Geriatric Outreach Team
Regional Geriatric Program of Toronto at Sunnybrook Health Sciences Centre
Vision: Better outcomes for older adults with frailty
Mission: Helping providers deliver the best care for older adults living with frailty
Values: Person- and family-centred care
Equity
Collaboration
Excellence
Integrity
Geriatric Outreach Team
The Geriatric Outreach Team provides an in-home consultative assessment to accomplish the following:
- Complete a Comprehensive Geriatric Assessment
- Establish goals in partnership with the older adult living with frailty and their family/caregiver(s)
- Develop recommendations in partnership with the inter-professional team
- Engage in health teaching with the client and their support system
- Action appropriate community linkages/referrals, including support with service navigation
- Communicate the assessment and recommendations to primary care and/or referral source
Clients may need to be followed until appropriate plans are in place and have been evaluated for effectiveness.
Team Composition
The Geriatric Outreach Team at Sunnybrook is comprised of the following health care professionals:
- Nurse clinician
- Physiotherapist
- Consulting Geriatrician
- Consulting Care of the Elderly Physician
Referral Criteria
- Older adults (65 years or older) OR
- Adults under the age of 65 who present with frailty and/or geriatric conditions
- Have complex medical, functional, cognitive or social challenges that interfere with their well-being and ability to function and/or evidence of significant burden on caregivers
Contact
For more information, call the Specialized Geriatric Referral Office at 416-480-6888. Referral forms can be downloaded here.
