How does the service work?

To help patients who may require care and support on discharge, the Homerton Hospital discharge planning team works with care managers (social workers) and practitioners who are based within or attached to acute hospitals. A multi-disciplinary team – including doctors, nurses, therapists, specialist nurses and care managers carry out the patient’s needs assessments.

The team members will always discuss the patient’s needs and options with the patient and (with the patient’s consent) will also involve their family or carers.

The assessments consider the following range of options:

1. Enabling patients to return home or to another chosen residence to live independently or with support or services such as home care or the provision of specialist equipment.
2. Enabling patients to return home with rehabilitation, intermediate care or interim services in order to help them to live as independently as possible.
3. Where all other options have been explored, to consider a care home placement. This may include submissions to Health and Social Care Panels for the community placement. 
4. Supporting and enabling End of Life care and discharges.

Sometimes making arrangements for people to receive care and support at home may take a while. Where necessary, your care manager or other members of the multi disciplinary team will help you to choose an interim or alternative placement to stay until your home based care or placement within a care home has been identified.

For most of these services there is a local authority means tested charge and this will be explained to you or your carers.

Further information on your discharge from the hospital:

http://www.homerton.nhs.uk/patient-information/your-stay-in-hospital/your-discharge-from-hospital/

Further useful web links

Support and advice:

Michele Amos-Yeo, discharge planning service lead at Homerton
tel: 020 8510 5014 or email: michele.amos-yeo@homerton.nhs.uk

Discharge co-ordinators: Bleep 345 or 347 through the main hospital switchboard.