Alfred Health Carer Services assists with short-term support to carers of all ages. Services include emotional support, respite brokerage, planning for the future, carer education and links to other services and supports. AHCS is unable to offer ongoing or regular assistance.

If you need to refer to our Commonwealth Home Support Program, please do so via My Aged Care.

Our assessment is based on each carer’s current and immediate need for support.

Brokered respite support to carers will be based on a carer assessment and will vary depending on service demand, other services involved and changes to our funding guidelines. Staff may also need to ask for details about the nature and extent of your involvement with the family.

Please be advised Carer Services staff will need to speak to all carers identified on these forms.

There may be a wait for some programs.

Eligibility (all criteria must be met)

Carer

  • The carer providing the support lives in the southern metro region of Melbourne            

  • The carer’s role must be ongoing or likely to be ongoing for at least 6 months
    (with the exception of palliative care)

  • The carer provides unpaid, regular and sustained care to a dependant family member or friend

  • The carer consents to this referral

Care recipient

  • The person lives in the community (not in a facility) and requires ongoing assistance (e.g. personal care) as a result of a disability, mental illness, dementia or age.

NDIS

Carer Services is unable to assist with funding respite if the care recipient has an NDIS Plan Approved. However, we may be able to assist with information, referral and emotional support to the carer in these instances.



All urgent referrals should call 1800 052 222.

REFERRER CONTACT DETAILS
Name of organisation referring client (if applicable)
Referrer name *
Referrer name
Name of person referring client
Role/Title of person referring
Describe the nature of your relationship and length of involvement with the carer
Do you have consent from the carer to make this referral
Do you have consent from the care recipient to make this referral?
Is the carer aware that Alfred Health Carer Services will need to speak to them to provide information and complete assessment information?
CARER INFORMATION
Information about the Carer
Carer name *
Carer name
Carer Date of Birth (must be accurate) *
Carer Date of Birth (must be accurate)
Please provide an accurate DOB. If the accurate DOB is not known, please contact the client to verify before submitting this form.
Carer address *
Carer address
The local government area of the carer
Is the carer of Aboriginal or Torres Strait Islander origin?
CARE RECIPIENT INFORMATION
Care recipient name *
Care recipient name
Care Recipient Date of Birth (must be accurate) *
Care Recipient Date of Birth (must be accurate)
Please provide an accurate DOB. If the accurate DOB is not known, please contact the client to verify before submitting this form.
Care recipient address *
Care recipient address
LGA for the Care Recipient
Is the carer of Aboriginal or Torres Strait Islander origin?
REQUEST
Please note there may be a wait for some services, so please include any information that will assist in prioritising the request.
How will the carer benefit from the referral? (E.g. Requires help to navigate the service system, carer requires respite to continue the caring role)
Is the request for support time dependent e.g. hospitalisation, school holidays?
If known/applicable
If applicable
COMPLETE THE FOLLOWING SECTIONS
If the carer requires respite/brokerage: COMPLETE SECTION A If the carer requires Equipment: COMPLETE SECTION B
SECTION A - RESPITE/BROKERAGE
Complete only if carer requires respite/brokerage
Details of service requested
Please include dates and times
(Male/Female PCA, cultural requirements, skills & experience)
SECTION B - EQUIPMENT REQUESTS
Complete only if carer requires equipment
(e.g. reduce caring time, reduce risk of physical injury, to enable access to services)
(Attach quote or invoice)
$
SUPPORTING DOCUMENTS
Please provide relevant documents such as epilepsy plan, behaviour support plan. *
Please email relevant documents to carerservices@alfred.org.au after submitting this form as applications without the necessary documentation will not be considered.