Age UK Sheffield’s Independent Living Coordinator Health Services

Patient details:
NHS No: / Combined predictive risk stratification score:
Title: Mr/Mrs/Miss/Ms / First name & Surname:
Address: / Postcode:
Telephone No: / Date of Birth:
GP Surgery: / Referrer name:
Contact number:
Profession:
Is the client aware of the referral? Yes/No / Would you like feedback: Yes/No
Alternative contact & number (e.g. daughter): / Communication needs (please specify):
Are you aware of any risks to our support workers from the patient, family/household members or home environment? Please state:
Long term health condition/s:
Diabetes / Respiratory (COPD)
Heart failure / Dementia
Short term memory loss / Hypertension
Stroke / History of falls
Osteoporosis / Risk of repeat infection
Mental health / Cancer
Other/s (please specify):
Does the patient have a PAMS score? (if yes, please provide score)
Does the patient have a care plan? (if patient has agreed to share, please attach copy)

Please inform us if the patient has:

  1. Two long term health conditions and two or more unplanned hospital admissions in the last year

  1. Two long term conditions with a history of one unplanned acute hospital admission and a
high risk stratification score that indicates a high risk of an unplanned acute hospital
admission.
  1. Two long term conditions with a history of one unplanned acute hospital admission and an unplanned admission to a community hospital. This could also potentially include any other use of health services which represent a demonstrable significant cost.

How the patient could benefit from the service…

Please return to:

Address:Age UK Sheffield, 44 Castle Square, Sheffield S1 2GF.

Email:

Tel:0114 250 2873Fax:0114 250 2860

Age UK Sheffield Independent Living Coordinator Service

The programme is delivered by Age UK Sheffield’s Independent Living Coordinator (ILC) service.

On referral the ILC will visit your patient and help them explore what will help them live independently, manage their health conditions and improve their health and wellbeing. We can help with a wide range of issues such as;

  • Income maximisation, for example helping claim Attendance Allowance and other benefits
  • Managing finances and day to day admin
  • Arranging equipment and adaptations around the home
  • Arranging practical support around the home
  • Help with transport
  • Home safety checks
  • Support getting out and about
  • Support around health care, such as attending hospital appointments
  • Cooking and healthy eating
  • Pursuing interests and enjoyable activities

We also help patients link in with organisations, groups and resources.

We work with patients for up to 12 weeks, during which time we support each referring practice by:

  • Sharing our holistic assessments with health professionals so that the information can be included within patient Care Plans
  • providing weekly update reports via NHS secure email. Reports are usually sent on Fridays.
  • being available (on request) to attend MDTs where the patient is discussed.
  • completing 2 Pam’s Questionnaires for all referred patients, at the start and closure of our intervention and report findings back to surgeries as appropriate on Fridays.

If you would like to make a referral please complete the form attached.