Hospital to Home - Discharge Support and Admission Prevention Worker

People who may benefit from the schemes 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 avoidable re-admission Individuals or health/social care professionals who have concerns about home situations and a person's ability to live independently. How the Schemes Work Professionals from teams in health/social care contact the office to arrange assistance for people being discharged from hospital or who are at home and at risk of readmission. Most of the requests are for short-term practical help and include but are not limited to: - Collecting a patient from hospital and transporting them home safely. Basic shopping.

Fitting temporary key safes. Delivering and fitting small pieces of equipment e.g., bed levers, commodes, pressure relieving cushions, chair raisers etc. Collecting clothes and other personal items from home and taking to the ward. Short-term feeding of pets left at home.

Picking up the patients key to provide access for a contractor e.g., for repairs, adaptations, environmental health. Assistance with moving small items of furniture to facilitate a hospital bed delivery, or to enable greater mobility and thus avoid admission to hospital. Referrer led home assessments. Escorting to hospital appointments.

Welcome the Individual home Support the Individual to follow-up any problems associated with the discharge from hospital process. For example: Contact as required District nurses, doctors etc. Signpost to appropriate community activities and services 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 Longer term referrals to GNS come from health and social care professionals as well as self, family and friends. The services we offer through volunteer and staff teams include face-to-face friendly visits (befriending in a clients home), telephone support and the pen pal scheme/happy post (regular mail/cards/letters). 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. Complete referrals taken by the team 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 hospital and/or residential care Provide support to those discharged from hospital or those likely to be re-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. Complete a check list to ensure all identified needs have been actioned. When appropriate for the particular scheme, ensure that each service user receives a home visit prior to allocation of a volunteer in order to confirm personal details, undertake a risk assessment and better understand them and their needs. As appropriate, ensure that those service users with complex needs and who are not suitable for a volunteer receive a monthly visit from a relevant staff member.

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 with the fundraiser in order to maximise donations to the organisation. Publicise the scheme through all appropriate channels.

Carry out other duties and relevant tasks consistent with the responsibilities of the post, which from time to time may be required as agreed between the post holder and the Senior Manager. This is not a complete description of duties and may be amended in light of changing needs of the organisation after consultation with the post holder We are particularly welcoming applications from people from black, Asian, and minoritised ethnic communities, people who are LGBT+, and individuals with varied accessibility needs, as these groups are underrepresented in our organisation and we wish to expand the variety of lived experience on our staff.