REFERRAL OF CULTURALLY & LINGUISTICALLY DIVERSE (CALD) SENIORS FOR VISITOR SCHEME in PERTH

Following the Aged Care Royal Commission, the Australian Government has introduced an Aged Care Volunteer Visitor Scheme to provide friendship and companionship to isolated older people.

In Western Australia, the Association for Culturally Appropriate Services (AfCAS) is one of the organisations delivering the scheme to people from culturally and linguistically (CaLD) backgrounds.

The scheme is open to seniors who are eligible for Australian Government funded residential aged care and home care packages.

The information is kept confidential and is only used to provide a suitable volunteer visitor to the senior being referred. The senior has the right to accept or reject the volunteer visitor at any point.

The residential site or Home Care Provider will be involved in providing organisational policy requirements

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* 1. Referred Senior Details

First Name:

Last Name:

Preferred name:

Date of Birth:

Preferred Language:

Gender:

Ethnicity:

Religion:

Interests (If known):

Current Visitors:

Suggested Activities:

Reason for referral (please mention any health or background information and/or preferences that will help us in matching them with a suitable volunteer):

Visitor Preference (Gender)

Visitor Age Bracket:

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* 2. Care Recipient Aged Care Status

Living in a Residential Aged Care

Approved and waitlisted for Residential Aged Care

Receiving a Home Care Package

Approved and waitlisted for Home Care Package

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* 3. Aged Care Details

Name of the Residential Aged Care (if applicable):

Address:

Postcode:

Contact Person:

Email:

Phone:

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* 4. Referring Person Details

First Name:

Last Name:

Organization (Aged Care Provider OR Community Organization):

Position:

Email:

Phone:

Mobile:

Address:

Postcode:

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* 5. Who has given verbal/written consent to submit this referral?

Recipient:

Next to Kin/Power of Attorney:

Other:

Relationship/Positions:

Organization:

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* 6. Emergency Contact Details

Name:

Relationship:

Email:

Phone:

Refer question to Mary Gurgone by emailing info@afcas.net