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Community Resource GuideTABLE OF CONTENTSAdvanced Directive1HIV/AIDSBehavioral Health1-4Home Care-Adult Outpatient/InpatientElderly Outpatient/InpatientSubstance AbuseSuicidality ManagementSubstance Abuse ManagementSection 12Section 351-22-33-4additional notes 49additional notes 49additional notes 53additional notes 54-56Caregivers-Case ManagementSupport Groupsadditional notes 5-7Dementia5-6 additional notes 8Dental6Disability6-8Hearing LossVision Impairment9Elder Services9-10Protective Services9-13 additional notes 41-43Ethics Consultsadditional notes 60Food Resources11-12Health Insurance12-13-BG/AGH Financial ServicesShine Counselors15-16 additional notes 19-2114-15 additional notes 22-23additional notes 2316-1 additional notes 24-25Housing15Guide for Visiting ALFadditional notes 26-35additional notes 34Guide for visiting Nursing Homes additional notes 35Interpreter Services17Legaladditional notes 36LGBTQ Support18Medication Assistance18Money Management18-19additional notes 37-418 additional notes 57-598Domestic Violence-Private ServicesVisiting Nurses (VNA)Home Safety Evaluation15-16 additional notes 19-23Hospice/Palliative Care5 additional notes 1-45 additional notes1-4CARFIT--131312Respiratory Careadditional notes 44Support Groups19Transitional Services19Transportation20-21additional notes 14additional notes 46-49Utilities21-22Veterans Care22Additional Notes1-56
Community Resource GuideProvided by Northeast Physician Hospital Organization Care Management Team /Resource Guide Team:Cheryl Clocher Care Management Team Assistant, Melissa Griswold MPH, Sandra Pajarillaga LICSW,Deirdre Putnam LICSW, and Karen Richard RN,BSN CCM.The purpose of this guide is to provide the primary care physician and staff with a simple guide to address patient needs in thecommunity. We do not in anyway endorse any of the agencies or organizations listed. This guide is never intended to replace theprofessional assessment and services of a licensed social worker or nurse care manager. Any questions or concerns can be sent toKaren.Richard@Lahey.orgCompiled by NEPHO (June 2017)Page 1
ADVANCED DIRECTIVEA link to the MOLST form can be found in the backPO Box 444Lincoln, MA t-ma.org/Honoring Choices Massachusetts is a consumer focused nonprofitorganization which informs, and empowers adults to make a personalhealth care plan and connect to the best possible care that honorstheir values and choices, all through their lives.Every adult, 18 years and old, or their Health Care Agent and Guardian,has the right to be fully informed about their health care to makechoices for care that reflect each individual’s care goals, values, andpriorities. Honoring Choices provides no-cost Massachusetts-basedhealth care planning information; tools and discussion guides to helpconsumers and care providers have effective planning discussions atevery phase of health.It’s generally recommended that a basic plan include a Health CareProxy, and a Durable Power of Attorney for the best protection of yourrights and choices under Massachusetts law.BEHAVIORAL HEALTHBeverly800 Cummings Center, Suite 266 T Beverly, MA 01915978.921.1190 Admissions: x 7192Daily walk-in intakes availableAdult OutpatientGloucester298 Washington Street Gloucester, MA 01930978.283.0296 Admissions: x 221Call for an intakeSalem41 Mason Street, Suite 1 Salem, MA 01970978.745.2440 Admissions: x 2Call for an intakeCompiled by NEPHO (June 2017)Page 1
BEHAVIORAL HEALTH (continued)Beverly Hospital – Leland Unit Beverly, MA (Adult psychiatric care)Provides acute care to patients 18 to elderly.Provides inpatient ECT treatment, mental health stabilization andsubstance abuse detox978.922.3000 x 2800 Admissions: 781.599.9200Adult InpatientBeverly Hospital – Partial Hospitalization Beverly, MAAdults w/ mental health &/or substance use disordersIntakes are scheduled for 8am.Group Program starts at 9am & run until 3pm.Consists of psychoeducational & skill building groups, grouppsychotherapy.BEHAVBayridge Hospital Lynn, MA (62-bed psychiatric hospital)60 Granite St. Lynn, MA 01902781.477.6940Acute inpatientBayridge Hospital – Partial Hospitalization Program (PHP) Lynn, MA781.477.6940Adults w/ mental health &/or substance use disordersGroup Program starts at 8:30 am & runs until 2:30 pm.Consists of psychoeducational & skill building groups, grouppsychotherapyCenter For Healthy Aging866.479.3302Elderly OutpatientAll of the services under ‘Adult Outpatient’ are available, plus Center for HealthyAgingPsychological assessment and counseling are performed to identify anyunderlying issues. Through the Behavioral Health consultation, theCenter offers diagnostic testing, medication management, individualtherapy, family therapy, and referrals to home-based medical servicesand agencies.Compiled by NEPHO (June 2017)Page 2
