RMH Community Services works to help patients remain active and well at home and avoid the need for hospital admissions.
We provide patients with the extra support that they need after a hospital stay.
These services work with patients to optimise their health, ability to manage everyday tasks and quality of life. Staff will work with patients by taking a holistic approach to help them achieve the goals that are important to them.
The role of the Community Services is to ensure a smooth pathway from hospital to home.
Community Services provides the following services:
- Post Acute Care (PAC) - short term assistance for people after a hospital stay (such as community nursing, home help and physiotherapy)
- Royal Park Campus Specialist Clinics - outpatient clinics for people with chronic conditions such as memory change, pain, falls and continence
- Community Therapy Services (CTS) - home and clinic-based therapy services (such as occupational therapy, physiotherapy and speech therapy) that help people work towards rehabilitation goals
- Hospital Admission Risk Program (HARP) - specialist treatment, care planning, education and support for people who are at risk of hospital admission because of chronic or complex health issues
- Aged Care Assessment Service (ACAS) - assessment, information and advice for older people and their carers to help them make informed decisions regarding individual care needs
- Case Management Services - ongoing support to assist older people remain as independent as possible in their own homes
- RMH@Home - hospital level care in the patient's home environment
- Residential In-reach
- Cardiac Rehabilitation
- Continuing Cardiothoracic Care
- Cardiomyopathy Clinic
- Transition Care Program: Residential
- Transition Care Program: Home-based
Complex care discharge and referral options
To help you determine what service is most appropriate for your patient, who to contact and how to make a referral, read our complex care and referral options guide.