The process
When a patient is ready to leave the hospital, they’ll receive a discharge plan outlining important details like medications, home care, and other community support services. Copies of this plan are provided to the patient’s GP and, if applicable, to their care home. It’s also essential to review the plan with any family members involved in the patient’s care.
If additional support is needed, a social worker or the reablement team (also called the discharge coordination team) will help with care planning. They coordinate with healthcare professionals and community organisations to set up the necessary support, managed by a team coordinator.
For up to six weeks, the NHS offers free support through Intermediate Care or Reablement services to help patients regain their independence. After this period, ongoing care must be arranged privately or through the local authority. To apply for local authority assistance, the first step is a Care Needs Assessment. If the reablement team hasn’t already requested one, family members can contact the local council to arrange it, provided they have the patient’s permission. Additional information on how to apply is available on the local authority’s website.
Find the Local Authority website here->
Further resources
Local authority services and funding
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