Community Coordinator Age Well

7 days ago


Towcester, Northamptonshire, United Kingdom Northamptonshire Healthcare Foundation Trust Full time

Job summary

As a Community Coordinator in one of the local Age Well Teams you will be responsible for undertaking comprehensive holistic assessments of identified frail older people, usually in their own homes, to create personalised care plans which will assist the person to live well in their own environment, manage their long-term conditions, reduce isolation and improve their general wellbeing and quality of life.

Candidates therefore need a range of experience, including hands on clinical care in a health setting, as a Health Care Assistant or similar, and be passionate about providing effective support to our older population within the community.

A good understanding of services available both within the community and hospital and an interest in frailty so patients can be supported is essential.

As a Community Coordinator you will co-ordinate referrals to ensure patients within the locality receive excellent and timely support. The ability to develop close working relationships with other health and social care partners is an essential aspect of this role. Every team member will have direct access to their local Befriending lead, and lead support workers for Falls and for Dementia.

Through additional training if required you will identify low level equipment needs and instruct for these to be provided and identify how technology can be used to maintain independence and help self management of long term conditions and instruct for digital solutions to be provided.

Main duties of the job

Make initial welfare telephone calls to persons including A&E discharges to identify needs.

Liaise with GPs and practice teams to identify persons who are elderly, frail or who have long term health needs and support Arrange, coordinate and undertake initial home visits and assessments of need within a patient's own home, making relevant referrals to local service provision. Undertake basic health checks such as weight, nutrition, blood pressure monitoring, temperature and personal care needs. Support persons within the community to be able to remain as independent as possible within their own home and reduce the risk of crisis support. Tasks may include but not limited to assessment and provision of low level mobility aids, house clearance and cleaning, provision of items to meet basic needs such as emergency food parcels, supporting individuals with housing, finances, medication and follow up appointments. Coordinate and attend PCN Frailty Clinics. Work alongside families and a person's wider support network, ensuring their choices, needs and support within their own home are met as a long-term plan. Helping persons to access existing groups and events taking place within their communities. Document and monitor aspects of patient co-ordination and service delivery, supporting data collection and audit using the practices clinical system as well as organisational data systems

About us

NHFT is an integrated primary care and mental health Trust, providing physical, mental health and specialty services in both hospital settings and out in the community. Because we put the person at the centre of all we do, we focus on delivering care that is as easy to access as possible. This means many of our services can be provided at home, work or in also provide health services to various prisons and detention centres in Bedfordshire and Cambridgeshire.

NHFT promotes a culture of learning to improve the care and safety of our patients and staff, which focuses on people who enable our Trust to be 'outstanding' by supporting opportunity, innovation, development and growth.

Job description

Job responsibilities

For further information on the advertised role, please refer to the job description located under the Supporting Documents heading. The full person specification can be accessed under the About You Section of the document.

Person Specification

Knowledge and Experience

Essential

HCA experience or equivalent Previous NHS experience Hospital or Community Understanding of physical and mental health needs IT Literate Able to work within a team oWorking knowledge of a wide range of therapy equipment and how to safely fit and use it.

Skills and Abilities

Essential

Evidence of extended competencies especially with patients in the community Ability to communicate confidential and sensitive information in written and verbal formats. Good time management and prioritisation skills. oAbility to communicate with a diverse range of people from various backgrounds
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