Admission to Residential Care Admission to Nursing Care Admission to Hospital Extended Hospital Stay Increase to Home Care Package & Day Care Services Admission to Emergency Respite Increased Demand on an Informal Carer Other (please specify) Please refer to your Referral Guide for Health & Social Care Services” for further “Telecare guidance, to download a copy go to Alternatively telephone 01227 775671 to request a copy. Risks/Incidents Prompting Potential Possible Telecare Support Y N Referral Benefit Options Safe & Secure at Home - Smoke & Socially Isolated CO Detectors & Bogus Caller Button Feels unsafe in their home Safe & Secure at Home Package Fallen and/or at risk of repeated Falls Package - Detector, falls automated Lighting Forgetful or disorientated at Memory Support Package – home and when leaving Property Exit, Smoke & Flood property Detectors, Heat Sensors Previous house fire, near miss or Safe & Secure at Home fire risk identified There have been safety Safe & Secure at Home Package or concerns e.g. unlit gas, burnt Memory Support Package food/pans Unable to control Temperature Extreme Sensors heating/thermostat Left water taps running/risk of Detector flood Forgets to take medication on Activity Reminders/Medication time/needs prompting to manage Dispenser daily activities Epileptic requires support in Epilepsy Detector, DDA event of seizure Solution Learning Difficulties – independent living support Safe & Secure at Home Package required Requires night time assistance DDA Pager Solution Enuresis Sensor, DDA Pager Incontinence problems Solution There is concern about the Safe & Secure at Home Package being of an informal carer SUPPORTING INFORMATION: have there been any examples/consequences of the issues – identified above? If so, how frequently, and what are the concerns as a result? Are the concerns during the day or night-time? How are any risks managed at present? Please include the person or carer’s perspective.
Admission to Residential Care Admission to Nursing Care Admission to Hospital Extended Hospital Stay Increase to Home Care Package & Day Care Services Admission to Emergency Respite Increased Demand on an Informal Carer Other (please specify) Please refer to your “Telecare Referral Guide for Health & Social Care Services” for further guidance, to download a copy go to Alternatively telephone 01227 775671 to request a copy. Risks/Incidents Prompting Referral Y N Potential Benefit Possible Telecare Support Options Socially Isolated Safe & Secure at Home - Smoke & CO Detectors & Bogus Caller Button Feels unsafe in their home Safe & Secure at Home Package Fallen and/or at risk of repeated falls Falls Package - Detector, automated Lighting Forgetful or disorientated at home and when leaving property Memory Support Package – Property Exit, Smoke & Flood Detectors, Heat Sensors Previous house fire, near miss or fire risk identified Safe & Secure at Home There have been safety concerns e.g. unlit gas, burnt food/pans Safe & Secure at Home Package or Memory Support Package Unable to control heating/thermostat Temperature Extreme Sensors Left water taps running/risk of flood Detector Forgets to take medication on time/needs prompting to manage daily activities Activity Reminders/Medication Dispenser Epileptic requires support in event of seizure Epilepsy Detector, DDA Solution Learning Difficulties – independent living support required Safe & Secure at Home Package Requires night time assistance DDA Pager Solution Incontinence problems Enuresis Sensor, DDA Pager Solution There is concern about the of an informal carer Safe & Secure at Home Package SUPPORTING INFORMATION: – have there been any examples/consequences of the issues identified above? If so, how frequently, and what are the concerns as a result? Are the concerns during the day or night-time? How are any risks being managed at present? Please include the person or carer’s perspective.
telecare-referral-form.docx