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If you are making a referral to ALONE on behalf of someone else, please make sure you have the person's consent to do so. If possible, complete this referral form in the company of the person being referred.


Who are our services for?

ALONE is a national organisation working with people over 60 years of age. If we cannot provide services directly, we will endeavour to locate a service that can. An older person does not necessarily have to live by themselves in order to be referred to ALONE.


ALONE’s Befriending and Support Visitation Service

ALONE’s Befriending and Support Service offers companionship to older people through weekly visits by trained, Garda Vetted and supported volunteers. We match volunteers to the people they visit ensuring compatibility and common interests where possible.

 

ALONE’s Befriending and Support Telephone Service

ALONE’s Befriending and Support Telephone Service offers daily contact by a friendly local volunteer who is trained and Garda Vetted.  It provides friendship, security and support to alleviate loneliness and improve their overall well-being. 


ALONE Support Coordination Service

Our Support Coordination service entails the coordination of supports and services for the older person who wishes to age at home. We engage with a wide range of services, including, but not limited to, health and medical, financial, social welfare and housing. Each older person is assigned a Support Coordinator, a trained professional, who acts as an independent advocate for the older person in coordinating the necessary services.


What happens after a referral is made?

1. We will confirm receipt of the referral. 

2. A Support Coordinator will phone to discuss the service with the person and discuss next steps. 

3. An Assessment will be carried out in the home of the person referred. 

4. If being referred for Friendship and Support, a Support Coordinator will work to match the older person with a volunteer, and will remain in contact during this process. 

If being referred for Support Coordination, a Support Coordinator will ensure that a plan is put in place to help resolve the difficulties of an older person seeking to avail of our Support Coordination Service, and will remain in contact until the difficulties are resolved.


Click the next page button below to make a referral.

Please fill out your own details here: 
Be as specific as you can here, for example, if you work for a hospital, enter the name of the hospital rather than the 'HSE', such as St.Vincent's Hospital, Mater Hospital.
Please use the key information section below to fill in the information about the person you are referring.
Key Information:
Please note that the person should be over 60. Date format 00/00/0000
The area where the person lives such as Kilmainham, Dundalk, Kilkenny City, Buncrana.
Please include name, contact details and relationship.
How can ALONE support? Please select one or more of our services below:
A visit from a trained and Garda Vetted volunteer in the home for a minimum of 1 hour per week.
A friendly telephone call with a trained and Garda Vetted volunteer on chosen days of the week.
Support from our staff around housing difficulties, finance, safety and security or physical or mental well being.
What is are the main reasons ALONE's support is needed? Is it loneliness, physical health, dementia, mental health, housing difficulties, or other?

Are you aware of any risks or potential risks to our staff visiting this person's home?
Supporter Details
Please use this section to provide us with the details of a medical or social professional. We may need to contact this person in advance of our first visit. Please confirm below if we have the permission to do so.
Consent:
In order to process the referral, you must confirm that consent has been received and the date that it was received:

Please note:
                    
When you press the submit button below you will see a summary of your form.
                    You must press the confirm button on the summary page for the referral to be completed. 
                    You will receive a confirmation email once the referral has been received by ALONE.