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.

1. A My Aged Care Comprehensive Assessment and STACS assessment in the hospital inpatient setting to determine suitability.
2. Over 65 years of age (younger patients with age related conditions considered).
3. 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.

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:

1. Is a resident of the Sutherland Shire and is aged 65 years or older
2. Has a cognition level suitable to engage in the program
3. Able and willing to exercise in a small group setting        
4. Is motivated to continue an exercise regime at home
5. Has a goal of participating in a community-based outside activity

Exclusion criteria:

1. People living in aged care facilities who have access to their own physiotherapist
2. Third party, insurance or NDIS clients
3. People who are currently accessing external community exercise programs
4. People with inability to listen/tolerate music
5. 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

1. Electronic Medical Record (eMR) referral (TSH) to Southcare Community
2. Fax Access and Referral Form to (02) 9540 7869 or scan and email to SESLHD-SouthCareIntake@health.nsw.gov.au

Yes

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.

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.

1. Electronic Medical Record (eMR) referral (TSH) Southcare Community or
2. Fax an Access and Referral Intake Form to (02) 9540 7869 or
3. Scan and email an Access and Referral Intake Form to SESLHD-SouthCareIntake@health.nsw.gov.au or
4. Phone SOS triage Nurse on 0410 550 867.

No

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.

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

1. Electronic Medical Record (eMR) referral (TSH) Southcare Community or
2. Fax an Access and Referral Intake Form to (02) 9540 7869 or
3. Scan and email an Access and Referral Intake Form to SESLHD-SouthCareIntake@health.nsw.gov.au

Yes

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.

People with chronic lung conditions who live in the Sutherland Shire.

A client that:

1. Is a resident of the Sutherland Shire.
2. 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.
3. 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.

1. Electronic Medical Record (eMR) referral (TSH) Southcare Community or
2. Fax an Access and Referral Intake Form to (02) 9540 7869 or
3. 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.

Those with chronic respiratory disease and for people prior to and post lung surgery/transplant.

A client that: 

1. Is a resident of the Sutherland Shire
2. Has a chronic respiratory condition, is for lung surgery or has had recent lung surgery
3. Has the ability to follow instructions
4. Has the ability to use some gym equipment
5. Is motivated to continue an independent exercise regime at home 

Exclusion Criteria: 

1. Severe cognitive impairment
2. Blind
3. Infection that places other participants at risk
4. People unable to walk independently (with or without walking aid)
5. If modified exercise is likely to exacerbate conditions
6. Has completed the program within the last 2 years

Mark attention Pulmonary Rehabilitation.
Referrals accepted from any healthcare provider.

1. Electronic Medical Record (eMR) referral (TSH) to Southcare Community or
2. Fax an Access and Referral Intake Form to (02) 9540 7869 or
3. Scan and email an Access and Referral Intake Form to SESLHD-SouthCareIntake@health.nsw.gov.au

Yes

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.

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:

1. 65 years or older
2. A resident, or residing with a resident, of the Sutherland Shire
3. Housebound / unable to access outpatient physiotherapy

Exclusion Criteria:

1. People under 65 years of age
2. People living in aged care facilities with physiotherapy services
3. Third party, insurance, or NDIS clients
4. DVA Gold Card holders
5. 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.

1. Electronic Medical Record (eMR) referral (TSH) Southcare Community or
2. Fax an Access and Referral Intake Form to (02) 9540 7869 or
3. Scan and email an Access and Referral Intake Form to SESLHD-SouthCareIntake@health.nsw.gov.au.

Yes

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.

Sutherland Shire residents who are living at home and at risk of hospital admission due to medication misadventure.

A resident of the Sutherland Shire (or residing with) who are:

1. Living at home.
2. Having problems with polypharmacy, pill burden, compliance issues, complicated directions for medications, (e.g. reducing doses of steroids, newly commenced on anticoagulant).
3. At risk of hospital admission due to medication-related incidents, (e.g. falls).
4. Taking medications with concerns of drug interactions, swallowing difficulties, etc.
5. Requiring medication optimisation and/or rationalisation.

Persons under 65 years: 

1. Electronic Medical Record (eMR) referral (TSH) or
2. Fax an Access and Referral Intake Form to (02) 9540 7869 or
3. Scan and email an Access and Referral Intake Form to SESLHD-SouthCareIntake@health.nsw.gov.au 

Persons 65 years and over: 
Online at My Aged Care www.myagedcare.gov.au or phone 1800 200 422. Ask to be referred to Southcare Community Services - Service Type – Pharmacist.

Yes

Referral priorities exist and all referrals will be prioritised according to clinical 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.

A resident of the Sutherland Shire needing Occupational Therapy services.

A resident of the Sutherland Shire (or residing with) who are aged or younger, physically disabled of 18 years of age and over, and who have the potential to remain in their own home. 

Exclusion Criteria: 

1. People living in a nursing home.
2. Third party insurance clients.
3. DVA Gold Card Holders.
4. NDIS clients.
5. People receiving a Home Care Package Level 3 or 4.
    

Persons under 65 years: 

1. Electronic Medical Record (eMR) referral (TSH) or 
2. Fax an Access and Referral Intake Form to (02) 9540 7869 or 
3. Scan and email an Access and Referral Intake Form to SESLHD-SouthCareIntake@health.nsw.gov.au 

Persons 65 years and over: 

Online at My Aged Care www.myagedcare.gov.au or phone 1800 200 422. Ask to be referred to Southcare Community Services - Service Type – Allied Health Occupational Therapy.
 

Yes – this can vary, contact Occupational Therapy to enquire if necessary.

All referrals are prioritised and allocated according to their functional need. 

URGENT referrals are usually seen within 1-2 weeks.

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.