More About Your Care Team

Primary Care Provider (Physician)
Your primary care physician leads your care team and serves as your main point of contact for managing your overall health. They coordinate your care across specialties, make complex medical decisions, and are responsible for diagnosing and treating a wide range of health conditions.

Advanced Practice Provider (APP)
An advanced practice provider is a nurse practitioner or physician assistant licensed in the state of Texas. Working closely with your physician, your APP provides preventive care, manages chronic conditions, and treats acute health issues to help keep you well.

Licensed Vocational Nurse (LVN)
The licensed vocational nurse plays a key role in supporting your health between and during visits. LVNs assist with medication management, medical questions, and help explain test results so you can better understand your care.

Medical Assistant (MA)
Medical assistants help ensure you’re prepared for your visit and that you receive recommended screenings and preventive services. MAs can administer vaccines, and you may hear from them between visits for follow-up.

Clinical Social Worker
Your clinical social worker helps identify and address barriers that may affect your health—whether emotional, social, or practical. They can provide counseling or connect you with community resources to support behavioral health and social needs.

Resident
Residents are licensed physicians who are completing specialized training in their chosen field of medicine. Under the supervision of your primary care doctor and attending physicians, residents provide hands-on care and play an active role in your diagnosis and treatment.

Fellow
Fellows are physicians who have completed residency and are undergoing advanced training in a medical specialty. Fellows work closely with your care team to provide expert-level care while gaining additional experience in complex or focused areas of medicine.

Student
You may encounter medical, physician assistant, pharmacy, or other health professional students during your visit. These students are part of our academic mission and work under the close supervision of licensed providers. Their involvement enhances your care by bringing fresh perspectives and contributing to a collaborative team environment.

GUIDE Model eligibility gives patients and their caregivers access to the Clinical Practice Group’s memory care team including experienced physicians, neuropsychologists, neurologists, social workers, ambulatory pharmacists, health coaches and more. In addition to your care team, caregivers can expect:

• 24/7 access to a support hotline
• Caregiver training, education, and support services
• Respite care coordination (up to $2563 a year awarded for these services)
• Connections to community-based providers
• Home visit assessment (if applicable)

The Center for Older Adults also hosts the Dementia CARES class for any caregivers who wish to participate, including those who do not qualify for the GUIDE program. Click here to find out more.

The focus of GUIDE is to improve the quality of life for both patients and their caregivers. With GUIDE, patients can delay nursing home care as long as appropriate by enabling people living with dementia to stay safely in their homes for as long as possible. People with dementia often have multiple chronic conditions and receive fragmented care, leading to high rates of hospitalization and emergency department visits. They also may have behavioral health symptoms and often need 24/7 care.

Patients can expect:

• Comprehensive health assessments
• Individualized care plans
• 24/7 access to support
• Ongoing monitoring of conditions
• Referral coordination
• Caregiver support, training, and resources
• Medication management assistance
• Care coordination with our interprofessional Center for Older Adults team and community partners

No, we can collaborate with your existing primary care provider to deliver the CMS GUIDE model services for patients and caregivers.

You qualify for GUIDE if you have traditional Medicare and a dementia diagnosis. If you are unsure if you have dementia or have not yet been diagnosed, please call 817-735-5900 to schedule a free consultation.

No, GUIDE is completely covered by traditional Medicare insurance.

Yes! You are eligible for participation if you are a Center for Older Adults patient with traditional Medicare. Call 817-735-5900 to schedule an appointment with your provider to discuss GUIDE eligibility.