Job Description
Job description
Job Purpose
To manage and develop the home from hospital settle service in the hospitals that you are responsible for, to support timely and successful patient discharges from hospital and prevent re-admissions. You will work in collaboration with hospital teams and community teams to lead and manage your team to support the smooth transition from hospital to home for service users. The service works with people for time limited support (usually up to 6 weeks) to adjust and settle back in their homes, and to prevent readmission into hospital.
Key Tasks
1. Work in partnership with the hospitals and other health and social care professionals to coordinate safe and timely discharges for referred clients. This involves attending meetings with hospital personnel including Discharge Co-ordinators and Ward Managers to discuss discharges and plan who and how individuals will be supported as appropriate.
2. Manage a team working across two hospitals and ensuring the service is available between the contracted hours.
3. Work collaboratively with other agencies providing support services.
4. Conduct initial assessments of people referred to the services as necessary.
5. Plan and develop person centred interventions to provide short term support for people after hospital discharge.