‘Well, what are you going to do when you’re out there?’: a scoping review of successful hospital discharge for people with acquired disability and complex needs aged 18–65 years

Tags: hospital discharge

Description:

Discharge planning is the organisation of medical needs, supports, allied health professionals and community-based rehabilitation services for a person to receive once they leave hospital. This can be a complex and lengthy process when a person has acquired disability and complex support needs. As a result, the experience of transitioning from hospital to home is often stressful. A scoping review by La Trobe University and the Summer Foundation explored peer reviewed studies that reported on hospital discharge outcomes for people with acquired disability and complex support needs. The research presented 4 main principles
relating to successful hospital discharge, which informed 6 recommendations for better discharge outcomes.

You can read summary of the report here.

Citation:

Cubis L., Roseingrave E., Gosden-Kaye E. , Winkler D., Douglas J. ‘Well, what are you going to do when you’re out there?’: a scoping review of successful hospital discharge for people with acquired disability and complex needs aged 18–65 years. Brain Impairment

Summer Foundation – La Trobe University Research Program 2022/2023

Tags: accessible housing, disability support, hospital discharge, NDIS, YPIRAC

Description:

The enduring research partnership between the Summer Foundation and La Trobe University’s Living with Disability Research Centre is testament to what is possible when rigorous academic methods are applied to real-world problems. The research program at the Summer Foundation is unashamedly ambitious. It needs to be in order to address the manifold challenges experienced by people with disability in Australia today.
 
Our Research team consists of more than 20 researchers, including experienced academics, clinical experts, research assistants, and doctoral candidates. They come from diverse backgrounds, including psychology, speech pathology, occupational therapy, physiotherapy and architecture. Together, the team work on more than 20 active projects covering topics as broad as younger people in residential aged care, hospital discharge, the disability housing market, and factors contributing to quality disability support.
 
This report outlines the research undertaken in 2022/23 as part of the program, our aims and our outputs.

Housing Needs and Preferences to Support Discharge

Tags: health professional, hospital discharge, housing

Citation:

The Housing Needs and Preferences to Support Discharge Guide and Template are for health professionals to support a person with disability to describe the housing and support they want and need so that they can be discharged to suitable housing.

Discharge planning toolkit

Tags: health professional, health system, hospital discharge, rehabilitation, training

Description:

This toolkit provides targeted information for hospital discharge staff, and staff in acute and rehabilitation hospital settings, relating to the discharge of people aged under 65 years who have acquired a disability:

NDIS readiness – a toolkit for hospitals

Tags: community, health professional, health system, hospital discharge, NDIS plan, training

Description:

This toolkit includes tailored resources for health practitioners that cover the entire hospital journey for people with disabilities, from admission to discharge back into the community.

First published: July 2018
Last updated: June 2023

Allied health housing assessments guide

Tags: allied health, hospital discharge, NDIS, NDIS housing resources, support coordinator

Description:

The aim of this guide is to assist support coordinators and allied health professionals collaborate on Housing Plans for National Disability Insurance Scheme (NDIS) participants. Housing Plans rely on appropriately framed allied health assessments and reports to support the participant pursue their goals and aspirations.

First published: April 2018
Last updated: June 2023
Updated for accessibility: March 2024

Sample transition NDIS plan

Tags: hospital discharge, NDIS plan

Description:

A transition NDIS plan aims to facilitate a successful and timely discharge from hospital for NDIS participants. It is a 3–6 month plan that acts as a transition to a more extensive plan to be used post discharge.
 
First published: December 2019 as Sample interim NDIS plan
Last updated: June 2023

Urgent access request cover letter

Tags: access request, hospital discharge

Description:

In some circumstances a person may be vulnerable to risk and need urgent supports. For example, they may be going back to live in a community setting with few supports of any kind after they are discharged from hospital, or they may not be able to return home and may be at risk of moving into a residential aged care facility.

Download a Word document template of the letter

First published: September 2019
Last updated: June 2023

Summer Foundation – La Trobe University Research Program 2021/2022

Tags: accessible housing, disability support, hospital discharge, NDIS, YPIRAC

Description:

The Summer Foundation – La Trobe University Research Program is designed to understand the issue of young people in aged care. By researching the issues at each stage of the critical pathways that lead young people to aged care we can provide the evidence needed to create systems change that will solve this problem.

Housing as a barrier to hospital discharge – Policy Position Statement by the Summer Foundation

Tags: hospital discharge, housing

Description:

People with disability who have high and complex needs often get stuck in hospital due to challenges accessing the housing and support needed to leave hospital. The transition from hospital to home requires a coordinated approach between the NDIS and health and housing sectors. Enabling access to appropriate housing and supports when participants are clinically fit for discharge prevents disruptions to patient flow and poor health outcomes stemming from extended hospital stays.

