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AUA 5-6: High Risk

Home and Community Care, Geriatric Assessment, and Wrap Around Care

An older adult who scores 5 or 6 on the AUA is not self-reliant with daily tasks, and is showing signs of personal or informal care distress. Strongly consider an urgent referral for geriatric assessment, in addition to some of the following services.

Health service providers should consider connecting with their local Health Link for patients with a 5 or 6 AUA score.
Find non-intervention related Resources for Seniors.
 
Start finding services with the menu below.

Care Support

  • Adult Day Programs
    Adult day programs (ADP) provide part-day supervised activities in a group setting for dependent adults, such as the frail elderly, people with Alzheimers disease, or people with disabilities. Services may include leisure activities, meals, ...
  • Caregiver Support Services
    A caregiver is someone who looks after a sick, frail or disabled relative, friend or neighbour. Supportive programs are available to help caregivers cope with their responsibilities and may include self-help, informal counselling, ...
  • Community Geriatric Services
    Community-based medical or rehabilitation services for older adults.
  • Dental Services - In-Home
    Dental services are provided in the home, retirement residences, or long-term care homes. The types of services are generally limited to denture care and dental hygiene services.
  • Geriatric Inpatient Services
    Inpatient hospital programs providing medical or rehabilitation services for older adults.
  • Geriatric Outpatient Services
    Outpatient hospital programs providing medical or rehabilitation services for older adults.
  • Geriatric Services (Aging Related Health Care)
    Geriatric services provide health care specifically related to aging, in particular the frail elderly who have multiple health problems or who have difficulty managing on their own.
  • Hospice Palliative Care - In-Home
    In-home hospice palliative care supports for individuals with life-limiting illnesses and their families and caregivers. These services focus on relieving suffering and the enhancement of the quality of life for persons who are living with, ...
  • Hospice Palliative Care Residences
    Palliative care that is provided in a supportive, home-like environment for people with a life-limiting illness. These services, which are delivered in the last months of life, focus on symptom and pain management and are provided on a ...
  • In-Home Nursing
    Nursing services provided in the client's home. Therapy, personal support, and home support may also be offered.
  • In-Home Personal Support
    Services that assist people at home with their daily care, mobility, routine activities of daily living, and provide respite care.
  • Memory Clinics
    Assessment, diagnosis, and treatment for people with memory issues.
  • Ontario Health atHome
    Health care services offered at home, at school, and in the community, as well as access to supported living programs and long-term care, are coordinated by Ontario Health atHome to ensure people of all ages can make informed choices about ...
  • Rehabilitative Care Inpatient - Activation/Restoration
    Healthcare beds for rehabilitation using exercise and recreational activities to help patients get stronger and more independent. Typical stays last 8 to 10 weeks, and include exercise, recreation, daily therapy, and weekly follow-ups with ...
  • Rehabilitative Care Inpatient - Complex Medical Management
    Hospital beds for medically complex patients provide rehabilitation to gradually improve strength and movement. Care includes access to doctors or nurse practitioners, nursing, and therapy. Typical short-term stays are up to three months. ...
  • Rehabilitative Care Inpatient - Rehabilitation High-Intensity
    Hospital beds for rehabilitation help patients get back their strength and independence after a serious medical illness or injury. Care includes daily access to a doctor or nurse practitioner, nursing care, and up to three hours of therapy.
  • Rehabilitative Care Inpatient - Rehabilitation Low-Intensity
    Hospital beds for rehabilitation help patients get back their strength and independence after a serious medical illness or injury. Care includes daily access to a doctor or nurse practitioner, nursing care, and up to three hours of therapy.
  • Respite Care for People with Alzheimer's Disease and Related Dementias
    Provides caregivers with temporary rest options that may include substitute living arrangements in a supported environment or in-home care for older adults with dementia.
  • Respite Care for Seniors
    Caregiver support services that provide a break or temporary relief, such as short-stay residential, day programs, as well as in-home supports.

