PROFESSIONAL REFERRALS · SYDNEY
A clearer pathway
to care at home.
A practical referral and collaboration pathway for health professionals helping older people access broader, well-coordinated support at home—while preserving continuity with the professionals they already trust.
Service areasInner North-West Sydney · Macarthur
A few sentences are enough. Please do not attach clinical records at this stage—we will confirm the next step and arrange secure transfer if required.
Non-urgent home care and nursing
Aim to acknowledge within 18 hours
Support at Home · Private · NDIS considered
Inner North-West Sydney · Macarthur
01 CHOOSE THE CORRECT PATHWAY
Where should this referral go?
Start with the person’s assessment status and urgency. This avoids unnecessary hand-offs and makes the next action clear.
PATH 01
No aged care assessment or support plan
Jade Care can help the older person or family understand the process, organise relevant information and prepare for a My Aged Care assessment. With consent, we can support the referral pathway.
Eligibility, assessment outcomes and funding decisions remain with My Aged Care and the assessment organisation.
PATH 02 · JADE CARE
Support plan, funding or private care pathway is available
Refer to Jade Care when home support needs to commence, change or be coordinated; when nursing input is required; or when private care is requested.
Check Jade Care suitabilityPATH 03
Urgent, acute or immediate-risk situation
Use the appropriate emergency, acute health or crisis pathway. Jade Care does not provide emergency or rapid-response care.
For a life-threatening emergency, call 000.
02 REFERRAL SUITABILITY
Is Jade Care the right service?
A concise clinical and service screen for GPs, hospital teams, allied health clinicians, care finders and community referrers.
Appropriate to refer when
- New or increasing care needs are affecting safe function, independence or quality of life at home.
- A Support at Home support plan or another funding arrangement exists, but services need to commence, change or be coordinated.
- A recent discharge, GP plan or allied health recommendation requires practical implementation and monitoring at home.
- Non-acute changes in function, cognition or behaviour, medication support, skin integrity, continence or falls risk may benefit from RN assessment.
- Carer capacity is reducing or the current care arrangement is no longer sustainable.
Contact us before referring if
- Complex nursing, palliative or end-of-life support is being considered.
- Same-day or time-critical service commencement is requested.
- The funding pathway, current provider arrangement or decision-making authority is unclear.
- The person lives outside our published service areas.
We will clarify whether the referral is within scope before detailed information is transferred.
03 REFERRAL INFORMATION
Start with the minimum information.
A concise first contact is enough for initial triage. We will request additional information only if the referral proceeds.
Referrer details
Name, role, organisation and preferred contact method.
Consent
Confirm the older person, or their authorised representative, has consented to the referral and contact.
Person and location
Suburb, approximate age, living situation and preferred contact person.
Reason and intended outcome
What has changed, the main concern and what you would like the referral to achieve.
Funding status
Support at Home support plan, current provider arrangement, other funding or private-pay request.
Timing
Requested commencement timeframe, discharge date if relevant and any known service gaps.
04 AFTER THE REFERRAL
A shared pathway—not simply a hand-off.
Jade Care aims to build practical working partnerships around each older person. We help address needs beyond the original referral so the person can access more complete support.
With the person’s consent, we keep the referrer appropriately informed and coordinate opportunities for the referring service to remain involved where its expertise is relevant to the agreed care plan.
Initial review
Check consent, service area, urgency, funding pathway and broad clinical fit.
Acknowledgement, missing information request or an alternative pathway. Aim: within 18 hours.
RN intake
Clarify needs, goals, current supports, risks and the reason for referral.
Confirmation of whether an RN assessment or another next step is appropriate.
Assessment & service design
Assess relevant clinical and functional needs, develop the care and services plan, and confirm staffing and scheduling.
Proposed scope, service frequency, communication arrangements and expected commencement.
Commencement & review
Onboard the care team, implement the plan and review it when needs or circumstances change.
Consented progress updates, clear escalation pathways, care-plan review and coordination with the referrer where continued involvement is appropriate.
05 CLINICAL & SUPPORT CAPABILITIES
Care organised around the person and the plan.
Services are selected according to assessed needs, goals, preferences, risks and the agreed funding pathway.
RN assessment & care planning
Initial assessment, risk identification, care and services plan development, scheduled review and change-of-condition review.
Nursing care at home
Condition monitoring, medication support, wound and skin care, continence care, education and health-service linkage.
Care coordination & communication
Service coordination, consented progress updates and active liaison with the referrer, GPs, specialists, allied health professionals and other providers—so relevant services remain connected around the person.
Personal care & daily living
Personal care, meals, domestic assistance, transport, respite, social support and community access.
Post-discharge & transitional support
Short-term practical and nursing follow-through while the person stabilises and longer-term arrangements are established.
Complex & palliative enquiries
Considered case by case following RN assessment, clinical suitability review and confirmation of appropriately skilled staffing.
06 SCOPE, FUNDING & COVERAGE
Clear boundaries before care begins.
Support at Home
For Support at Home-funded services, Jade Care coordinates and delivers care on behalf of a registered aged care provider. Funded services must align with the older person’s support plan, provider agreement and available budget.
Other payment pathways
Private top-up and private-pay services are available. NDIS-funded enquiries may be considered when the requested supports are within scope and an appropriate funding arrangement can be confirmed.
Service coverage
Inner North-West Sydney: Gladesville, Ryde, Hunters Hill and selected nearby suburbs.
Macarthur: Campbelltown, Camden and selected nearby suburbs.
Clinical boundaries
Complex nursing and palliative or end-of-life support depend on clinical suitability, care coordination requirements and staffing capacity. Where relevant, care is coordinated with the treating GP, specialist or state palliative-care service.
PROFESSIONAL REFERRALS
A clear referral starts with a concise handover.
Send a brief enquiry. We will confirm the correct next step, clarify what the person may need, and discuss how we can coordinate with your service if the referral proceeds.