Evaluating the discharge planning process: Barriers, challenges, and facilitators of timely and effective discharge for people with disability and complex needs

Tags: hospital discharge

Description:

Improving the pathway from hospital to the community is the key to reducing the number of younger Australians stuck in hospital and/or discharged to residential aged care (RAC). This report presents preliminary findings from three studies initiated to explore and identify barriers, challenges and facilitators of timely and effective discharge for people with disability and complex needs.

You can read a summary of the report here.

View the poster here.

Citation:

Cubis, L., Ramme, R.A., Roseingrave, E., Minter, E., Winkler, D., & Douglas, J. (2022). Evaluating the discharge planning process: Barriers, challenges, and facilitators of timely and effective discharge for people with disability and complex needs. Summer Foundation and La Trobe University.

Pre Budget Submission (2022)

Tags: hospital discharge, housing, NDIS

Description:

The Summer Foundation is pleased to work alongside the Federal Government to enable significant improvement in the lives of people with disability. The National Disability Insurance Scheme (NDIS) is an incredible social policy initiative, providing life changing opportunities to people with disability.

Hospital Discharge of NDIS Participants with High and Complex Needs – Policy Position Statement by the Summer Foundation

Tags: for policy makers, hospital discharge

Description:

Immediate action is needed to improve outcomes for people with complex disability. Significant reforms of the National Disability Insurance Scheme (NDIS) and health interface systems are needed to reduce unnecessary hospital stays and to prevent younger people with high and complex disabilities from being forced into unsuitable housing and support such as residential aged care (RAC).

 
This report examines the various problems and solutions specific to the NDIS and health interface to minimise extended hospital stays and increase successful returns to community life for people with disabilities.

Capacity building framework training manual

Tags: health professional, health system, hospital discharge, NDIS participant, training

Description:

In striving for best practice outcomes for NDIS participants, a health service may use this resource to provide a framework in the provision of information, training and mentoring to staff for practice change.

Chris’s story – everything’s changed

Tags: disability support, hospital discharge, support coordinator

Description:

Chris shares his journey from hospital to his new home and the value of having good support around you.

NDIS foundations training videos

Tags: health professional, hospital discharge, NDIS, training

Description:

These videos for health services are part of the NDIS Capacity building framework training manual.

• Embedding Practice Change: Health Services and the NDIS
• Introduction to the NDIS (Webinars 1–4)
• NDIS Foundations (Modules 1–3)
• Streamlining Health & NDIS for Better Discharge Outcomes

Health service FAQs

Tags: health professional, hospital discharge, training

Description:

All health services are building their capacity in working with the NDIS and people with disability aged under 65. This resource contains health’ frequently asked questions (FAQs), and answers relating to a number of different topics.

Health services may choose to download the Word version of this resource and add their own FAQs to maximise local relevance.

Introduction to the NDIS for health professionals

Tags: health professional, hospital discharge, NDIS, training

Description:

This is a series of 4 webinars which cover the Introduction to the NDIS for health professionals.

Penny’s story

Tags: hospital discharge, NDIS

Description:

After a hospital stay and her husband no longer her carer, Penny was unable to return home. She put in a change of circumstances to the NDIS. Penny now says her supports enable her to live the life she wants to live.

Life After Discharge – from hospital to home

Tags: community, hospital discharge, occupational therapist

Description:

Donna King is an Occupational Therapist Case Manager. Donna discusses the importantce of communication after discharge and establishing community links.

Discharge Planning from Hospital to Home

Tags: hospital discharge, occupational therapist

Description:

Donna King is an Occupational Therapist Case Manager working in the area of traumatic brain injury. Donna deals mainly with clients in rural locations. Donna says early contact is key to a good Discharge Plan.

Chris’s experience with the health system

Tags: community, hospital discharge, support coordinator

Citation:

Chris was in hospital and rehab for 3 months. Chris’ explanation of that time was “I felt like a ping pong ball between the hospital and my care coordinator”.

Chris’s aged care story

Tags: hospital discharge, nursing home, residential aged care (RAC)

Description:

Two and half years ago Chris was hospitalised. Chris knew he couldn’t return to his home in Launceston, he wanted to move closer to his parents on the north west coast of Tasmania. With no choices this would mean living in a nursing home.

THE NDIS: A new landscape for people who acquire a disability

Tags: health professional, hospital discharge, NDIS

Description:

The NDIS is creating new possibilities for people with disability, but is a whole new world for health care professionals.

Life in a nursing home

Tags: hospital discharge, NDIS, nursing home

Description:

Daniel went from hospital to a nursing home. He shares his experiences and ideas on how to improve the life of young people living in nursing homes.