GAIN Clinic

GAIN Clinic

Available at our Centenary and General hospitals, the Geriatric Assessment and Intervention Network (GAIN) Clinic is a network of coordinated health care services that provide clinical care and education to ensure the best care for frail older adults and their families.

An interprofessional team of health care professionals works collaboratively with patients and families and their primary care providers to strengthen supports and capacity for older adults whose health concerns threaten their ability to live independently at home (including retirement residences). Our GAIN teams draw upon the expertise of nurse practitioners, physiotherapists, occupational therapists, social workers, pharmacists, personal support workers, dedicated health career case managers, collaborating geriaticians, and other specialists.

Community partnerships

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.

Services

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
  • Incontinence
  • Multiple medications

Services include:

  • 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

Interventions

  • 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

What to bring to your appointment

  • A family member or someone who knows your health care history
  • Walking aids
  • Eyeglasses
  • 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

Contact us

Centenary - GAIN Clinic

Phone: 416-281-7446
Fax: 416-281-7082

Located on the first floor of the Margaret Birch Wing

General – GAIN Clinic

Phone: 416-431-8111
Fax: 416-289-2961

Located on the ground floor of the Crockford Pavilion

Referral forms

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.