Let’s get you home to what matters to you

When am I going home?

We know that it’s much better for your physical and mental wellbeing to leave an acute hospital as soon as you are medically ready to do so. That’s why we are doing everything we can to reduce prolonged hospital stays and ‘get you home to what matters to you, this can be to your beloved pet, your favourite armchair or simply using your own tea bags again. If you can’t go straight home, we will work with you to provide an alternate place most suited to your needs.

Once we are happy that you can be discharged, your hospital bed will become available to another person who needs a high level of care.

‘When am I going home?’ – Colin’s hospital to home story

Why your hospital discharge is important

When you no longer need hospital care, it is better to continue your recovery at home or at another location in the community. This is because:

  • Nobody wants to stay in hospital any longer than is necessary.
  • Being in hospital with others who are unwell can sometimes expose you to infection.
  • Extremely poorly patients may not be able to access an urgent hospital bed if they are occupied by patients who no longer need them.
  • Meaningful and accurate assessments of your needs, as well as long term decisions about your care, are better made when you are outside of the hospital.
  • If you stay in bed for long periods, you will lose muscle strength.

What we will do for you and how we will help prepare for discharge…

As soon as you arrive in hospital, our main priority is to get you better again so you can return to the comfort of your own home, or a suitable alternate place.

Your nurse will be responsible for planning your care and discharge with you and your family/carer. To read more about your time in hospital visit: About your stay and discharge – United Lincolnshire Hospitals (ulh.nhs.uk)

Never be worried about speaking to staff in charge of your discharge to make sure you have everything you need. This includes a date, care plan and equipment. It is also very important that you ask 4 questions every day when you see the team caring for you:

  • What is the matter with me?
  • What is going to happen to me today?
  • When am I going home?
  • What is needed to get me home?

You’ll be involved in the discharge planning and agree a care plan together. This should include things like:

  • treatment and care when you get home
  • who’s in charge of your care and how to contact them
  • when and how often you need care

How you can help with your discharge?

  • How you can help with your discharge?

    To help us help you there are a number of things in which you can do to help make the process smoother. These things include:

    • arranging for a relative or friend to collect you when you are being discharged, or let the staff know if they need to make other transport arrangements for you.
    • making sure you have everything you need for your recovery, (It may be helpful to ask a friend or relative to stay with you or visit regularly. If this is not possible, make sure you have plenty of food, drink and other essentials at home).
    • If you’re sent home with a medical device, make sure you know how to set it up and have been taught how to use it.

    Other things you can do to help:

    • provide a forwarding address for any post
    • collect your hospital discharge letter for your GP or arrange to have it sent directly to them
    • ensure you have the medication you needget a copy of your care plan (if applicable) – if you’re being discharged to a care home, the home should be told the date and time of your discharge, and have a copy of the care plan`arrange your follow-up appointment if you need one
    • ask for any medical certificates you may need

    If you require help with the above or for further information on leaving hospital along with other guidance please visit: Discharge from hospital: What support will I get | Age UK

  • What if I have housing issues?

    When you are admitted to hospital it is important to consider whether you will have accommodation to return to.

    Please consider:

    • If your home may be unsuitable for your medical needs.
    • Whether a long term stay in hospital may have an effect on your rent payments and tenancy.
    • If you have nowhere permanent to stay.

    Please tell your ward nurse if you have housing issues. There is a Homeless Team in the hospital who will provide advice and guidance.

What can I do as a friend, family member or carer?

  • What can I do as a friend, family member or carer?

    We understand that the hospital process can be stressful for those involved, especially when it comes to discharge. However, it’s important to understand that your loved one or the person you care for are more likely to recover quicker in a home environment.

    Once they’re admitted to hospital, their treatment plan, including details for discharge or transfer, will be developed, and discussed with them. A discharge assessment will determine whether they will need more care after they leave hospital.

    They should be fully involved in the discharge process and with their permission, you will also be kept informed and given the opportunity to contribute.

    If your loved one / the one you care for has been able to return to their home, there are things you can do to help. These are things such as:

    • Picking them up from hospital when they are ready to be discharged
    • Staying with them until they re-gain their health / confidence or visit regularly
    • Make sure they have everything they need for their recovery
    • Get food, drinks, and other household essentials in ready for them to come home
    • Check their home for any potential hazards, such as rugs which could cause trips.

    However, if they are not able to return straight to their home there are other options which will be explored. This could be a recovery bed in the community or into a care home, but this will be discussed in hospital with the staff member in charge or a member of the Adult Social Care Hospital Team.

After you are discharged

  • Follow up appointments

    If you need a follow-up appointment or any further investigations, we will arrange this before you leave, or will contact you as soon as we can when you get home.

    When you are discharged, we will send a letter to your GP explaining the reason why you were in hospital. This will tell your GP everything they need to know about your stay in hospital, your medication and your discharge location.

  • Help at home

    If you need help at home when you are discharged, community support services will be arranged before or upon your return.

