The District of North Fraser, a suburb of Vancouver, Canada, has a population of 250 000 people with 11.2% over age 65 and 5.4% over age 75. A regional geriatric assessment and treatment program, designed to provide a range of services, commenced in October 1992. The program consists of a geriatric evaluation and management (GEM) program on a 12-bed rehabilitation ward, an outpatient consulting service, a domiciliary consulting service and a 20-place per day geriatric day hospital. The GEM unit is staffed by a clinical nurse specialist who coordinates services, a full-time occupational therapist, a halftime physiotherapist, a half-time social worker, and rehabilitation aides. The regional program was developed to help patients within intermediate care facilities, at home or in the acute hospital, who were heading for permanent placement, and who may have remediable disease. Potential patients are referred by their family physician, and are examined by the core team of the geriatrician, nurse and social worker to assess suitability for any part of the program. Patients admitted to GEM remain under the care of their family physicians; however, the clinical director and the program physician supervise rehabilitation plans and perform regular clinical rounds on all patients. Each patient is assessed by all team members, an interdisciplinary problem list is developed, and goals are established. Weekly team meetings are held to discuss progress, and family conferences take place during the patients' stay. The continuing care programs of the region are contacted frequently to draw on their knowledge of the patient, and to assist in discharge and followup care planning. Three established assessment tools were used to compare the patients' function on admission and discharge: the Functional Independence Measure (FIM), the Barthel Index, and Pulses. These give a "rounded" impression of the state of the patient, and indicate change over time. Among other scales, caregiver stress, instrumental activities of daily living, and care levels (as defined by the Ministry of Health Assessors) were also measured. A further assessment tool used in GEM is the Draft Workload Measurement Program developed by the provincial Ministry of Health to evaluate the care needs of long-term care residents. This program identifies the amount of support required to maintain the resident at his stable level. The tool has been modified to identify care needs at the beginning of the rehabilitation process, and compares them with the care needed when the rehabilitation plan is completed. The study population consisted of the first 45 patients (16 men, 29 women) admitted to the GEM. The mean age on admission was 83 years (range 63 to 94). All patients had multiple illnesses, with a mean of 4.6 major problems identified. The most common diseases are listed in Table 1. The mean length of stay on the GEM unit was 87.5 days, including time spent by patients waiting for placement in long-term care facilities. (The mean stay excluding time spent waiting for placement was 72.9 days). Those who went home averaged the shortest stay, 49.2 days. Table 2 lists the living locations of patients before and after GEM unit stay. Nearly all patients improved significantly, and could be transferred to a lower level of care. Figure 1 compares level of care designations for patient at admission and discharge from the unit. Considerable improvement in functional sta-