The @home service is provided in the best place for the person, which could be in their own home, or, if the team feels someone needs more in-depth assessments or diagnostic tests to better understand their health and care needs, they will ask them to visit the @home community doctors, nurses, therapists and social care team who are based at Epsom Hospital.
This team will thoroughly review the person’s situation and needs in the @home Community Assessment and Diagnostic Unit (CADU) and then arrange the required services. For example, for equipment to be delivered at home or for visits from doctors, nurses, physiotherapists, occupational therapists, community matrons or social care re-ablement assistants. The review could take a few hours, so people are given drinks and meals if necessary while they wait for the assessments, tests and results. Friends or family members are welcome to attend as well, and the CADU team can arrange transport if required.
The @home team will arrange additional short-term support at home for people who run the risk of becoming acutely unwell or who need extra support after being discharged from hospital. If someone’s care needs to be coordinated for longer, they will be supported by the specialist @home community matrons and dedicated care coordinators (who arrange all of the care someone needs at home).
The @home team will liaise with the individual, their family and carer(s), and communicate with each other to organise the care and services the person needs. This may include, for example, organising assessments or diagnostic tests, equipment to be delivered and set up at home, arranging outpatient appointments or transport, or arranging visits from community matrons and therapists.