How social care is organised after discharge from hospital
Being told that you are ready to leave hospital is positive news. But 20% of mainly elderly people also need to have social care organised. This enables you to stay well, and prevent readmission to hospital. It is sometimes called a ‘social package’; which can mean many different things, depending on your needs.
And it is complicated, very [“Thanks, we thought you might say that”, MyHSN Ed]. There are a lot of options. Which one happens depends on your:
- Needs (e.g. whether medical or social or both)
- Diagnoses
- Life expectancy
- Financial situation.
So, how is social care is organised after discharge from hospital? We will now go through the options. You may need more than one of these.
Reablement
This a focused, time limited care package to get you back on your feet. It is sometimes called intermediate care, or aftercare. It is a type of care that helps you relearn how to do daily activities, like cooking meals and washing.
Most people who receive this type of care do so for around 1 or 2 weeks; although you can have it free for a maximum of 6 weeks. It will depend on how soon you are able to cope at home.
If you need further support after 6 weeks, you will be given a plan for transferring to another service. Ask your local authority’s social services for a free needs assessment if you have not already been assessed.
But you may have to start paying for care yourself.
NHS continuing healthcare (CHC)
This can start after reablement finishes.
If you have a complex health condition which means you will require significant, ongoing health care after leaving hospital, you could be eligible for NHS Continuing Healthcare (CHC). CHC is a care package for people with complex medical needs that is fully-funded by the NHS.
Your eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition. If your needs change then your eligibility for NHS continuing healthcare may change.
NHS-funded Nursing Care (FNC)
This can also start after reablement finishes.
If you need to move into a care home but you do not qualify for NHS Continuing Healthcare, you might be eligible for NHS-funded Nursing Care (FNC). FNC is funding provided by the NHS to cover the cost of care by a registered nurse in a residential or nursing home.
Council-funded healthcare
This can also start after reablement finishes.
You may not be eligible for either NHS CHC or FNC. This can be the case, for example, if you have ‘pure social health needs’ (say dementia) but no active medical problems. Then you may be eligible for council-funded care (either carers or a nursing or residential home).
If requested, someone from social services at the local authority will evaluate your care needs. They will carry out an assessment. If personal care needs are confirmed, they will assess your financial means, check whether you are eligible for paid assistance, and then organise it. You may have to part-fund this care.
Private or self funded care
This may be necessary if you are not eligible for council-funded or NHS healthcare.
Another NHS services, e.g. rehabilitation
Another NHS service – e.g. palliative care
This is called Fast-track assessment for NHS continuing healthcare. If your health is deteriorating quickly and you’re nearing the end of your life, you should be considered for this fast-track pathway; so that an appropriate care package can be put in place as soon as possible – usually within 48 hours.
Assisted living aids – e.g. wheelchairs, specialist beds, or aids and adaptations such as stairlifts.
Voluntary organisations – e.g. Age UK provides companionship and home support.
Summary
We have described how social care is organised after discharge from hospital. We are sorry it is so complicated. Who pays for all of this partly depends on your long-term conditions, needs and financial situation.
Last Reviewed on 11 March 2024