  • Information for carers and family members

    If a family member or a friend care for you on a regular basis, they can access free support and advice from Support and benefits for carers - NHS (www.nhs.uk) and may be eligible for a carer’s grant.

    For more information on grants visit: Benefits and financial support if you're caring for someone - GOV.UK (www.gov.uk)

    If you would like a copy of this information in leaflet form to be given to someone else, please speak to your nurse or discharge coordinator.

  • Further assessments

    Once you have been declared medically well, you may require further health and social care assessments. These will be completed outside of the hospital setting and wherever possible, within your own home.

    Our Transfer of Care Hub has a range of services in place to help you to return safely to your own home. If you can't return home when you are ready to leave hospital, your assessment will be completed in the place you go to on discharge.

    If you need support at home, the Adult Social Care Team will arrange this prior to discharge and complete an Assessment of your needs when you are at home. If a Carers assessment is required, this will be completed either before your discharge or once you are at home.

  • Age UK

    Age UK Lincoln & South Lincolnshire also offer many services to make the post-discharge process more straightforward for all. These are services such as:

    • Personal care
    • House clearance
    • Laundry service
    • Lifestyle support
    • Cleaning

    More information can be found at: Services Booklet (ageuk.org.uk)

Next steps after leaving hospital

  • Temporary care

    If you have had a short illness or an operation, you might only need care for a short time to get back to normal. The aim of this type of short-term care is to help you:

    • look after yourself rather than having someone care for you all of the time
    • stay as independent as possible
    • avoid unnecessary hospital stays

    (Most people receive this care for around 1 or 2 weeks) Read more here: Care after illness or hospital discharge (reablement) - NHS (www.nhs.uk)

  • After care costs

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

    This short-term care is sometimes called intermediate care, or aftercare. Reablement is a type of care that helps them relearn how to do daily activities, like cooking meals and washing.

    Most people who receive this service usually only need a couple of weeks but, if necessary, it can be available for up to 6 weeks free of charge. However, if long terms needs are identified earlier, the service will end.

    If they need care for longer than 6 weeks, they may have to pay for it.

    For more information visit: Care after illness or hospital discharge (reablement) - NHS (www.nhs.uk)

  • Ongoing and transitional care

    Returning you back to the comfort of your own home is a priority for us, however, sometimes this may not be the best option for your health.

    Bridging the gap between hospital and home to maximise recovery and promote independence Lincolnshire Community Health Service (LCHS) is working Alongside Lincolnshire Reablement Service to develop a range of reablement services to promote faster recovery from illness, prevent admission into acute hospital or residential care, support timely discharge from hospital and maximise independent living.

    LCHS wish to make your stay with them as pleasant as possible and aim to return you to your normal place of residence as soon as you become well enough and no longer require transitional care. More information can be found at: Transitional Care :: Lincolnshire Community Health Services NHS Trust and Community Hospitals :: Lincolnshire Community Health Services NHS Trust

  • Care Homes

    If all other options have been explored and they are still not suitable for your needs, another option may be going into a care home, however,

    all efforts will be made to support you to return home. More information can be found here: Care homes – NHS (www.nhs.uk) or on the Age UK’s website Care homes | Information and Advice | Age UK

Will I need to pay for my care?

  • Provision of care in your own home

    If it appears that you have longer-term social care needs, Lincolnshire County Council Adult Social Care can offer you an assessment, which will determine the level of care and support you require. This may take at home, in hospital or in a community hospital or a Care Home setting.

    Adult Social Care can give you information and advice or, if required link you into other appropriate services.

    Adult Social Care staff will talk to you about which services are chargeable. If you receive services, you will need to complete a financial assessment form and any charges will apply from the start of the service.

    A package of care and rehabilitation may also be provided by the NHS. This is subject to assessment by the team on the ward.

  • NHS Continuing Healthcare

    If you have a high level of health or care needs the ward team involved in your care may complete an NHS Continuing Healthcare assessment. NHS Continuing Healthcare is a package of services arranged and funded by the NHS for people outside of hospital with complex continuing health needs. These services can be provided in your own home or in a care home with or without nursing. This assessment can also take place in the community.

  • NHS-Funded nursing care

    People with lower nursing needs who require a care home with nursing may be eligible for a weekly contribution towards registered nursing care. Your ward team can advise you on this.

    For more information, please ask for the leaflet: NHS continuing healthcare and NHS-funding nursing care - public information booklet. It is also available at this link: Public information leaflet: NHS continuing healthcare and NHS-funded nursing care - GOV.UK (www.gov.uk)

Partner toolkit

Find out how you can make a difference in reducing long stays for patients in hospital. Making this happen is a team effort and we all have a part to play. Download our resources to use across your digital and social media platforms.

Two healthcare professionals and a female patient 'Think 'Why not home? Why not today?' every day

Staff Hub

Find out how you can make a difference in reducing long stays for patients in hospital. Making this happen is a team effort and we all have a part to play. As healthcare professionals, there are several practical actions you can take to help get patients to the best place for them. Visit the staff hub.