Health Conditions and Diseases

  • Alzheimer's Disease and Related Dementias
    Dementia is the loss of intellectual functions, such as thinking, remembering and reasoning, of sufficient severity to interfere with a person's daily functioning. It is not a disease in itself, but rather a group of symptoms that may ...
  • Arthritis
    Services that provide support, or diagnosis and treatment for people with chronic joint inflammation and other conditions affecting joints and other tissues.
  • Blindness and Vision Loss
    Counselling, support, and referral services for people with blindness or sight loss, and their families. They may also provide information on assistive technologies to support independence.
  • Bone Disease
    Services or programs that specialize in providing treatment, counselling, or support for people affected by bone disease, such as bone cancer, brittle bone disease, and osteoporosis.
  • Breast Health and Diseases Support Groups and Organizations
    Information and support for women with breast cancer, breast cancer survivors, or women with questions about breast health.
  • Cancer and Tumour Support Groups and Organizations
    Support groups, associations, and foundations provide information and support to those living with cancer or tumours and their families/caregivers.
  • Deafness and Hearing Loss
    Programs and services for people who are deaf or hard of hearing, which may include diagnostic hearing tests, counselling, education, and the provision of hearing and communication assistance devices.
  • Heart Disease
    Services that provide support, or diagnosis and treatment for many types of heart disease such as coronary artery disease, heart failure, and heart rhythm disorders.
  • Lung and Respiratory Conditions
    Services that provide support, or diagnosis and treatment for people with lung diseases.
  • Pain
    Pain can interfere with work, sleep and overall enjoyment of life. If you are living with pain, support is available to help you cope and improve your quality of life. Most painful conditions can be treated.
  • Prostate Cancer
    The prostate is a gland in the male reproductive system. Prostate cancer is a disease in which cancer cells form in the prostate. Services offer information and support, screening, management and treatment of prostate cancer.
  • Stroke
    Services that provide support, or treatment and rehabilitation, for people who have suffered a stroke because blood flow was stopped or restricted to a part of their brain.

Health Coverage and Care Planning

  • Advance Care Planning
    Advance care planning is a process that guides a person to talk about their wishes, values, and beliefs that would inform future decisions when a person is unable to make or communicate their own healthcare choices.
  • Consent, Capacity, and Substitute Decision Making
    A person's ability to make choices can be challenging at times. Government agencies and organizations provide a structure for ensuring informed consent, determining capacity and substitute decision making, as well as upholding people's ...
  • Drug Benefits
    Drug benefit programs that assist Ontario residents with the cost of prescription drugs.
  • Health Insurance Plans
    For eligible individuals, the Ontario Health Insurance Plan (OHIP) covers the cost of a wide range of essential health care services. Other government health insurance programs are available for specific groups, such as Indigenous peoples, ...
  • Power of Attorney and Public Guardianship
    In Ontario, a Power of Attorney is a legal document which allows a person to appoint someone to make decisions about their property, finances, or personal health care if they become mentally incapable. If a mentally incapable person has no ...

Housing Options

  • Assisted Living for Adults with Acquired Brain Injuries
    Frequent and unscheduled personal supports for adults with acquired brain injuries (ABIs), who need higher levels of assistance to live independently.
  • Assisted Living for Adults with HIV
    Frequent and unscheduled personal supports for adults living with HIV, who need higher levels of assistance to live independently.
  • Assisted Living for Adults with Physical Disabilities
    Frequent and unscheduled personal supports for adults with physical disabilities, who need higher levels of assistance to live independently.
  • Assisted Living for High-Risk Seniors
    Frequent and unscheduled personal supports for older adults who need higher levels of assistance to live independently.
  • Long-Term Care Homes
    Long-term care homes are subsidized facilities providing nursing and personal care to individuals who are no longer able to live independently. Many long-term care homes also offer short term respite care. Long-term care homes are also ...
  • Ontario Health atHome
    Health care services offered at home, at school, and in the community, as well as access to supported living programs and long-term care, are coordinated by Ontario Health atHome to ensure people of all ages can make informed choices about ...
  • Residential Care for People with Alzheimer's Disease and Related Dementias
    Residential care offers medical and personal care for adults who can no longer be cared for at home. Respite care may also be available at these locations.
  • Veterans
    Veterans Affairs Canada provides pensions for disability or death, economic support in the form of allowances, health care benefits and services to: members of the Canadian Forces and Merchant Navy veterans who served in the First World ...

Meals and Nutrition

  • Dietitian Services
    Registered dietitians are food and nutrition experts who work with clients, their caregivers, and health care providers. Together, they manage nutrition based on medical conditions and individual needs.
  • Meal Delivery Services
    Services or programs that prepare and provide regular delivery of meals to older adults or people with disabilities or other medical conditions.
  • Shopping and Grocery Assistance
    Services or programs that provide assistance with shopping and errands for older adults or people with disabilities or other medical conditions.

Medical Care

  • Community Health Centres
    Community health centres provide primary care, health promotion, education and illness prevention services using a community development approach. Health care professionals including physicians, nurse practitioners, nurses, counsellors, ...
  • Diagnostic Imaging Clinics
    Diagnostic imaging clinics provide a wide range of services such as X-rays, ultrasound, bone mineral densitometry (BMD), mammography, and magnetic resonance imaging (MRI).
  • Family Health Teams
    Family health teams are teams of doctors, nurse practitioners, nurses, social workers, and other health care providers who work together to provide team-based primary care in their communities.
  • Flu Shots (Influenza Vaccines)
    During flu season, these services provide the flu vaccine, the best defense against influenza, a disease caused by a virus infecting a person's respiratory system (nose, throat, and lungs).
  • Medical Laboratories
    Laboratories that take and collect samples for analysis to get information about the health of a person to aid in diagnosis, treatment, and prevention of disease. A requisition from a health care professional is required.
  • Pharmacies
    Pharmacies provide drug prescription services, as well as medication checks and guidance. Some also provide vaccinations and immunizations, and non-prescription healthcare services.
  • Urgent Care Centres
    Medical clinics that provide same-day urgent treatment for non-life-threatening illnesses or injuries, such as infections, sprains, earaches, broken bones, and fevers. These centres may have access to diagnostic equipment and on-site ...
  • Walk-In Medical Clinics
    Medical clinics for walk-in or same-day non-urgent care, often without an appointment. Doctors and nurses at these clinics can assess and treat minor illnesses and injuries.

