GAIN Community Team

The Geriatric Assessment and Intervention Network (GAIN) Clinic is a network of coordinated health care services that provide clinical care and education. A team of health care professionals work collaboratively with patients and families where health concerns may threaten a person’s ability to live independently.

GAIN is a collaboration between 11 health care providers in our region, including Home and Community Care (formerly Central East Community Care Access Centre (CCAC)).

Senior Persons Living Connected partners closely with local GAIN teams at Scarborough Health Network and Carefirst Seniors & Community Services Association.

 

Who are we?

Our team consists of:

• Clinical Team Assistants
• Nurse Practitioners
• Occupational Therapist
• Dietician
• Pharmacist
• Social Worker
• CCAC Care Coordinators
• Behavioural Support Ontario Nurse

Our team speaks English, Italian, French, Mandarin, Cantonese, Korean, Arabic, Punjabi, Urdu,Tagalog, Filipino and Tamil to assist with communication if necessary. 

 

How can you benefit?

Our team will carry out a geriatric assessment, which is an appointment where illnesses are identified and treated. The GAIN team will also look at other areas that may affect a senior’s life, such as self-care, brain function, physical ability, education and support for caregivers.

Geriatric Assessments

Assessment of memory and thinking Balance, mobility, risk of falls Medication/supplement assessment General health/chronic disease assessment Mood/mental health

Interventions

Education (chronic diseases/self-management) Teaching about dementia/behavioural care Advance care planning Referral to community support, such as Adult Day Programs, Transportation Services, Meals on Wheels Access to personal support/home safety assessments De-prescribing/adjusting medication Treatment for dementia

 

How do I know if I’m eligible?

GAIN supports older adults living at home/retirement residency with multiple medical problems such as: Cognitive impairment  Decreased function Falls/risk of falls Impaired mobility Incontinence Multiple medications If you are experiencing any of the above, as well as safety concerns, psychosocial/mental health concerns/frequent health service usage, then consider contacting us.

 

 

What else do I need to know?

	The GAIN team works with patients and families to identify any concerns and create an appropriate plan to meet your needs and goals.
	We provide a complete report to your primary care provider and referring agency that describes the plan, changes that were made to your care and any needed follow-up.
	Ask a family member/person who is familiar with your health care history to accompany you to your appointment.
	Please bring any aids such as glasses, hearings aids, all medications, etc. to your appointments. This includes eye drops, creams, etc.

 

Making a Referral and Accessing our Services

I’m a Health Care Professional. How can I make a referral?

You can download a referral form found below and fax it to our GAIN clinic at 416-352-5086.

I’m a potential patient/family member. How can I make a referral?

You can download a referral form found below to make a self-referal and fax it to our GAIN clinic at 416-352-5086.

Where can I find you / Where will my appointment take place?

You can visit us at our onsite clinic at Senior Persons Living Connected  We also conduct home visits

 

What are your hours?

We provide care Monday-Friday morning and afternoon; we also provide service on Saturdays & evenings as needed.

For additional information, feel free to call our Senior Persons Living Connected clinic at 416-493-3333 ext. 311