Complex Continuing Care (CCC) is for patients with chronic, complex, and multiple non-urgent medical needs who need to stay in the hospital for specialized services and resources.
The CCC unit at our Centenary hospital is meant to be a temporary care setting to support patients in improving their abilities and functioning. It is a next step in patients’ recovery journey, on their way to their destination of home or community care. The goals for patients are to optimize quality of life, learn to manage their condition, and transition safely from the hospital to home or a community care facility.
The program is a regional collaboration between SHN, Lakeridge Health and Peterborough Regional Health Centre, as well as the Home Care Services through the Central East Local Health Integration Network. SHN has formally partnered with community agencies, including Carefirst Seniors and Community Services Association and St. Paul’s L’Amoreaux to provide additional geriatric services to support our patients’ overall well-being.
The GAIN Clinic also works closely with many other organizations including the Alzheimer Society of Ontario, Transcare Community Support Services and Scarborough Centre for Healthy Communities to support our patients and their families.
The GAIN Clinic provides services for seniors generally aged 75 and older with multiple complex medical problems including:
- Cognitive impairment
- Decreased function
- Falls or risk of falls
- Impaired mobility
- Multiple medications
- Comprehensive geriatric assessment
- Assessment of memory and thinking
- Balance, mobility and falls risk
- Medication (and supplement) assessment
- General health, as well as chronic disease assessment
- Mood and mental health
- Education regarding chronic disease self-management
- Teaching about dementia and behavioural care
- Advance care planning
- Referral to community supports such as adult day programs, transportation services and
- Meals on Wheels
- Access to personal support and home safety assessments, where appropriate
- De-prescribing and medication adjustment
- Initiation of treatment for dementia
- A family member or someone who knows your health care history
- Walking aids
- Hearing aids,
- All medications, including over-the-counter products (please bring all medication containers, bottles, eye drops, cream, etc.)
- A light lunch/snack, as your assessment may take up to two hours.
Following the clinic visit, a summary of recommendations will be sent to your referring primary care provider or specialist.
How to Access Care
The GAIN clinic accepts referrals from: primary care providers (family doctor, nurse practitioner, family health team, etc.), community support service agencies, and Emergency Medical Services. Patients and families may self-refer, but are asked to first speak with their primary care provider first.
Centenary – GAIN Clinic
Located on the first floor of the Margaret Birch Wing
General – GAIN Clinic
Located on the ground floor of the Crockford Pavilion