Home From Hospital Discharge Support and Admission - Doncaster, United Kingdom - Sheffield Churches Council for Community Care

Description

People who may benefit from this service are: Older and vulnerable people who may be frail, socially isolated, have no relatives, living alone or with older carers and other vulnerable adults Older and vulnerable people who may be at risk of re-admission Individuals or health/social care professionals who have concerns about home situations and their ability to live independently. How the Service Works Professionals from teams in health/social care or the patient themselves contact the office to arrange assistance and practical support for people/themselves leaving hospital. The service runs 7 days a week including bank holidays. Tasks will include PRE DISCHARGE PLANNING AND SUPPORT Make contact with Individuals / carer to talk through the Pre discharge process and what it will entail based on the needs of the Individuals.

Establish with permission of the Individual the links with family, friends, neighbours who may be able to support the Individuals following discharge from hospital Ensure that any medication prescribed is with the Individual in readiness for their discharge.

Check that utilities and main services are switched on and working (e.g.

power, water, phone, etc.) to ensure hot water and sufficient basic level of warmth in the home Check state of food stocks, particularly stored in fridge and freezer, disposing of all out-of-date or suspect items Bed made up with clean bedding Facilitate the installation of any Telecare and other equipment prior to discharge (support the installation of response mechanism) If, Telecare (key safe, pendant alarm etc.) is required link with the Service Provider to support this to be in place at earliest pre/ post discharge from hospital Provision of basic foodstuffs and household essentials as required for initial 48 hours Main rooms aired and cleaned, sink cleared of dishes Clothes washing Arrange for timely retrieval/return of pets where appropriate Prepare list of tasks completed, suggested further action, special instructions.

POST DISCHARGE SUPPORT Welcome the Individual home Provide re-assurance that they will receive support at home based on need Support the Individual to follow-up any problems associated with the discharge from hospital process.

For example:
Contact as required District nurses, doctors etc.

Support Individuals to change anti embolic stockings Signpost to appropriate community activities and services Signpost to relevant agencies and Service Providers where appropriate e.g.

Well Being Service, Volunteer Befriending Scheme Low level support in essential areas such as food preparation, shopping, prescription and pension collection, light household cleaning, washing etc.

Undertake level 1 falls assessment Advice and guidance on healthy lifestyle, safety around the home etc.

Signpost to appropriate benefit advice service if required Assist with ensuring Individuals are familiar with the medication they have been provided with on discharge and by providing prompts if required Provide a list of Emergency Numbers Establish repeat prescription delivery service Complete a check list to ensure all identified needs have been actioned.

Duties and Responsibilities (dependent on the scheme): Work closely with other team members to take referrals from a range of referrers, including health and social care staff, friends and family members and the individual themselves, and carry out those referrals or allocate volunteers where appropriate.

Work proactively to plan discharges from hospital in a safe and supported way Prevent the deterioration in the health condition and aid the reduction of inappropriate readmission/ avoidance to hospital through the provision of low-level practical interventions Aid the reduction of premature admission to residential care Provide support to those discharged from hospital or those likely to be admitted, to regain their confidence to be able to continue to live independently Ensure Individuals reintegrate back into their community and feel supported both emotionally and socially through social interaction Deliver a flexible Individual-centred service Provide support to informal carers Be available for enquiries from service users and their families and respond to any requests for information in a timely and professional manner.

Follow up, check, and review all referrals with volunteers, service users and service providers in a systematic way.

As appropriate, provide telephone support to service users.

As directed provide ongoing support and supervision to volunteers within SCCCC and ensure that the service is responsive to the needs of its volunteers.

Ensure that all duties and functions are carried out in accordance with SCCCCs regulations, policies, and procedures. Maintain appropriate records of work undertaken and produce written reports as required.

Attend the meetings of the organisation and any other meetings as required. Attend appropriate training courses to enhance and develop her/his own skills. Liaise