Carer helping out elderly woman in her home

Hospital Avoidance Services – Aged Care

These services support GPs, carers and Residential Aged Care Facility (RACF) staff to provide home based management of elderly people at risk of hospitalisation. They can also facilitate fast track through the hospital system when required.



  • Aged Care Rapid Response Team – ARRT
    ARRT supports GPs, carers and residential aged care facility (RACF) staff to provide home-based management for frail elderly people who are deteriorating and are at risk of hospitalisation, in the Royal North Shore and Ryde area. See AART Flipchart.
  • Beaches RAPID ACCESS care of the elderly (BRACE)
    Brace is a multidisciplinary service aiming to provide a timely assessment of frail, older people in the community, either in their own homes or residential aged care facilities. The team consists of a geriatric doctor, physiotherapist, occupational therapist and specialist nurse and an administration assistant. See BRACE Flipchart.
  • Geriatric Rapid Acute Care Evaluation – GRACE
    The GRACE Service will enhance the resident’s journey by facilitating communication and trust between Hornsby Ku-ring-gai hospital, RACFs and GPs through the provision of an outreach service and as required prioritise hospital treatment. See GRACE Flipchart.
  • Hospital In the Home (previously APAC Service)
    The APAC service will is rebranded to Hospital in the Home (HITH) and HITH will have a direct referral line managed by HITH cliniciansReferrals by General Practitioners have been streamlined and are given priority; patients accepted to HITH are clinically managed by HITH staff specialists.  Referrers can access the HITH service between 8:00am – 10:00pm, 7 days a week. Call: 1300 790 790 or Fax: 9462 9059
  • Dementia Support Australia & DBMAS
    Dementia Support Australian (DSA) provides the Dementia Behaviour Management Advisory service (DBMAS) and Severe Behaviour response teams (SBRT) nationally. DSA provides support to carers of people with Dementia who have behavioural and psychological symptoms that are impacting their care. To access this service you can either call 1800 699 799 or email: dsa@dementia.com.au.
  • Behaviour Assessment Management Service (BAMS)
    Provides assessment, intervention, management strategies and care co-ordination for people with moderate to very severe and persistent Behavioural and Psychological Symptoms of Dementia (BPSD) and/or Mental Illness (BPS-MI). Referral Criteria is any person currently accessing Northern Sydney Local Health District (NSLHD) facility who displays BPSD and/or BPS-MI in the moderate to very severe and persistent range. Generally over 65 years or under 65 years when it can be demonstrated that the person has significant functional disabilities of old age. People of Aboriginal and Torres Strait Islander cultural background over 55 years.
    Access to BAMS clinicians for NSLHD facilities is via the relevant community mental health sector teams.



  • Aged Care Services in Emergency Teams – ASET
    Aged Care Services in Emergency Teams (ASETs) work with emergency department clinicians to provide specialised care, assessment and treatment to older people presenting to the Emergency Department (ED).
  • Royal North Shore Hospital – Acute Assessment Unit – AAU
    The Acute Assessment Unit (AAU) has been developed in local hospitals aiming to provide patients and referring doctors with a medical service that eliminates long waits in the Emergency Department (ED) and delivers a multi-disciplinary, comprehensive care plan for patients with complex medical issues.
    Hornsby, Ryde, Manly and Mona Vale Hospitals: Patients are admitted through the emergency departments. There is currently no direct GP referral. Ideally, patients should present with copies of previous test results and relevant correspondence, as well as details of any care plans in place. A phone call from the GP can be useful in helping staff prepare for the patient and get necessary background information.


For more information on aged care in the region, please see our Aged Care page or contact SNHN’s Aged Care Coordinator.


HealthPathways: Hospital Avoidance services will also be available through the HealthPathways website which will launch at the HealthPathways Launch and Expo on Tuesday 30 May from 6.30pm – 9.00pm at the Epping Club. For more information on the Launch please visit here.
For more information on the HealthPathways program please contact healthpathways@snhn.org.au


Northern Beaches mobile X-Ray service for RACF’s

GPs can access the radiology images through the radiology provider PRP.  Please contact them if you do not already have this access.

Referral forms for the mobile X-Ray can be accessed here. For more information or the Northern Beaches Mobile X-Ray Department via phone (02 9998 0268).

More information.