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Southern DHB Needs Assessment & Care Coordination - Southland

Public Service, Older People's Health


8:00 AM to 5:00 PM.


The Aged Care Needs Assessment and Service Coordination is a district-wide service that is based in Dunedin, Invercargill and the Rural Hospitals.

The service provides assessment to identify the level of need for ongoing support in the home and community settings. Services are allocated based on this identified need.

The service provides support for elderly people with an ongoing disability.

Access to the service is Monday to Friday 8.00am to 5.00pm.

For more information on this service in other areas please click on the following links:

Referral Expectations

Outpatient Services
Your GP will refer you to this service if they think you would benefit from seeing a team of people to assist with any difficulties related to illnesses affecting you in old age or if they feel you would benefit from a specialist doctor’s advice regarding your medical condition.


The waiting times for clinic range from 1 week to 3 months depending on the urgency of the condition described in your GP’s referral letter. 
You will see either a Geriatrician or a Registrar (a doctor training to become a specialist) with supervision.  Before seeing the doctor, you will be seen by a nurse who will ask you some questions and take some recordings such as blood pressure and weight.  The average length of a clinic appointment is 1 hour with tests occurring afterwards often taking another 30 mins.  During the clinic appointment you will be asked about any symptoms you have as well as your past medical history.  Please bring all your medications with you.  It is very common in this clinic to be asked a series of questions to test your memory.  You will have a physical examination and are likely to have blood tests, an ECG (tracing of your heart) and a Chest X-Ray, depending on what problems you have.


Home Visits

Your GP may request a home visit by one of our doctors.  This occurs if you are unable to come into hospital or would be best assessed in your own home.  You will be phoned the day before and asked if it is OK for us to visit.  The waiting times for home visits are usually 1-2 weeks.
Assessment For Going Into A Rest Home
Before going into a rest home or private hospital, government agencies require an assessment.  This has two parts to it.  The first is an assessment by a specialist doctor to look at any health issues that could be affecting your ability to live independently.  It is often a good chance to have a general review of your medications.  At the clinic your medical history will be reviewed and you will have a physical examination.  Depending on your wishes you may see other members of the team to look at what could be done to help keep you in your own home.  The second part of the assessment is done by the needs assessment coordinators.  They look at what options you have with respect to home assistance and the financial implications of going into a rest home.  This assessment usually takes place after the clinic appointment.
Inpatient Services
You will be referred to hospital if your doctor thinks you would benefit from time in hospital to undergo assessment of your condition or for rehabilitation.  You may be referred from home by your GP or from another ward in the hospital if you need more time and therapy to regain strength to get home.
What To Expect
Although there are doctors involved with your care they may only see you once or twice a week if you are medically stable but can visit more often if needed.  They are always happy to talk with you or your family.  Your nurse can set up a time to suit.
The time you spend on the ward depends on the progress you make and whether or not you benefit from daily rehabilitation with the therapists.   The purpose of rehabilitation is to regain independence so you will be encouraged to do as much for yourself as possible as you recover.  Depending on your problems and abilities, you are encouraged to be as independent as possible during your time on the ward. 
Before going home you may have a home visit where the occupational therapist takes you home for about an hour to see how you manage with day to day things in your own home to assess what help or equipment might be needed. Before discharge you and your family may wish to have a meeting with staff if you want to discuss what has happened to you and what help you might need at home.


8:00 AM to 5:00 PM.

Mon – Fri8:00 AM – 5:00 PM

Public Holidays: Closed Waitangi Day (Observed 7/2/22) (7 Feb), Good Friday (15 Apr), Easter Sunday (17 Apr), Easter Monday (18 Apr), Southland Anniversary (19 Apr), ANZAC Day (25 Apr), Queen's Birthday (6 Jun), Labour Day (24 Oct).
Christmas: Open 20 Dec — 24 Dec. Closed 25 Dec — 26 Dec. Open 27 Dec — 31 Dec. Closed 1 Jan — 2 Jan. Open 3 Jan — 7 Jan.

Procedures / Treatments

  • Memory Problems

    There are several types of memory problems people can have.   If you are referred because of memory concerns it is very helpful to bring along a family member.  It is also very important to bring all of your medications with you as these can often affect memory.  A full medical… More

  • Dementia

    This is a condition of gradual loss of memory and other functions of awareness or thinking such as concentration over time.  There are several types of dementia including Alzheimer’s disease and vascular dementia, which is due to the same sort of illnesses that cause stroke.  More

  • Falls

    These are not a natural part of aging.  There are many reasons why people fall over and a review of your medical problems and medications may well reveal some reasons for falling that can be fixed.  If you have lots of falls, seeing a specialist as well as the physiotherapist… More

  • Strokes

    A stroke is where the blood supply to an area of the brain is interrupted causing damage to brain cells.  This happens either with a clot in the blood vessel or the blood vessel bursting.  The effects of a stroke depend on where in the brain, and how big, the… More

  • Urinary Incontinence

    Urinary incontinence or a loss of bladder control is the involuntary passage of urine.… More

  • Osteoporosis

    Osteoporosis is a disease that weakens your bones. Osteoporosis is not painful but it makes your bones more prone to breaking (fracture).  Women are more likely than men to suffer from osteoporosis and as you get older you are more likely to have it.… More

Contact Details

Kew Road
Southland 9812

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Street Address

Kew Road
Southland 9812

Postal Address

Southland Hospital
PO Box 828
Invercargill 9840

This page was last updated at 2:23PM on June 18, 2019. This information is reviewed and edited by Southern DHB Needs Assessment & Care Coordination - Southland.