Service Information

Supports for Daily Living: Central Registry Intake
Organization: Central Registry > Nucleus Independent Living
Description: Provides assistance in connecting clients with a variety of services from local community agencies. Services include in-home personal support and homemaking services.
LHIN/Hospital Information
Please Indicate RAI Scores (if being referred by LHIN)
Assessment Information (for all referring sources to complete)
What Support Activities are Required Throughout a 24hr Period?
Personal Hygiene:
Toileting:
Transferring/Turning:
Dressing/Undressing:
Preparing Meals/Assistance with Eating:
Medication Reminders:
Safety Check:
Exercise/Range of Motion:
Essential Light Housekeeping:
If yes, what Meals resources are required?

Are these eligibility requirements met?

Client must be living independently and able to be left alone between visits
Client is medically stable
Client requires approximately 1.5 hr daily of intermittent support
Client does not pose a risk to self or others
Client's need for support with homemaking does not exceed the need for personal support (more IADLs than ADLs)
Client does not require specialized behavioural care or mental health support not provided by this service (physically combative, verbally abusive, etc.)
Minimum Age: 65 yrs
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Client Information

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Email (Confirmation and reminder emails will be sent here)
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Referral Source

Email

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Power of Attorney

Email

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Health Information
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Hospital

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List all medication, and dosages per day

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What other services have been initiated?

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Additional Information

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Send additional documentation online through Caredove, or separately via other methods (e.g., fax)

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Summary

Reference #: -
  • Registrant:
  • Organization:
    Central Registry > Nucleus Independent Living
    Service:
    Supports for Daily Living: Central Registry Intake
    Inquiry Phone:
    1 (905) 281-4443

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