This service provides a multi-clinical health and social care short term response to avoid admissions and readmission to hospitals or care homes. The service aim to help people to remain at home with support instead of being admitted to hospital or a care home. The service also identifies and maximises independence around all aspects of daily living.


The objectives of the service are:
*to initiate short term care in a crisis situation and co-ordinate the ongoing
care of people experiencing a health or health-related social care crisis in their
own home; maximise independence and improve outcomes for patients;


*reduce hospital and residential admissions through crisis intervention and support;


*link individuals back into their community and support networks thereby promoting their
independence and reducing their need for on-going health and social care support;


*ensure that external carers and families are reassured and supported to enable
the person to remain living in the community.

Service Description

The service is delivered by a team of Occupational Therapists, Nurses, Mental Health Nurses, Physiotherapists and Rehabilitation/Social Care Support Staff.

The service can support people who are medically stable but require health or social care support to stay in their own home. Following receipt of a referral, the Urgent Care Co-ordinators will pass the case to the crisis team to respond within two hours to assess the person’s needs. The service offers time-limited intervention which promotes the individual's independence and enables them to re-learn old skills and abilities. After this the service will transfer the ongoing care to the most appropriate community service, if required. Elements that the team can support include: Occupational Therapy (everyday activities supporting independence; Physiotherapy (mobility and movement); Nursing (rehabilitative nursing); Community Care Officers (social care); Rehabilitation Support Workers (RSW) and Assistant Practitioners (AP); Home Care Support Workers. Home Care Support Workers can help people with medication prompts; personal care (washing/bathing, dressing, toileting); shopping and assessment of low level community equipment needs.


Days/hours of operation

Comprehensive multi-disciplinary support is available between 8am and 10pm, seven days per week including Bank Holidays.
A reduced clinical staffing model operates between 5pm and 10pm.

Referrals

Referrals are accepted from health or social care professionals involved in the care of an adult experiencing a health or social care crisis
where there is no need for medical intervention. Referrals are accepted from the Falls Rapid Response Team where an ongoing
need for short term support is required.