Medical Equipment and Aids

  • Hearing Aids and Communication Devices
    Services that provide hearing devices and communication aids, as well as programs that help cover the cost of purchasing these items. If eligible, the Ministry of Health's Assistive Devices Program (ADP) may contribute to the cost of ...
  • Home Modification
    Modifications can be undertaken to make a home barrier-free for people with physical disabilities or mobility challenges. Financial assistance may be available.
  • Medical Equipment and Supplies - Loans
    Organizations that loan medical equipment to individuals recovering from surgery or living with mobility limitations. Some organizations may require a donation or have other criteria for use of equipment. Local service clubs may also loan ...
  • Medical Equipment and Supplies - Sales and Rentals
    Programs and services offering medical equipment and supplies to help people recover from surgery or maintain their wellbeing.
  • Oxygen and Respiratory Services
    Programs and services providing oxygen, medical equipment, and supplies for people with chronic lung disease and other respiratory conditions.
  • Veterans
    Veterans Affairs Canada provides pensions for disability or death, economic support in the form of allowances, health care benefits and services to: members of the Canadian Forces and Merchant Navy veterans who served in the First World ...

Mental Health and Addictions

  • Alcohol and Drug Addiction Assessment and Treatment
    Alcohol and drug programs that provide therapy and mutual support for people who have a substance use disorder. These services help them better understand their dependency and support their efforts to recover.
  • Bereavement Support
    Bereavement programs provide emotional support, problem-solving assistance, information, and guidance for people who have recently lost a loved one. Included are counselling programs and mutual support groups for widows and widowers, ...
  • Counselling - Family, Couple, Individual
    Counselling aims at assisting people to understand and overcome or manage personal problems, such as difficulties in relationships, anger, conflict, trauma, and abuse.
  • Mental Health for Seniors
    Programs and services for older adults who are experiencing challenges with their emotional, psychological, and social well-being.
  • Mood and Anxiety Disorders
    Services or programs that specialize in providing treatment, counselling, or support for people affected by mood or anxiety disorders, such as obsessive-compulsive disorder, depression, bipolar disorders (manic depression), and states of ...
  • Problem Gambling
    Services or programs that specialize in providing treatment, counselling, or support for people affected by problem gambling or related problems.
  • Smoking
    Smoking prevention programs and support services that help people to quit smoking or vaping.

Pain

  • Pain
    Pain can interfere with work, sleep and overall enjoyment of life. If you are living with pain, support is available to help you cope and improve your quality of life. Most painful conditions can be treated.
  • Palliative Pain and Symptom Management Consultation Programs
    Pain and symptom management are an essential component in the delivery of hospice palliative care. The Palliative Pain and Symptom Management Consultation Program provides health care providers with access to consultation, education, ...

Safety

  • Elder Abuse and Neglect
    Services or programs that focus on preventing or responding to the abuse of older people.
  • Exercise and Falls Prevention Programs
    Exercise classes with a focus on falls prevention help older adults stay healthy, active, and mobile. Classes are publicly-funded and held at various community locations. There is no fee for eligible participants.
  • Helplines for Seniors
    Confidential phone or online supports available to seniors and their caregivers.
  • Hoarding
    Services for people living with a hoarding disorder, and their families, may include education, mental health, housing, and cleaning supports.
  • Personal Emergency Response Systems
    Medical alert systems that contain a help button which connects with a live agent at a response center.
  • Police Services
    The police provide services that help with crime prevention, law enforcement, assistance to victims of crime, and emergency response.
  • Seniors' Intervention and Assistance Services
    Government-funded programs that assist seniors with access to non-medical services to help them live independently. Includes information, advocacy, forms filling, referrals, income tax clinics, crisis intervention, and coordinating other ...
  • Telephone Reassurance and Security Checks
    Community support services which provide regular phone calls and safety checks for seniors and people with disabilities who live alone.

Transportation

  • Patient Transfer
    Non-emergency transfer services for people with stable, non-urgent health conditions who may require stretchers, chair lifts or oxygen. Transportation may include transfers to or from a hospital, long-term care home, or other health care ...
  • Transportation - Accessible
    Wheelchair accessible transportation is available through public transportation services, community organizations and private companies.
  • Transportation - Non-Accessible and Volunteer
    Transportation services for the elderly or people with special needs who are mobile (ambulatory). Most transportation services are provided by volunteer services and a nominal fee may be charged. Some providers may offer accompaniment ...