Sutherland Transitional Aged Care Service (STACS)
The Sutherland Transitional Aged Care Service (STACS) provides short-term, goal-directed interventions (up to 12 weeks) for older persons who have the capacity to benefit from a package of services that include low intensity therapy, social work, nursing support, and personal care.
The service aims to assist older persons to complete their recovery, optimise their functional capacity and, if required, assistance making long-term care arrangements.
Hours/Days of Operation:
8.00am - 4:30pm
Monday to Friday
(NB: Limited service on weekends)
-34.038246574702, 151.11341342925
Hospital in-patients who are medically stable and ready to be discharged and who wish to actively participate in an in-home, goal orientated rehabilitation program.
- A My Aged Care Comprehensive Assessment and STACS assessment in the hospital inpatient setting to determine suitability.
- Over 65 years of age (younger patients with age related conditions considered).
- Must be a resident of the Sutherland Shire.
Hospital in-patients over 65 years of age (or over 50 for Aboriginal/Torres Strait Islanders) who are medically stable and ready to be discharged, and who have capacity and desire to actively participate in an in-home, goal orientated program.
Request an In-Patient Comprehensive Assessment seeking approval for TACP via ‘My Aged Care’ - www.myagedcare.gov.au - or by phoning 1800 200 422.
Discharge Planner/Referrer to discuss suitability with STACS NUM on 9540 7201 or 0429 231 087 prior to placing the referral through My Aged Care.
Not applicable
Not applicable
17.5% of the single aged care pension (NB: No one refused if unable to pay)
Please let us know if you need an interpreter. You can contact us by telephoning the Translating and Interpreting Service (TIS) on 131 450. Tell the operator what language you speak, and then ask the interpreter to set up a telephone conversation between you, an interpreter, and us on 9540 7201.
Sutherland Heart And Lung Team (SHALT)
The Sutherland Heart And Lung Team (SHALT) is a community based multidisciplinary team that provides home monitoring, specialised education and outpatient gym or home-based exercise programs to people with chronic heart failure, chronic cardiac disease and pulmonary hypertension, who live in the Sutherland Shire. A multidisciplinary client assessment and goal development plan is attended to on referral.
Hours/Days of Operation
8.00am - 4:30pm Monday to Friday
-34.038246574702, 151.11341342925
People with chronic heart failure, chronic cardiac disease and pulmonary hypertension, who live in the Sutherland Shire.
The client has chronic heart failure, chronic cardiac disease or pulmonary hypertension, and requires one of the following services:
- The client requires monitoring and education to enable self-management of their chronic heart failure, chronic cardiac disease or pulmonary hypertension.
- The client would benefit from undertaking a supervised rehabilitation exercise program in an outpatient gym setting or home-based setting, to improve their exercise capacity and quality of life.
Exclusion Criteria:
- People who reside in aged care facilities.
- People who reside outside the Sutherland Shire. (Exemption for clients willing to participate in the hospital outpatient gym program).
- Gym: people who require constant 1:1 supervision e.g. high falls risk, blindness, unable to follow instructions.
Mark attention SHALT.
Referrals accepted from any healthcare provider.
- Electronic Medical Record (eMR) referral (TSH) to Southcare Community or
- Fax an Access and Referral Form to (02) 9540 7869 or
- Scan and email an Access and Referral Form to SESLHD-SouthCareIntake@health.nsw.gov.au
A prioritisation tool is utilised to triage referrals.
URGENT referrals are seen within 48 to 72 hours.
NON-URGENT referrals are seen within 1 to 2 weeks.
No cost for any sessions.
There is limited bus transport to pick up and drop off patients in the Sutherland Shire for the outpatient gym program. A cost of $5 per session is payable to the Southcare bus driver.
Donations towards gym equipment maintenance are welcome.
Please let us know if you need an interpreter. You can contact us by telephoning the Translating and Interpreting Service (TIS) on 131 450. Tell the operator what language you speak, and then ask the interpreter to set up a telephone conversation between you, an interpreter, and us on 9540 7540.
Steady Steps - Falls Prevention Exercise Class
Steady Steps is a once a week for 8 consecutive weeks falls prevention group exercise program for clients aged 65 years and over who have experienced a deterioration of their balance or unsteadiness when mobilising.
