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1300AGECARE

Who We Are
How We Help
Getting Started
Resources
Where to find us
Contact Us

First Contact Screening

Home First Contact Screening

Who is completing this assessment?

First Last

Your Email

Franchise ID

Participants Details

Participants Name(Required)

First Last

Participants Address

Street Address City State / Province / Region ZIP / Postal Code

Date Of Birth

MM slash DD slash YYYY

Care Recipient ID

My Aged Care Number

Gender

Male (includes transgender men)

Female (includes transgender women)

Indeterminate (non-binary, gender-fluid, agender)

Intersex

Unspecified

Preferred Pronouns

He/ Him/ His

She/ Her

They/ Them

Ethnicity

Aboriginal

Torres Strait Islander

Other

Religion/ Spirituality

Preferred Language

Languages Spoken

AUSLAN/ Language Interpreter required?

Yes

No

Previous Occupation (if applicable)

Individual background information

Program funding for this individual

Transitioned Home Care Program

Support at Home Program

Commonwealth Support at Home Program

Restorative care

End of life pathway - Palliative care

Does the individual have the following documentation with Senior Helpers.

IAT assessment

Support plan

MAC support plan

ACAT assessment

Notice of decision

Any retrievable reports and documents from My Aged Care portal

Has a Care Health and Risk (CHR) screening been conducted?

Yes

No

Other

If completed, when was the last CHR screening?

MM slash DD slash YYYY

Access to the property

Is the property accessible with a standard car

Yes

No

Is there onsite parking or parking close to the house?

Yes

No

Are there stairs (either inside or outside) to climb to the provide the service?

No

Yes, some stairs to climb to provide service, no damage

Yes, some stairs AND are damaged- which is a fall or trip hazard

Is the house seen from the street or has access to neighbours?

Yes

No

Is the home easy to move around or free from clutter to provide services?

Yes

No, house is cluttered and risk of trips or falls

Some clutter, but can move safely

Is there mobile phone coverage or reception?

Yes

No

Who do you normally live with at this address?

Alone

Partner

Carer

Other

Occupants

Who lives in the house

Would anyone at home be upset by us visiting?

Yes

No

Does anyone smoke at home?

Yes

No

Would anyone at your house with contagious illness?

Yes

No

Do you have anyone at home take drugs or drink a lot of alcohol?

Yes

No

Are there any weapons or unsecured firearms at the house?

Yes

No

Do you have any animals or pets?

Yes

No

If yes, please provide more information

Are there any court orders served to anyone living the same household of the older person?

Yes

No

eg. or court orders: Domestic Violence order, restraining order, Mental health treatment order.

Emergency Preparedness

Leave behind "know your risk fact sheet - Australian Red Cross Heatwave Information sheet

For older person information - A Safety Pack will be provied (e.g responding to bush or house fires, storms, flood, a heatwave)

Bush fire

House fire

Storm

Flood

Heatwave

Nil

Tick as many boxes, when information is shared with the older person and their household

First Contact Risk Assessment

Decision tree - select all of the instructions you received from the questions above

Visit will go ahead at no risk have been identified

Visit to proceed. Staff member to contact line management before and after visit

Visit to proceed with two staff members in attendance

Visit has been postponed until infection period has passed

Visit will not proceed - discuss with one or more matter with Manager

Jessica Ponting

Operations Manager

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Christina Chartrand

Vice President of Training

Christina has over 25 years’ experience of training and teaching. She has created numerous training programs on a variety of topics for families, employees, managers and business owners, including the Senior Gems® and Parkinson’s Care Programs.

Robert Sharkey

Chief Financial Officer

Robert came to Senior Helpers in 2013 with an extensive background in finance and operations across many businesses, including Medicare.

Mari Baxter

Senior Vice President of Operations

Mari is responsible for managing the Business Development Team. She has been with Senior Helpers for over 10 years with 14 prior years’ experience as a successful business owner and entrepreneur.

Peter Ross

Chief Executive Officer & Co-Founder

Peter co-founded SH Franchising with Tony Bonacuse in 2004 and is the current CEO for Senior Helpers. He has led the organisation to become a national leader in non-medical home care in the USA. He is also the past President of the Home Care Association of America’s board of directors.

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Contact Head Office

163 Sheridan Street, Cairns North, QLD 4870

1300 AGECARE or 1300 243 2273

Monday – Friday: 8:30am – 5pm

07 4281 6816

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