Caregiver with patient

Care Navigation in St. James

Care Navigation. Nurse-led. Doctor-supported.

Nurse-led coordination across physicians, specialists, WRHA Home Care, insurance, and community resources — so families stop playing case manager for a system that does not talk to itself.

Care planning in St. James: A St. James care plan may connect follow-up at Grace Hospital or Deer Lodge Centre with foot care, physiotherapy, personal care, medication reminders, transportation, and practical support between appointments.

How this service connects to local care

A plan for the person, the home, and the schedule

How the service fits

Care navigation can organize referrals, discharge planning, equipment, public Home Care applications, Self and Family Managed Care, insurance, and the handoff between family and paid care.

Hospital and appointment handoff

If care follows a stay or appointment at Grace Hospital, share the discharge date, written instructions, medication changes, mobility limits, equipment needs, and follow-up schedule. Prime provides discharge planning, hospital-to-home transportation, appointment escorts, nursing, and post-surgery support.

Home and scheduling details

The nurse assessment should review entrances, stairs or elevators, bathroom access, safe transfers, medication storage, caregiver access, parking, and whether overnight support is required. Confirm preferred visit times, appointment dates, family handoffs, language preferences, and whether overnight care means an awake shift or a live-in arrangement.

What's Included

Physician & specialist coordination
WRHA Home Care liaison
Insurance navigation & direct billing
Hospital discharge planning
Community resource referrals
Funding & benefit application support
Family care meetings
Care plan development & updates

What Your Family Gains

Family burden lifted

Adult children stop being the full-time case manager for a parent.

Funding maximised

We know the programs and paperwork most families never find.

Gaps closed

The cracks between hospital, family doc, specialist, and Home Care get bridged.

Nurse-led

Care navigation with clinical expertise — not a call centre script.

Geographic and facility context for St. James, Winnipeg

Nearest hospital

Grace Hospital (~8 min)

Care facilities nearby

Golden Door Geriatric Centre · Lions Place (nearby) · Deer Lodge Centre

Area character

Established postwar district in west Winnipeg next to the airport and Polo Park, known for Portage Avenue's commercial strip and modest bungalow streets.

Community context

Aging postwar homeowner base with a notable veteran population served historically by Deer Lodge Centre; many long-term residents 70+.

Common Questions