yenifer Valera is a bilingual Dementia Care Coordinator. She received her bachelor's degree in Social Work from James Madison University. She previously worked for UVA in the Social Work Department. Yenifer is passionate about helping families, meeting them where they are, and advocating for them. Yenifer is particularly excited to share her interest in learning about the lesser known dementia illnesses with her patients and colleagues. When Yenifer is not working, you can find her hiking and enjoying the outdoors.


Read more about the work that we do in this Daily Progress Senior Navigator article (pages 30-32).


Testimonials about the Dementia CCC Program at UVA

"Thank you, I really appreciate all you have done for us over the past year. I don't often let others into what is really going on, so it was really nice to know I had someone I could count on."


"Well I can't say enough how helpful you have been."


"I just completed the one-year care coordination program in partnership with the Memory and Aging Care Clinica at UVA. I want to strongly recommend the continuation of robust funding for this invaluable program, which I believe should be widely available to caregivers of those with Alzheimer's and other forms of dementia. Here are a few examples of how the care coordination program helped me:

- Individualized attention - Dementia Care Managers (DCMs) are able to provide personalized, sustained contact with caregivers, which allows for tailored sessions and suggestions that help support both caregivers and families in ways doctors and other care providers may be not able to due to time constraints. 

- Beyond a support group - Maintaining regular communication with a DCM had a direct impact on quality of life; I knew there was a supportive individual with knowledge of my specific challenges whom I could contact when needed. 

- Educational resources - DCMs are in a unique position to offer guidance on a broad range of topics and situations but make them relevant for the exact circumstances of caregivers. For example, I worked with my DCM on issues such as communication with family members, navigating in-home care, and managing expectations for current and future care. 

- Reducing caregiver burden - Throughout the care coordination program, I felt like I was able to focus on providing the best care possible for both of my parents as they experience the myriad changes that accompany my mom's dementia.

Furthermore, the telehealth model is ideal for this program and should always be an option. It allows for care and support despite an already busy schedule of work, family, and caregiving responsibilities. Thank you for the opportunity to participate. A final shout-out for DCM Liz Boyd, whose stellar listening skills, patience, and caring attitude were a welcome addition to a stressful situation."


"Thanks so much for providing this valuable service! I really appreciate all the assistance and support that was provided."


"As I think about all of the special people who cared for that sweet man and supported me as a caregiver, you always come to mind. I so appreciate your kindness, guidance, and moral support."



Program Awards

2018 Best Practices Award  - Commonwealth Council on Aging

2018 Aging Innovations Award - National Association of Area Agencies on Aging