Discharge Planner

Faircape Health is extending the subacute care and rehabilitation services of one of our long-term healthcare facilities in Somerset West. We are catering to patients in need of short-term, long-term, dementia, respite, and palliative care within a secure and nurturing environment.

Our world-class care aims to bridge the gap between hospital and home. Our Multidisciplinary Team (MDT) of leading healthcare professionals administers care in the most therapeutic environment possible and supports healing outcomes in all aspects.

Faircape Group is currently looking for a qualified social worker to act as a** Discharge planner / Rehabilitation Coordinator **who will ensure clients achieve their agreed outcomes within the set planned discharge date and also coordinate and manage the discharge planning process at Heritage Manor

**Specific duties include but is not limited to the following**:
Discharge planning:

- Attend and participate in appropriate Multidisciplinary meetings.
- Assist patients and families with discharge arrangement as identified in the Multidisciplinary meetings.
- Scheduling and facilitation of family meetings of patients identified.
- Provide emotional support and refer to a psychologist if ongoing support is needed.
- Advocate for the best interest of the patient.
- Report suspicions of abuse or neglect according to the guidelines set out in the Older Persons Act 13 of 2006
- Provide feedback and communication to the appropriate MDT’s.
- Assist with staff training within area of skill and competence
- Provide health education/promotion written materials or presentations to residents/families

Rehabilitation Coordinator:

- Facilitate subacute viewings
- It is crucial to ensure the patient has a clear understanding of the following after the MDT meeting:

- Goals set by MDT: The specific goals that the multidisciplinary team has established for the patient's recovery, which will guide their rehabilitation program.
- Length of stay based on the goal: The expected duration of the patient's stay at the facility, aligned with the rehabilitation goals and progress benchmarks.
- Medical-aid feedback: Any feedback regarding the medical aid coverage, including whether there's a maximum stay or if additional payment options might be needed.
- Family and patient communication: Ensuring that both the patient and their family are aware of and understand the MDT feedback.
- Confirm discharge dates of patients
- Ensure discharge patient experience surveys are completed and escalated if needed, one day prior to discharge / discharge report / follow up appointment
- Book clients for and manage the post discharge clinic
- Complete the relevant discharge tasks once the patient is discharged
- Ensure specialist referrals are completed and sent through to the referring specialist
- Follow up patients who is being transferred back to hospital

**Requirements**:
**Qualifications**:

- Bachelor's Degree in Social Work

Experience and Knowledge
- Proven experience working in a similar role
- Proven experience in hospital case management discharge planning or related medical field will be beneficial
- Knowledge pertaining to external private and government frail cares and home care services will be beneficial
- Knowledge of the Older Person Act

Skills and Attributes
- Computer literate
- Excellent communication skills (verbal and written)
- Excellent organisational and time management skills
- Deadline driven
- Able to perform under pressure
- Demonstrate respect for the individuality of the patients and families
- Ability to establish and maintain collaborative and effective working relationships
- Demonstrates analytical and critical thinking abilities with proactive decision making and negotiation skills

**Specific Requirements**
- Solid and positive references
- Clear health record
- Clear credit record
- No criminal record

The salary on offer from R 25 000 cost to company. The amount offered will be dependent on qualifications, experience, and other market-related factors.

Working Hours - Normal working hours are 45 hours per week. You will be required to work from Monday to Friday from 08h00 to 17h00 with a 45 minute lunch break and one 15 minute tea break.