Frail seniors (over age of 65) with complex care needs requiring further assessment. Clients who are medically stable and experiencing acute functional and / or cognitive decline. Clients under 65 years of age will be considered for service on a case-by-case basis.

Geriatric syndromes such as:

• falls / immobility
• polypharmacy
• cognitive impairment (including behaviour changes)
• pain management
• incontinence (bowel or bladder)
• nutrition / weight loss or weight gain

Referrals are accepted for all Designated Supportive Living and Private Supportive Living clients. Note that the GEM team cannot respond to an urgent referral.

The GEM team consists of a geriatric physician and a Supportive Living (SL) gerontology-certified Registered Nurse (RN). This partnership assists primary care physicians with assessment and management of complex older adults, with functional and / or cognitive decline. GEM RNs provide clients with assessment and support in conjunction with family physicians, a SL Case Manager (CM), and Contracted Service Provider site staff. All referrals require primary care physician approval. Ongoing care is provided by the client’s primary physician during this intervention.