Referrals come from various sources including patients, caregivers, family members, doctors, aged care assessment teams, the police and paramedics. Nurses triage referrals by researching medical records and talking to the family or the care recipient’s doctor, with an on-site visit typically occurring within 1-2 days.
Comprehensive assessments in the care recipient’s home include medical, social, cognitive and environmental dimensions, with patients discharged after 3-4 months. Team members meet weekly to discuss current cases and coordinate goals and treatments.
Since the squad began, hospital emergency visits by the community’s elderly have fallen, while quality of life measurements have increased for those receiving the squad’s care.