BEHAVIORAL HEALTH (continued)Senior Adult Unit (SAU)Admissions: 781.477.6940298 Washington St., Gloucester, MA 01930In addition to caring for seniors in the traditional hospital setting,Addison Gilbert Hospital's Senior Adult Unit of Inpatient BehavioralHealth and a designated unit at Beverly Hospital specialize in treatingseniors with both emotional and medical illnesses simultaneously. Forindividuals who require palliative or hospice care, Hospice at AddisonGilbert Hospital provides all of the necessary resources and services ina home-like environment.Elderly InpatientNorth Essex ESP/CCS (Emergency Services & Crisis Stabilization)978.744.158524 hour mobile crisis team that offers emergency psychiatricassessments to determine what service could benefit the personserved, as well as intervention and stabilization servicesEmergency psychiatric assessment to determine what services couldbenefit patient.EMERGENCY SERVICES/CRISISServices offered to both children and adults. Also serves local hospitalemergency rooms.The DISCOVER Program provides an alternative to, or a step downfrom Addiction Treatment Program, Outpatient Counseling inpatientaddiction care. DISCOVER provides crisis stabilization and supporttoward community integration. The program is based on a recoverymodel, which assists participants in regaining an optimal level offunctioning in their community, family and vocational roles.Substance AbuseThe DISCOVER ProgramEmail: discover@nhs-healthlink.org.978 283-4001, ext. 422 or discover-programDaily services are provided Monday through Friday for individuals withaddictions or dual diagnosis and for their families.Compiled by NEPHO (June 2017)Page 3
BEHAVIORAL HEALTH (continued)Lahey Health Behavioral Services offers exceptional, community-basedmental health and substance abuse services of the North Shore andLower Merrimack Valley.Substance Abuse INPATIENTMedically supervised detoxification services, counseling and casemanagement therapy and aftercare planning.Danvers: 978.777.2121Boston: 617.247.1001 Substance Abuse OUTPATIENT Substance Abuse d-alcohol-treatmentTherapeutic Services: traditional and intensive outpatient therapy forindividuals, families and teens, 978.745.8890Adolescent Structured Outpatient Addictions Program (SOAP): astructured outpatient after-school program, 978.745.8890Intensive Outpatient Program (IOP) for Adults: outpatient option formen and women who want to aggressively address their drug oralcohol use, while maintaining their daily commitments, 978.745.8890Court Programs: for men and women mandated to treatment for DUIfirst and second offenses. Programs available for youth involved withSalem and Lynn juvenile courts for non-violent, drug-related crimes,978.745.8890Buprenorphine (Suboxone ) Outpatient Treatment: an approvedmedication for relatively stable patients dependent on prescription orillegal opioids, 978.777.2121Methadone Maintenance Treatment: highly regulated program foropioids users, 978.777.2121H.A.R.T. House: substance abuse program for women and theirchildren, 978.851.0969Ryan House: two working half-way house programs; one for men andone for women, 781.598.1270Transitional Support Services House: residential program for men andwomen who have gone through detoxification and are in transition tolong-term residential care, 781.598.1270CAB Transitions: stabilization and transitional program for homelessmen with a history of substance abuse problems, 978.851.8776Compiled by NEPHO (June 2017)Page 4
CAREGIVER SUPPORT & CASE MANAGEMENTList of specific caregiver support groups, including adult day health groups on the North Shore, are listed in the back Alzheimer’s Association1-800-272-3900www.Alz.orgThe Longevity Connection152 Sylvan StreetDanvers, MA 01923Information & education about Alzheimer’s disease andrelated memory disordersIncreased understanding through shared experiencesMutual support from other caregiversFacilitated by NSES. “One-stop resource for seniors, the disabled, andcaregivers.” The center provides Longevity Liaisons, ProfessionalAffiliates, a Store (has adaptive equipment, vision/hearingtechnologies, adaptive clothing, and more), a Library/Bookstore, and aComputer Lab.(978) 539-8245www.longevityconnect.orgOnline and onsite programs, publications, and products. Onlineblog/connection resource for caregivers.20 Haverhill Rd.Topsfield, MA 01983Phone: (978) 887-4202http://rest-stop-ranch.comDEMENTIAA list of social daycare, and adult day health programs can be found in the backThe Alzheimer’s Association’s website contains information s Association MA ChapterPhone: (800) ?id 178412 ORhttp://www.alz.org/Many topics including; Get day-to-day help to deal withBehaviors, Communication, Activities, Respite care andMemory loss; Get support from Your local chapter, Messageboards, Support groups, about your health and care training;How toPlan for the future – including Legal matters, Care options,Paying for care, Safety and Dementia & drivingCompiled by NEPHO (June 2017)Page 5