Clients will have their gait analysed and balance tested and will be taught a program of low impact movements and sequences to music that incorporate balance exercises. An individualised home exercise program to improve balance is provided to participants.
At the end of the Steady Steps program, clients are encouraged to continue their exercise regime at home and/or join a community-based exercise group for long-term maintenance of activity.
Hours/Days of Operation:
9.30am - 10.30am Tuesdays
-34.038246574702, 151.11341342925
A resident of the Sutherland Shire aged 65 years and older who has experienced a deterioration of their balance or unsteadiness when mobilising.
A person that has balance issues and:
- Is a resident of the Sutherland Shire and is aged 65 years or older
- Has a cognition level suitable to engage in the program
- Able and willing to exercise in a small group setting
- Is motivated to continue an exercise regime at home
- Has a goal of participating in a community-based outside activity
Exclusion criteria:
- People living in aged care facilities who have access to their own physiotherapist
- Third party, insurance or NDIS clients
- People who are currently accessing external community exercise programs
- People with inability to listen/tolerate music
- People unable to mobilise independently (with or without walking aid)
Mark attention STEADY STEPS.
Referrals accepted from any healthcare provider.
Must complete an Access and Referral Form
- Electronic Medical Record (eMR) referral (TSH) to Southcare Community
- Fax Access and Referral Form to (02) 9540 7869 or scan and email to SESLHD-SouthCareIntake@health.nsw.gov.au
A prioritisation tool is utilised to triage referrals.
Priority is given to clients with a recent history of falls.
Donations towards gym equipment are welcome.
Limited bus transport to and from the program is available for residents of the Sutherland Shire at a cost of $5 per session.
Please let us know if you need an interpreter. You can contact us by telephoning the Translating and Interpreting Service (TIS) on 131 450. Tell the operator what language you speak, and then ask the interpreter to set up a telephone conversation between you, an interpreter, and us on 9540 7540.
Southcare Outreach Service (SOS)
The SOS is a multidisciplinary rapid response community team for the ageing population over 65 years* or
- > 50 years for the Aboriginal and Torres Strait Islander population.
- > 16 years for clients referred by the RADIUS unit.
- > 18 years for clients referred by TSH HITH for allied health requirements.
The SOS provides short term acute and sub-acute clinical interventions for a maximum of six weeks. The aim of the SOS is to provide safe and effective interventions to allow clients at risk of presenting or re-presenting to the Emergency Department (ED)/ Hospital to remain at home. The SOS integrates and coordinates clients care with their GP and executes care plan requirements including referral on to services to ensure clients can remain safe at home.
The multidisciplinary team includes: Nursing, Physiotherapy, Occupational Therapy, Social Work and Geriatrician’s working in partnership with General Physicians (GPs).
-34.038246574702, 151.11341342925
Clients suitable for referral to the Southcare Outreach Service:
- Reside in the Sutherland Shire catchment area.
- Are over 65 years* or
- > 50 years for the Aboriginal and Torres Strait Islander population.
- > 16 years for clients referred by the RADIUS unit.
- > 18 years for clients referred by TSH HITH for allied health requirements.
- Are at risk of presenting to ED or re-presenting to ED within the next 48 hours.
- Have goals that can be addressed by a multidisciplinary team in the client’s home.
Exclusion Criteria:
The following clients are excluded:
- Clients admitted in Hospital. Referrals are not taken for admitted in-patients. Referrals are only taken for clients being discharged from the Emergency Department, short stay unit, HITH or RADIUS unit.
- Clients residing care in a Residential Aged Care Facility.
General Practitioners, Staff specialists such as Geriatricians, Emergency Department staff, Aged Care Services Emergency Team (ASET) staff, RADIUS staff, HITH staff, NSW Ambulance Service, NSW Police, clients and carers as well as Southcare and community services can refer.
- Electronic Medical Record (eMR) referral (TSH) Southcare Community or
- Fax an Access and Referral Intake Form to (02) 9540 7869 or
- Scan and email an Access and Referral Intake Form to SESLHD-SouthCareIntake@health.nsw.gov.au or
- Phone SOS triage Nurse on 0410 550 867.
