As health and care providers, our ultimate goal is to get the people in our care well enough to return to the place they call home, safely and with the support that they need to stay there.
One of the teams that play a big role in supporting people to get home and stay home is the Health Improvement Team. Part of Salford Council, team members are embedded within some of the key teams throughout Salford Care Organisation to help the people in our care and connect them with support out in the community.
Positioned within the Adult Health & Social Care Contact Team (AHSCCT) sits a member from the Health Improvement Team, Teresa Tocher, who can intervene and help people find the support they need to keep them get well at home and avoid wait lists and unnecessary referrals all within 48 hours of contact.
When someone is referred to Teresa, her first task is to get their full story. This helps her to get an understanding of the issues that need tackling first. Some of the key areas that Teresa can help people address are loneliness, housing support, debt management, bereavement, hoarding and signposting to community support such as legal aid.
With Teresa’s intervention, the people she has worked with have been able to avoid long wait lists, lengthy stays in hospital, and sometimes avoid hospital admission altogether.
The Health Improvement Team is also on hand to help the people in our care get home as soon and as safely as possible. Sat within our Home First Community Multidisciplinary Team Hub is Health Improvement Team member Emma Mcleod, who helps support patients due to return home.
Emma can help to solve a number of the issues people face when nearing the time to go home such as, making sure their heating and electricity is working, that they have a way to get into their home, that they have a ride home, that they have fresh clothes and shoes to wear, that the necessary equipment to support their recovery is fitted and much more.
She is even able to ensure there is fresh bedding on the bed, the house is nice and clean and that there is food in the fridge for when the person gets home.
She is also on hand to help while the patient is still in hospital, discussing with them some of their worries about their stay in hospital and about their return home. It can be as simple as ensuring their pets are cared for, or as complex as arranging for cooking and budgeting support for someone who is recently widowed to make the transition back home easier.
By working together across the organisation and across the community we can ensure that our patients are getting the care they need, where they need it and when they need it.