DEMENTIA (continued)A list of social daycare, and adult day health programs can be found in the back MedicAlert Alzheimer's Association Safe ReturnPhone: (888)-572-8566www.medicalert.org/safereturn A 24-hour nationwide emergency response service for individuals withAlzheimer's or a related dementia who wander or have a medicalemergency. They provide 24-hour assistance, no matter when orwhere the person is reported missing.DENTALTwo Willow StreetSouthborough, MA 01745(800) /senior-dentalcareWhere can I find low-cost dental care? re-can-ifind.dental-care/index.htmlUse the search tool on the website to find a plan and/or a dentist thatoffers affordable senior dental care options through the ACA,Medicare, or Medicaid.DISABILITYMassachusetts Department of Developmental ps://disabilityinfo.org/Compiled by NEPHO (June 2017)Page 6
DISABILITY (continued)The Northeast Arc helps people with disabilities become fullparticipants in the community; choosing for themselves how to live,learn, work, socialize and play. They serve approximately 8,000 peoplein nearly 190 cities and towns.https://ne-arc.org/Their specialized services include: www.allsupcares.comSocial Security Disability Insurance Claim RepresentationOverpayment ReimbursementMedicare CoordinationReverse OffsetAllsup Medicare Advisor The Independent Living Center of the NorthILCNSCA is a service and advocacy center run by and r peoplewith disabilities. ILCNSCA supports the struggle of people whohave all types of disabilities to live independently andIndependent Living Center of The North Shoreand Cape Ann Inc.participate fully in community life .http://ilcnsca.org/Phone: V/TTY 978-741-0077Financial assistance for older adults and adults living with disabilitieswho are ineligible for state home s/mrc/1-800-245-6543 (Voice/TDD) or (617) 204-3600MRC is responsible for Vocational Rehabilitation Services, CommunityLiving Services, and eligibility determination for the Social SecurityDisability Insurance (SSDI) and the Supplemental Security Income (SSI)federal benefits programs.Compiled by NEPHO (June 2017)Page 7
DISABILITY (HEARING)Deaf, DeafBlind, Hard of Hearing, and Late-Deafened peoplecan find a range of essential programs and services in a Deafaffirmative, supportive community environment. All ourservices are linguistically and culturally accessible for Deaf,Hard of Hearing, DeafBlind, and Late-Deafened people whouse many different communication modes and havedifferent ethnic and cultural backgrounds.35 Congress St., Suite 204(978) 910-0165 VP/V(978) 740-0394 TTY(978) 740-0329 VDISABILITY (VISION)Lahey Medical Center, Peabody, provides comprehensive eye care andcomplete ophthalmic medical and surgical treatment – all in acomfortable community setting.978.538.4400Also check:http://lowvision.preventblindness.org/600 Washington StreetBoston, MA 02111617-727-5550800-392-6450 (MASS. ONLY) Voice800-392-6556 (MASS. ONLY) TDDThe Massachusetts Commission for the Blind is a state agency,established in 1906, to provide a wide range of social andrehabilitation services to Massachusetts residents of all ages who arelegally blind. Agency services may address a number of varied needs ofindividual blind persons Massachusetts law (C.6, s.136) requires thatall eye care providers who find a person to be legally blind report thisperson to the Massachusetts Commission for the Blind within 30 daysof the date of examination.Compiled by NEPHO (June 2017)Page 8
DOMESTIC VIOLENCEHAWC offers a wide variety of comprehensive services to thecommunity. Whether a client is interested in leaving an unhealthyrelationship, or is simply seeking more information about domesticviolence and what it means, our programs are designed to meet theindividual needs of each person who is looking for help. Service area:all of North Shore including Cape Ann.27 Congress StreetSalem, MA 01970(978) 744-8552www.hawcdv.org24-hour hotline number is 1-800-547-1649.ELDER SERVICESList of homecare services for each organization can be found in the back;List of reportable conditions and mandated reporters are in the back49 Blackburn CenterGloucester, MA(978) rCare Inc. provides and coordinates services to elders and others,enabling them to live independently at home or in a setting of theirchoice while remaining part of their community. To qualify forhomecare, you must be 60 years of age or older; a resident ofMassachusetts, not live in a rest home, nursing facility, convalescenthome, hospital, or assisted living residence, meet financial eligibilityguidelines, and have been assessed by a care manager or nurse andfound to be in need of services.PROTECTIVE SERVICESTo report elder abuse call:SeniorCare serves nine communities on Boston’s North Shore,including: Beverly, Essex, Gloucester, Hamilton, Ipswich,Manchester by-the-Sea, Rockport, Topsfield, and Wenham.1 -800-922 227524 hours a day7 days a weekCompiled by NEPHO (June 2017)Page 9
