A free health service that connects people with health and wellbeing services aimed at helping them stay out of hospital has been expanded to the entire South Eastern Melbourne area.
The extended Care Coordination Support Service is being provided by Silverchain, Australia’s leading in home care specialist and is funded by the South Eastern Melbourne Primary Health Network (SEMPHN), through the Australian Government’s PHN Program.
The service was first launched in 2023 for the Cities of Frankston and Greater Dandenong before expanding to include Casey and Kingston, as well as the Shires of Cardinia and Mornington Peninsula.
Following the success of the program in its first year, Silverchain and SEMPHN have now ensured the service covers the whole south east with the addition of the Cities of Stonnington, Port Philip, Bayside and Glen Eira.
Silverchain’s Executive Director Victoria and New South Wales, Carolyn Bell, said the growth of the service in the past year enabled more than 600 people to directly benefit from the service.
“We look at each person’s needs holistically, so we’ve also been able to obtain housing for homeless clients and support people during their transition to residential aged care. We’ve also helped clients obtain citizenship and therefore access to appropriate pension, as well as link clients to a local GP if they don’t have one,” Ms Bell said.
“We have helped expedite assessments for aged care services through My Aged Care, as well as improve access to care through education on navigation of the health care system, which often includes the support of interpreters.
“Through this service clients feel heard, empowered and are educated on how to manage their health. They understand where, how and when to access care and how to escalate concerns and deterioration appropriately. This in turn helps to reduce unnecessary ED presentations, admissions and readmissions, particularly after hours.
“In the initial stages of our service, the referrals were coming from GPs and pharmacies. As the service became more established, this has grown to include referrals from public and private hospitals, community health services, and people self-referring.”
Ms Bell said the initiative linked people into services and providers, in collaboration with GPs, to assist clients to remain healthy and independent. Both medical and non-medical factors were assessed with respect to their impact on a person’s health and wellbeing.
Silverchain’s multidisciplinary team includes a GP, nurses, a social worker, a physiotherapist, and diabetes nurse educators. This team has a broad skillset and experience across various facets of health including aged care, Home Care Packages, emergency nursing and alcohol and other drugs.
Silverchain’s service for the south east Melbourne is one of five care coordination services across Victoria, New South Wales, Queensland and Western Australia that Silverchain provides.
So far, Silverchain has provided services to more than 1700 clients across four states as part of the PHN funded care coordination service. In Victoria, 60 percent of the clients have been aged over 65. Services such as Silverchain’s Care Coordination Support Service help alleviate pressure on the tertiary health system, including reducing hospital admissions and reducing the time spent in hospital.