Most people who are admitted to hospital for treatment go home after a few days and are able to look after themselves.
But not everyone can go straight home. Some people may need extra help and support to enable them to return home following their stay in hospital. So an assessment of their needs is made to find out what extra support they need.
Here are some answers to frequently asked questions:
What happens when I am ready to leave hospital?
Health professionals and council social workers will work together to make sure that your discharge from hospital is planned with you and your carer.To do this, medical and nursing staff will discuss with you:
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any further treatment and discharge arrangements;
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follow-up appointments at the hospital;
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any aides/adaptations you may have at home;
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the kind of community health support (from a doctor/district nurse) you can expect, if this is appropriate a referral would be made by the nursing team;
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if it is identified that you need help with personal care, then with your consent a member of the nursing team will contact the council and ask for an assessment of your needs.
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How does the assessment process work?
Once a referral for an assessment is received, the team manager for the social work team at the Queen Elizabeth Hospital will decide who would be the most appropriate worker or team to help you.
This may be a worker from either the hospital team or a team based near where you live.
This worker will undertake, with you, an assessment of your needs that will help us understand your circumstances and what help you need to stay independent in your own home.
As part of our assessment with you we will look at the following areas:
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How you manage daily living tasks;
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Whether it is safe for you to go home;
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What sort of support you need with personal care;
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What support your carers need.
An assessment may involve a social worker/assessing officer, physiotherapists, or occupational therapist. A visit to your home may also be arranged and rehabilitation may be discussed with you at this time.
Once the assessment is done, the worker will discuss your needs and what options/support services are available to meet your needs.
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What are the options that are available?
These include:
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Intermediate Tier - short-term support in your own home, for you to regain daily living skills so that you can cope when you go home;
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Alternative Housing - this may include sheltered accommodation and Housing 21 schemes;
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Aids and Adaptations - aids are provided or adaptations made to your home so that you can return. It may be necessary for you to consider temporary accommodation while adaptations are completed.Your assessing worker will be happy to discuss this with you;
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Support at home, which could include home care, support from voluntary agencies, day care, or help from district nursing services;
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The Expert Patient programme - This is a new approach by Government; to help patients take more control of their health treatment, be key decision makers in their own care and, be more empowered.
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Assessment
If it is determined that you are medically stable and ready to leave hospital, but are unable to return home safely, you may need an assessment of your long-term circumstances.This would be done away from the hospital.
This means that you will need to move to temporary accommodation which will give you an opportunity to have your assessment and some rehabilitation to see if you can manage at home. It will also show us which areas you need help with.This may incur a charge.
Residential care
If, after your assessment and period of rehabilitation, you need to live in a residential home and the home you choose has no vacancies, then you would need to move to another similar home until a vacancy becomes available in the home of your choice.
Your assessing worker will discuss all these aspects with you and your carers/advocates where necessary.
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Assessment of the needs of Carers
When you are offered an assessment of your needs, a relative or friend who cares for you is entitled to ask for their needs to be taken into account. Your carer can ask to have their assessment carried out with you or separately on their own.
Your carer’s needs would be taken into account when preparing a Care Plan, which is acceptable to you both.
Support and advice for carers is available from:
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What other information is available
There is a duty social worker available for part of every day - Monday to Friday - should you and/or your family have immediate concerns.
They have knowledge of the many services and organisations that can be of help to someone who is in hospital and will liaise with them on your behalf.
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What if I live outside of Gateshead?
With your permission, a member of the nursing team can make a referral in the usual way to the hospital team. If an assessment of your needs is required this will be organised with your home authority.
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How can I contact the social work team in the hospital?
The telephone number for the social work team at the Queen Elizabeth Hospital is 0191 445 2200. Please use this number if you are calling about a Gateshead resident in another hospital.
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What happens if I am not satisfied with the help I am getting?
You should contact the team manager at the appropriate social work team who will listen to your concerns and attempt to resolve them.
Or use the 'Have Your Say' online form|.
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