Personal Independence Coordinator

3 weeks ago

Canterbury, United Kingdom Age UK Canterbury Full time

**Purpose of the Job**

This is an innovative role which forms part of the charity’s Integrated Care Team which is being developed to improve the coordination and quality of personalised care interventions and health outcomes for individuals, their carers and families. The service offers up to a maximum of 12 weeks’ intensive, free support to those that need help to remain independent and improve their health and wellbeing. The service is commissioned by Ashford and Canterbury Clinical Commissioning Groups. The post holder will offer a consistent supportive presence, avoid duplication of service provision by other agencies and ensure that care and support is personalised and timely. To achieve this, you will be working closely with a dedicated team of volunteers.

You will work within the Ashford and Canterbury CCG areas to support older people referred by a range of partners, including GP’s, social care and community nursing. This role will focus on supporting people registered with G.P. practices in Canterbury.

**Main Responsibilities**
- To visit individuals at home to undertake person centred assessments (Guided Conversations).
- To ensure each person (client) is supported to live the life they wish to, to the best of their abilities, keeping their lifestyle goals at the forefront of their care planning
- To work with clients to co-develop a goal directed, individually tailored Action Plan. This may involve liaising with relatives, carers and other agencies/ services as agreed with the individual, to ensure an integrated and personalised approach to care and support.
- To monitor/ update individuals Action Plans and submit to GP Practices in order to contribute to shared care planning.
- To assist the individual to build social networks and participate in their chosen activities such as carer support, peer support, exercise, activity, and cognitive stimulation opportunities, and/or enabling them to pursue new and old hobbies.
- To inspire and motivate individuals to make healthier lifestyle choices by entwining options such as physical activities, healthy eating, and long-term condition peer support into their action plans.
- To liaise with other community services to make appropriate links on behalf of individuals.
- Understand and maintain a good working knowledge of the range of support services on offer e.g. assistive technology, equipment, specialists services e.g. hydration, dementia care, police, social care, therapy, handyperson, health trainers, peer support groups
- To establish positive relationships and communication with referrers and colleagues across broad ranging services.
- To introduce (where appropriate) and work alongside volunteers as part of the support team.
- To monitor clients to identify any deterioration in health and wellbeing to highlight any patterns or triggers. Raise alerts as necessary.
- To undertake Community Assessor Training in order to be able to order basic assistive technology and equipment in order to improve the safety and independence of clients.
- To report on outcomes and client satisfaction using agreed tools at agreed time periods
- To accept referrals for the programme and work with colleagues to ensure clients receive the service promptly.
- To maintain accurate records and reporting information. Submitting this to the PIP Service Manager within agreed time frames.
- To attend Multi-Disciplinary Team meetings within GP practices in order to accept referrals, feedback on support being offered, raise concerns and provide non-medical contributions.
- To report issues that could have a positive or negative impact on service delivery or quality to the PIP Service Manager.
- To work within all policies and procedures of the employing Age UK, ensuring that client and carers’ information remains confidential.
- Adhere to NHS Information Governance.
- To undertake such other duties which are consistent with the responsibilities of this post as required by the PIP Service Manager.

**Working Conditions**:

- It is essential that the post holder has a current driving licence and access to a car. Daily travel to home visits will be required. Travel expenses will be paid according to the local employing Age UK policy and procedure.
- The post will involve lone working, visiting people in their own homes, including exposure to dealing with difficult and emotional circumstances/situations.
- It is essential that the post holder is prepared to work with clients, GP practices and local Age UK’s across the Ashford and Canterbury CCG areas.

**Person Specification-** _This details the experience, skills, knowledge, personal qualities and qualifications required for the post._

**Knowledge and Skills**
- **Essential**_
- Personalised care and support planning skills
- Knowledge of self-care and self-management opportunities
- Understanding of issues affecting cognition and communication
- Appreciation of how long term health conditions may impact on individuals, t

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