Acute Care for the Elderly

The Acute Care for the Elderly (ACE) program at SHN provides inpatient acute care at our Birchmount and General hospitals. Our interprofessional care team works together with our senior patients and their families to enhance and maintain their functional and cognitive capacity, so they are well enough to return to the community.

The care team meets daily to discuss patients’ goals and address any challenges that may affect discharge planning. Family meetings are available to provide education and support. Progress is communicated to both patients and families to ensure a seamless transition into the community. Our efforts to ensure the wellness of our senior patients help to minimize the need to transfer patients to long term-care facilities.

Services

The ACE Program focuses on supporting an overall level of well-being.

• Therapy assessments with a physiotherapist and occupational therapist
• Consultation with a registered dietitian, speech language pathologist, social worker and pharmacist
• Consultation with a nurse practitioner or physician
• Coordination with community partners to support transition back home, including:
  • Geriatric rehabilitation
  • Geriatric Assessment and Intervention Network (GAIN)
  • Community Care Access Centre
  • TransCare
  • CareFirst

Referrals

Individuals 65 years of age and older with varied medical challenges are assessed for participation in the ACE program.

Referrals are accepted from:

• Emergency departments
• Any member of the care team including nurses, physiotherapists, occupational therapists, social workers, pharmacists, nutritionists and, speech and language pathologists
• GAIN clinic
• SHN inpatient units

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