ELDER SERVICES (continued)List of homecare services for each organization can be found in the back;List of reportable conditions and mandated reporters are in the back300 Rosewood Drive, Suite 200Danvers, MA 01923(978) 750-4540http://nselder.org/NSES offers a variety of successful elder care programs (ie: Home Care,Nutrition) to ensure older adults can live life to the fullest. Most of theservices are free, while others are low cost, and all are proven todeliver results. As part of an interdisciplinary team, a care managerassesses an individual’s needs, then develops and monitors the plan ofelder care. Several programs offer an increased level of services forfrail elders at home.PROTECTIVE SERVICESTo report elder abuse:1 -800-922 2275Danvers, Salem, Peabody, Middleton & Marblehead area24 hours a day7 days a weekGreater Lynn Senior Services provides a wide range of social services—information, transportation, meals, advocacy, homecare, housing, andmore—for one reason: to help those 60 and older live fuller, moreindependent lives, safely and with dignity.LYNN LYNNFIELD NAHANT SAUGUS SWAMPSCOTT8 Silsbee Street, Lynn, MA 01901 (781) 599-0110http://www.glss.netTo report elder abuse:1 -800-922 2275 24 hours a day/7 days a weekSupporting the wellbeing, dignity and independence of elders, adultsliving with disabilities, and caregivers residing in Chelsea, Everett,300 Commercial Street #19Malden, MA 02148(781) 324-7705http://www.mves.orgMalden, Medford, Melrose, North Reading, Reading,Revere, Stoneham, Wakefield and Winthrop.To report elder abuse:1 -800-922 2275 24 hours a day/7 days a weekCompiled by NEPHO (June 2017)Page 10
FOOD RESOURCESThe Acord Food Pantry provides food assistance to the residents ofEssex, Hamilton, Ipswich, Manchester, Topsfield and Wenham.69 Willow StreetSouth Hamilton, MA(978) 468-7424www.acordfoodpantry.orgBeverly Bootstraps provides critical resources to families andindividuals so they may achieve self-sufficiency. We offer emergencyand long-term assistance including: access to food, housing stability,adult and youth education, counseling and : Food pantry visitors must be residents of either Beverly orManchesterThe Open Door Food Pantry provides a free, three to five day supply ofemergency groceries once every seven days for income-qualifiedresidents of our service area. Their service area includes Gloucester,Rockport, Ipswich, Manchester and Essex.www.foodpantry.orgThe Salem Pantry provides Salem residents with nutritious food andgroceries in an atmosphere of dignity and respect. The Salem Pantryoffers residents emergency food at the end of each month when billsare due, but before salary and support checks arrive to ensure thatlocal residents have health perishable food and groceries during timesof need.(978) 744-3224www.thesalempantry.orgCompiled by NEPHO (June 2017)Page 11
FOOD RESOURCES (continued)Supplemental Nutrition Assistance Program (SNAP) is the new namefor the Food Stamp Program. SNAP helps people and families with lowincomes buy the food the need for good health.866-950-3663www.mass.gov/snapWomen, Infants, and Children (WIC) is a program that providesnutrition, health education, health food, and other services free ofcharge to qualifying Massachusetts residents.Women, Infants, and Children (WIC) Nutrition Program1-800-942-1007www.mass.gov/wicHEALTH INSURANCESHINE (Serving the Health Insurance Needs of tml1-800-841-2900 / ments/masshealth/The SHINE Program (Serving the Health Insurance Needs of Everyone)is a state health insurance assistance program that provides toMassachusetts residents of any age who have Medicare free healthinsurance information, counseling and assistance to Massachusettsresidents with Medicare and their caregivers. The SHINE Program isadministered by the Massachusetts Executive Office of Elder Affairs inpartnership with elder service agencies, social service and communitybased agencies and Councils on Aging.In Massachusetts, Medicaid and the Children’s Health InsuranceProgram (CHIP) are combined into one program called MassHealth.MassHealth members may be able to get doctors visits, prescriptiondrugs, hospital stays, and many other important services.Compiled by NEPHO (June 2017)Page 12
HEALTH INSURANCE (continued)Medicare is the federal health
Danvers: 978.777.2121 Boston: 617.247.1001 Lahey Health Behavioral Services offers exceptional, community-based mental health and substance abuse services of the North Shore and Lower Merrimack Valley. Medically supervised detoxification services, counseling and case management the
