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Metrohealth  Integrated Care

 

 We offer integrated care to support our over 65 year old population and their carers.

 

By reviewing the cases of those who are frail or where care or support can be improved we work with you and our integration partners to identify your needs and address them.

 

We can only do this if you allow us to do this (consent) and this will enable us to appoint a care coordinator to your case to supervise your care plan.

 

We will meet with you and your carer (if you have one) to review your case, identify your concerns and needs and help to address them.

 

We will also help you to be better informed about how to manage and maintain your health.

 

We will put our partners in touch with you to help support you when needed; this might follow a discussion about your particular concerns and needs by the integration team.

 

Our partners who are represented in our integration meetings include Hillingdon Social Services, Hillingdon Hospital, Community nurses and Mental Health teams, Specialist Nurses eg. For patients with diabetes, heart or lung problems. Voluntary organisations we work with include Age UK,  Hillingdon Carers,  Mind,  Dash and the local hospice who can provide community and overnight support when needed

 

We will feed back to you the outcomes of your case discussion by sharing this in your care plan and as a result we hope that you will feel better supported and more confident in your future. We will also encourage you own your health and help you to set goals for the future.

 

Your care plan will belong to you so that those that are involved with you and your care can refer to it and update it. It will be reviewed regularly with your care coordinator.

 

 

 

 
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