48 hours per fortnight
The Transition Care Program (TCP) was established in 2005 as a joint partnership between the Commonwealth and State Governments. The program became operational in 2006.
TCP provides what can be considered slow stream rehabilitation care in unfunded beds or in the community (home) for people who have been inpatients of an acute or subacute facility. The aim is to transition people back to being independent in home and to avoid premature admission in to long term residential care. The program is designed on a patient centred model of care that can improve patient flow and patient outcomes.
The TCP Guidelines can be accessed on the Department of Health and Ageing website at www.health.gov.au/internet/main/publishing.nsf/Content/ageing-transition-guidelines.htm
Since August 2009 our Wodonga Campus has operated 2 bed based and 2 community based TCP places. This number will be expanding to a total of 16 places through September and October 2010.
We now seek to appoint 2 Care-Coordinators, one of whom will have the lead role in managing the service.
Care coordinator responsibilities include:
- attendance and participation at relevant discharge planning meetings and case conferences to facilitate early identification of suitable clients for Transition Care
- working collaboratively with the discharge planner and ACAS to ensure a timely and consistent approach to Transition Care
- providing information, support and education to ensure client's and carer's participation in the decision making process
- responsibility for implementation of the care plans that is goal centred
- ongoing assessment of clinical needs of residential and community based clients and implementation of appropriate interventions when required
- coordinating referrals to support achievement of the care plan
- assessing self management capacity and working with clients to identify and achieve self management objectives
- identifying and organising opportunities for better access to services and community connectedness for clients recruited to the program
- when necessary, undertaking an advocacy role on behalf of clients and /or their carers
- facilitating exit planning through to case closure with clients and their carers
The Lead role will also:
- Develop, oversee and implement Transition Care at Wodonga Hospital
- Develop transition care tools, procedures and protocols
- Develop collaborative relationships with internal and external service providers for acute, sub acute, residential and community
- Maintain data collection and reporting requirements
- Remain aware of budgetary limitation and adhere to both program and organisational policies and procedures related to expenditure
- collaboration with Department of Health and regional TCP providers
The successful applicants will have excellent interpersonal skills and be competent at working both autonomously and as part of a team. They will be able to develop and maintain strong and effective relationships between acute, subacute and other service providers, contracted bed (residential care) providers, and of course with clients, carers and their families.
A sound understanding of the health system and issues associated with ageing, functional decline and rehabilitation is essential.
Salary and conditions of employment will be according to qualifications and experience. It is essential that applicants, where relevant, hold current registration with their professional Registration board. A current drivers' licence is also a requirement.
Wodonga Campus has a commitment to providing professional development opportunities and support for all staff.
Further information regarding these positions can be obtained through contacting Sue Thomas, Director of Allied Health on 02) 6051 7400
Applications addressing the selection criteria, with CV and referee information should be forwarded by no later than 5pm on Friday 11th June 2010 to:
Director of Human Resources
Albury Wodonga Health
Wodonga Campus
PO Box 156
Wodonga Vic 3689