All referrals are considered URGENT and are seen within 48 hours of referral being accepted.
The SOS offers a seven day per week service:
0800 - 1900 hours Monday - Friday.
0800 - 1830 hours Saturday and Sunday, including public holidays.
Nil
Please let us know if you need an interpreter. You can contact us by telephoning the Translating and Interpreting Service (TIS) on 131 450. Tell the operator what language you speak, and then ask the interpreter to set up a telephone conversation between you, an interpreter, and us on 0410 550 867.
Social Work and Welfare Officer
Southcare Social Workers assist people and/or their carers who have complex health and psychosocial issues and/or ageing related illnesses that impact on their ability to live independently in the community. Social Workers work within a strengths-based and reablement model. Social work provides consultation, comprehensive assessment and link people to community supports as needed. Social work can also assist and advise with issues such as: guardianship and financial management, suspected abuse of older persons, dementia/cognition and capacity concerns, and hoarding and squalor.
Consultation to other professionals within Southcare, TSH and the general community is also provided.
The Welfare Officer assists with facilitating the provision of formal services or residential aged care placement/respite through referral, advocacy and case management, if there is not a suitable family/carer/friend to assist.
Hours/Days of Operation:
8.00am - 4:30pm
Monday to Friday
-34.038246574702, 151.11341342925
A resident of the Sutherland Shire who is needing and eligible for social work services as outlined above.
Residents and/or carers of the Sutherland Shire (aged over 65 years or over 50 years for Aboriginal and Torres Strait Islander population) who have complex health and psychosocial issues that impact on their ability to live independently in the community. Consideration will be given to younger clients with ageing related illnesses. Complex psychosocial issues may include;
- Guardianship and financial management
- Concerns around abuse
- Dementia/cognitive capacity concerns
- Carer stress
- Hoarding and squalor
Exclusion Criteria: People whose primary issue relates to mental health, alcohol and other drugs, or intellectual disability
- Electronic Medical Record (eMR) referral (TSH) Southcare Community or
- Fax an Access and Referral Intake Form to (02) 9540 7869 or
- Scan and email an Access and Referral Intake Form to SESLHD-SouthCareIntake@health.nsw.gov.au
All referrals are prioritised and allocated according to need.
Nil.
Please let us know if you need an interpreter. You can contact us by telephoning the Translating and Interpreting Service (TIS) on 131 450. Tell the operator what language you speak, and then ask the interpreter to set up a telephone conversation between you, an interpreter, and us on 9540 7540.
Respiratory Coordinated Care Program (RCCP)
The Respiratory Coordinated Care Program (RCCP) is a community-based respiratory multidisciplinary team that provides home monitoring, education and specialised nursing and physiotherapy care, to people with chronic lung conditions who live in the Sutherland Shire.
The aim of the program is to integrate and coordinate services between hospital, GP’s and Specialists for patients with complex respiratory disorders; assisting them to optimise their function and quality of life at home.
-34.038246574702, 151.11341342925
People with chronic lung conditions who live in the Sutherland Shire.
A client that:
- Is a resident of the Sutherland Shire.
- Requires home monitoring, assessment, physiotherapy (chest and/or physical activity interventions), and education to enable self-management of their chronic lung condition, particularly after a recent admission to hospital or presentation to emergency, to reduce their risk of representing to hospital due to their respiratory condition.
- Would benefit from supervision to facilitate adherence to medical management (e.g. Prednisone doses) which may have changed or modified whilst in hospital or after presentation to emergency department for an exacerbation of their respiratory condition. Examples are infective exacerbation of COPD, Pneumonia/LRTI, Interstitial Lung disease.
Mark attention RCCP.
Referrals accepted from Respiratory Specialists and GPs.
For administration of medications, a medication authority form must be completed.
- Electronic Medical Record (eMR) referral (TSH) Southcare Community or
- Fax an Access and Referral Intake Form to (02) 9540 7869 or
- Scan and email an Access and Referral Intake Form to SESLHD-SouthCareIntake@health.nsw.gov.au
No.
URGENT referrals seen within 48 hours.
NON-URGENT referrals seen within 1 week.
