We aim to provide a service by moving more care out of hospital and into the local community, closer to people’s homes to improve health, maintain independence; looking for an alternative to hospital admissions. The @Home Service have a team made up of doctors, advanced nurse practitioners, registered nurses, health care support workers, physiotherapists, occupational therapists, speech and language therapists, dieticians, mental health nurse practitioners and administrators.
Our overall aim is to offer a single point of access and clinical triage followed by clinical intervention at an appropriate environment, including consultant-led assessments, initial responses, integrated assessment and community IV intervention.
Patients 18 years and over who live in the Cwm Taf Morgannwg area who:
Yes, providing they live in the Cwm Taf Morgannwg area and are 18 years and over. This includes residential and nursing home residents. Where possible, a referral form also needs to be completed.
Monday to Friday (8:00am – 4.30pm) and Saturday to Sunday (8:00am – 4.30pm) for treatment interventions only.
Our @Home Team will contact patients by telephone to arrange a date for an appropriate assessment or care intervention.
This assessment will either take place at Dewi Sant Hospital or the patient’s home.
It may be necessary to refer some patients to Core Services within our Health Board, or offer direct referrals to Local Authority/Voluntary agencies.
If referrals are considered to be inappropriate, they will be directed back to the referrer.
Once the @Home Service has completed their intervention, patients will be discharged from the service back to their GP, and a summary report will be provided.
All General Practitioners within Cwm Taf Morgannwg University Health Board are able to refer to the service.