Involving your family and caregivers in these discussions is recommended.

 

What happens while you’re in hospital

If you need care and support after you leave, staff will talk with you about how you can get this. They will work with the family, caregivers and social services staff, if necessary, to plan your short-term care.

If you’re likely to have long-term health and care needs, social services will arrange a care needs assessment. This may occur while you’re in a hospital or in your home.

 

Preparing to go home from the hospital

If you can manage on your own at home with a little help, hospital staff should make sure:

• Someone is taking you home or you have a taxi, transport from a voluntary organization (like Grange, Masons, Elks, VFW, etc.) or hospital transport.
• You have any medicine or new equipment you need and know how to use it.
• They share information about your care with your physician/surgeon.
• You know the next steps in your care and how to get help from the hospital.
• Local voluntary organizations are there to support you for the first few days, if you need it (Church, Grange, VFW, Masons, Red Cross, Salvation Army, etc.)
• That you home is prepared for your arrival i.e., food available, walkways are clear, contact system set-up, future appointments with physicians/specialist’s set-up or their contact information is provided.

 

When you get home from hospital

 

What to do if you’re unhappy with your hospital discharge

You can complain if you’re unhappy with your hospital discharge, or the discharge of someone you know.

For example, if:

• The hospital plans to discharge you before you think it’s safe.
• You don’t think your discharge assessment was done correctly – Speak to the hospital staff or your MD who arranged your discharge.

 

Care after illness or hospital discharge (rehabilitation)

If you or someone you know has been in a hospital or had an illness or fall, you may need temporary care to help you get back to normal and stay independent.

This short-term care is sometimes called rehabilitation, intermediate care, or aftercare. Rehabilitation is a type of care that helps you relearn how to do daily activities, like cooking meals and bathing.  Most people who receive this type of care do so for around 2-3 days for each day in the hospital.  It will depend on how soon you are able to cope at home.

 

When you can get short-term care and how to get it

After a fall or short illness

Care can help you avoid going into hospital if you do not need to.

If you or someone you know falls or needs help because they’re ill, speak to your Primary Care Provider (PCP), surgeon, nursing staff or social services.

They may be able to arrange for someone to come to your home and discuss what you need.

If you have started to find everyday tasks difficult

You can get help with daily tasks. This can help you learn new ways of doing things before needing paid home help.

What care you can get

A team could be a mix of people from your local hospital, specialist, and social services will help you do the things you need to do to stay independent.

This might include getting dressed, preparing a meal, grocery shopping, bathing, or getting up and down stairs.

They might care for you at first but will help you practice doing things on your own.

Your team might include:

• A nurse
• An occupational therapist
• Physical therapist
• Speech and language therapist
• Social worker
• Healthcare Provider
• Caregivers

They’ll start with an assessment that looks at what you can do. You’ll agree together what you want to do and set out a plan.

The plan will include a contact person who’s in the team and the times and dates they’ll visit you.

 

What happens when aftercare finishes

When aftercare finishes, your team should work with you and your family or caregivers to agree what happens next.

This should include:

• Other care you might need, such as home help.
• How you can refer yourself again if you need to.
• What you should do if something goes wrong.
• Information about what other types of support or equipment might help.

Ask your team’s contact person about what happens next if your aftercare is coming to an end.

Reference:  much of above taken from UK NHS Website Content under the Department of Health and Social Care

 

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