FAQ

What is MyCareSteps?

MyCareSteps is a care coordination program designed to help people in Grey Bruce navigate health and social services more easily. The program connects participants with a dedicated nurse care coordinator who helps them organize their care, understand available services, and move through the healthcare system with greater confidence and support.

Who is the MyCareSteps program for?

MyCareSteps is designed for people in the Grey Bruce region who may need extra support navigating care. This may include individuals who:

Do not currently have a primary care provider
Have complex or ongoing health needs
Are transitioning between care settings (such as hospital to home)
Need help coordinating multiple services or appointments

The program focuses on people who would benefit from guidance and support in managing their care.

How does MyCareSteps work?

Participants are connected with a nurse care coordinator who works with them to understand their needs and goals. Together, they create a plan to help the participant access the right services at the right time.

The nurse care coordinator may help with:

Connecting to healthcare providers
Preparing for appointments and services
Navigating community and social supports
Supporting care transitions
Answering questions and providing available resources
Providing educational information about your health and care

How can someone join the program?

There are several ways someone may be referred to MyCareSteps:

A primary care provider may refer a patient
A hospital or healthcare team may make a referral
Individuals may be able to express interest directly

Interested participants can visit www.mycaresteps.ca/greybruce, call 1-833-640-2215, email info@mycaresteps.ca, or ask your doctor for more information.

Is there a cost to participate?

No, there is not cost to participate.

The program is being evaluated by the Brightshores Research Institute, with support from Health Excellence Canada (HEC), to better understand how care coordination can improvepatient experience, care coordination, and provider workflows. Insights from this work will help inform future approaches to care coordination in Grey Bruce and beyond.

What types of health needs or conditions might benefit from a care coordinator?

Care coordination can benefit everyone at different points in life.

Some people join MyCareSteps because they are managing ongoing or complex health needs and want help coordinating care across multiple providers. Others may simply need guidance finding and accessing the right health or community services.

Examples may include people who:

Do not currently have a family doctor or nurse practitioner and need help finding healthcare services
Are living with chronic or multiple health conditions, such as diabetes, heart disease, or COPD
Have mental health or substance use concerns alongside other health needs
Are recovering after a hospital stay and need help coordinating follow-up care
Need support accessing community, social, or home care services
Are navigating everyday situations such as balancing health and work, welcoming a new baby, or aging well while living independently

MyCareSteps supports people whose care involves multiple services or providers, as well as those who simply want help navigating available services and understanding what supports are available in their community.

Is MyCareSteps a replacement for a family doctor?

No. MyCareSteps does not replace a family doctor or primary care provider.

Instead, the program helps participants navigate the healthcare system and connect with appropriate services while supporting coordination between different providers involved in their care.

Can family members or caregivers access support through MyCareSteps?

Yes. Family members and caregivers can play an important role in helping someone manage their health and navigate services.

With the participant’s permission, caregivers or family members can be involved in conversations with the nurse care coordinator and may receive guidance on available health and community supports. This can be especially helpful when someone is assisting a loved one with appointments, services, or care decisions.

MyCareSteps recognizes the important role caregivers play and aims to support both individuals and the people helping care for them.

Is my personal health information protected?

Yes. Protecting participant privacy is a priority.

MyCareSteps follows all applicable health privacy regulations. Personal health information is handled securely and only shared with appropriate providers when necessary to support care coordination.

Who is involved in delivering the MyCareSteps program?

MyCareSteps is delivered through a collaboration between:

Serefin Health – care coordination service provider
Grey Bruce Ontario Health Team – stakeholder engagement; referrals
Brightshores Health System – referrals; evaluation by the Office of Research and Innovation

Together, these organizations are working to improve how people in Grey Bruce access and navigate health care and community services.

This project is a partnership between Serefin Health (service provider), Grey Bruce Ontario Health Team (stakeholder engagement and referrals) and Brightshores Health System (referrals; evaluation by the Office of Research and Innovation).

Frequently Asked Questions