A prioritisation tool is utilised to triage referrals.
Prioritisation is given to clients who are at risk of deterioration and hospitalisation.
8.00am - 4:30pm
7 days/week nursing service; Mon, Tues, alternate Wed physiotherapy service
Nil.
Please let us know if you need an interpreter. You can contact us by telephoning the Translating and Interpreting Service (TIS) on 131 450. Tell the operator what language you speak, and then ask the interpreter to set up a telephone conversation between you, an interpreter, and us on 9540 7540.
Pulmonary Rehabilitation Gym
An 8-week, twice a week multidisciplinary group gym exercise and education program to improve exercise capacity and quality of life, and to enable self-management, for people with chronic respiratory disease and for people prior to and post lung surgery/transplant.
Oxygen may be provided in the gym for exercise if needed.
-34.038246574702, 151.11341342925
Those with chronic respiratory disease and for people prior to and post lung surgery/transplant.
A client that:
- Is a resident of the Sutherland Shire
- Has a chronic respiratory condition, is for lung surgery or has had recent lung surgery
- Has the ability to follow instructions
- Has the ability to use some gym equipment
- Is motivated to continue an independent exercise regime at home
Exclusion Criteria:
- Severe cognitive impairment
- Blind
- Infection that places other participants at risk
- People unable to walk independently (with or without walking aid)
- If modified exercise is likely to exacerbate conditions
- Has completed the program within the last 2 years
Mark attention Pulmonary Rehabilitation.
Referrals accepted from any healthcare provider.
- Electronic Medical Record (eMR) referral (TSH) to Southcare Community or
- Fax an Access and Referral Intake Form to (02) 9540 7869 or
- Scan and email an Access and Referral Intake Form to SESLHD-SouthCareIntake@health.nsw.gov.au
A prioritisation tool is utilised to triage referrals. Priority is given to clients with a recent history of lung surgery or hospital admission for COPD exacerbation, or for lung surgery/transplant work up.
Those who have completed the program within the last 2 years will not be accepted.
Donations towards gym equipment are welcome.
Limited bus transport to and from the outpatient gym is available for residents of the Sutherland Shire at a cost of $5 per session.
Assessments run via telehealth & clinic
Clinic days: Wednesday & Thursday
Exercise groups run 11:30am - 3:30pm Tuesday & Friday
Please let us know if you need an interpreter. You can contact us by telephoning the Translating and Interpreting Service (TIS) on 131 450. Tell the operator what language you speak, and then ask the interpreter to set up a telephone conversation between you, an interpreter, and us on 9540 7540.
Physiotherapy
The Physiotherapy Service provides a Short-Term home visiting service for housebound elderly and disabled residents of the Sutherland Shire over the age of 65.
Physiotherapy treatment is provided for:
- Rehabilitation after a recent operation
- Mobility assessment and to determine need for walking aids
- Exercise program assessment and prescription
Hours/Days of Operation:
8.00am - 4:30pm
Monday to Friday
-34.038246574702, 151.11341342925
An elderly or disabled resident of the Sutherland Shire over the age of 65 needing a short-term home visiting physiotherapy service.
A client that is:
- 65 years or older
- A resident, or residing with a resident, of the Sutherland Shire
- Housebound / unable to access outpatient physiotherapy
Exclusion Criteria:
- People under 65 years of age
- People living in aged care facilities with physiotherapy services
- Third party, insurance, or NDIS clients
- DVA Gold Card holders
- People who can access outpatient or private physiotherapy (e.g. Home care package Level 3 or 4)
Mark attention Southcare Physiotherapy.
Referrals accepted from any healthcare provider.
- Electronic Medical Record (eMR) referral (TSH) Southcare Community or
- Fax an Access and Referral Intake Form to (02) 9540 7869 or
- Scan and email an Access and Referral Intake Form to SESLHD-SouthCareIntake@health.nsw.gov.au.
A prioritisation tool is utilised to triage referrals.
Nil
Please let us know if you need an interpreter. You can contact us by telephoning the Translating and Interpreting Service (TIS) on 131 450. Tell the operator what language you speak, and then ask the interpreter to set up a telephone conversation between you, an interpreter, and us on 9540 7540.