Recommended referrals post diagnosis
Effective interventions that seek to reduce decline and improve quality of life should be made available at all stages of the patients journey with the aim to manage physiological needs, simplify daily routines and address any communication, environmental and carer issues.
Information about the community services available and how to access them needs to be offered as soon as possible after diagnosis. This information and advice could be provided by a Practice Nurse.
All Allied Health and Community Service Provider referrals, including to Dementia Australia, for frail older people over 65 years is through My Aged Care. If patients do not meet the eligibility criteria a direct referral to Allied Health and Community Service Providers is required.
Hospital Admission Risk Program (HARP)
The Hospital Admission Risk Program (HARP) prevents re-admissions to emergency departments and acute hospital settings by using a number of time-limited, evidence-based approaches delivered in the community / ambulatory setting.
Referrals are predominately via Emergency Department or Inpatient Units; however, consideration will also be given to clients referred by GPs and any community programs who may identify the client at being at risk of presenting to the Emergency Department.
The care coordinator role in HARP provides opportunity to explore the comprehensive support needs of clients and carers, and develops an interagency care plan to address these needs through sustainable primary care services.
Triggers for referral
The complexity of needs exceeds the capacity of usual care, resulting in frequent presentation to hospital or imminent risk of presentation.[1]
Contact details
Ballarat Health Services
Service Contact
Tel: (03) 5320 3893
Tel: (03) 5320 6690
Lake Bolac Bush Nursing Centre
Service Contact
Tel: (03) 53558700
Wimmera Health Care Group Horsham
Service Contact
Tel: (03) 5381 9022
1. Department of Health - A guide to services for people with dementia and their carers 2012, pg. 41