Home Support Team of the Integrated Discharge Support Program for Elderly Patients (PWH)
Introduction
Background
Prince of Wales Hospital (PWH) has launched the Integrated Discharge Support Programme for Elderly Patients in January of 2012. With collaboration of Evangelical Lutheran Church Social Service – Hong Kong (ELCSS-HK), the programme provides transitional home and community support services to the discharged elderly patients in Shatin for an average period of 6-8 weeks.
As an experienced home support team of the programme, ELCSS-HK has established a comprehensive “Medical-Social SMART Care Model” since 2022. The service model mainly adheres to the four principles of “medical-social collaboration”, “home-based”, “co-care” and “self-management”, thereby effectively assessing and supporting the needs of newly discharged elderly patients and their carers, avoiding unnecessary hospitalisations, and promoting ageing in place.
Target Participants
Newly discharged elderly aged 60 and above, residing in Shatin District. The participants are assessed and referred by the Discharge Planning Team of PWH, and in need of rehabilitation, personal care and home care support or supervision services.
Program Objectives
1. The Discharge Planning Team and Home Support Team work as an integrated team to plan for the hospital discharge and to provide transitional community support services to the participants for an average period of 6-8 weeks.
2. To reduce the risk of unplanned hospital re-admission of the participants through better discharge planning, transitional community-based rehabilitation and/ or support services to those in need upon discharge from hospital.
3. To enhance support and training to carers to relieve their stress from post-discharge care of the elderly.
Fees
This is a paid service. The level of service fee is set according to the standard of Social Welfare Department and the financial condition of the participants.
Prince of Wales Hospital (PWH) has launched the Integrated Discharge Support Programme for Elderly Patients in January of 2012. With collaboration of Evangelical Lutheran Church Social Service – Hong Kong (ELCSS-HK), the programme provides transitional home and community support services to the discharged elderly patients in Shatin for an average period of 6-8 weeks.
As an experienced home support team of the programme, ELCSS-HK has established a comprehensive “Medical-Social SMART Care Model” since 2022. The service model mainly adheres to the four principles of “medical-social collaboration”, “home-based”, “co-care” and “self-management”, thereby effectively assessing and supporting the needs of newly discharged elderly patients and their carers, avoiding unnecessary hospitalisations, and promoting ageing in place.
Target Participants
Newly discharged elderly aged 60 and above, residing in Shatin District. The participants are assessed and referred by the Discharge Planning Team of PWH, and in need of rehabilitation, personal care and home care support or supervision services.
Program Objectives
1. The Discharge Planning Team and Home Support Team work as an integrated team to plan for the hospital discharge and to provide transitional community support services to the participants for an average period of 6-8 weeks.
2. To reduce the risk of unplanned hospital re-admission of the participants through better discharge planning, transitional community-based rehabilitation and/ or support services to those in need upon discharge from hospital.
3. To enhance support and training to carers to relieve their stress from post-discharge care of the elderly.
Fees
This is a paid service. The level of service fee is set according to the standard of Social Welfare Department and the financial condition of the participants.
Services Overview
Service Contents
Personal Care
Elderly sitter services
Rehabilitation exercises
Home-making services
Meal services
Transport and escort services
Purchasing services
Simple nursing care services
Counselling services
Day or residential respite
Carer training and support
Referral services
24 hours emergency support
Personal Care
Elderly sitter services
Rehabilitation exercises
Home-making services
Meal services
Transport and escort services
Purchasing services
Simple nursing care services
Counselling services
Day or residential respite
Carer training and support
Referral services
24 hours emergency support
Contact Information
- Unit 1312-13, 13/F, Delta House, South Wing, No.3 On Yiu Street, Shatin, New Territories
- 3703 5511
- 3596 3406
- hhst@elchk.org.hk
Opening Hours
Mon to Sat：8:00am – 6:00pm