Returning homefrom hospital

A guide for you, your family and carers

Hertfordshire County CouncilAdult Care Services

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Contents

Moving on from hospital 1

A social care assessment 2

Helping you back to independence 3

Equipment and technology 4

Help if you are unable to return home 5

When your discharge is delayed 6

Carer’s assessment 6 - 7

Your finances and benefits 7 - 8

Help and support in the community 8 - 9

Ensuring that your voice is heard 9

Returning to work after a stay in hospital 10 - 11

Who can look after my pet 11

Useful resources 12

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Introduction

Following a stay in hospital, you and your carers may need advice and support to return home. This booklet will help you and your carers as you plan to leave hospital and make decisions for the future.

Moving on from hospital

The Consultant or Doctor in the hospital will decide when you are well enough to go home. If you have any queries regarding your medical treatment or follow up care speak with them about it.

If you are likely to benefit from support and advice, with your consent, the hospital will refer you to a social care team for an assessment. You and your carers can also ask the ward to refer you to the hospital social work team if this has not happened.

If you are admitted to a hospital in a different county, we will work together to help you to return to Hertfordshire. This is the same for private hospitals.

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Social care assessment

An assessment is an opportunity to talk to us about your situation and get information and advice you may need to make the most of life. Following the assessment we will agree a discharge plan.

If you are in a hospital out of county, the assessment may take place over the phone with you and we will gather information from medical professionals and carers as needed.

You will always be at the centre of this discussion and can involve a family member or a friend to support you. In some cases we may offer you the support of an independent advocate.

The assessment will be about you and things which are important to you:

• Things you want to do

• How you are managing at home

• Any concerns you may have

• How your friends and family can support you

• What organisations in your community can offer

• What we can help with

Once we get to know you, we can provide information and advice about how you can live the life you want and help you find any services and support to do so.

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Helping you back to independence

Enablement If you need help to regain your skills and confidence, we may offer you a short term enablement service.

We will discuss what you want to achieve, what you can do for yourself and what help you may need to get back to your normal routine. Care staff will work with you to regain your independence with the tasks that have become difficult, such as washing and dressing, preparing meals, getting out and about and much more. This can mean learning new skills and doing things differently.

Enablement can be provided in your home or an enablement home and usually lasts up to four weeks. There is no charge for this service whilst you are making progress. We will review it regularly and discuss the way forward. If enablement is not available or it is not the right service for you we will discuss other ways to support you.

Care and support at homeIf you need regular support, or are not expected to regain the skills and independence lost during your hospital stay, we will discuss all available options including help from family and friends, community services and the council.

If we arrange the care for you or provide a Direct Payment so you can arrange your own care, we will regularly review the care in place to ensure that it is right for you.

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Equipment and Technology

Safety at homeIf you need help with daily tasks there is a wide range of equipment available to support you and your carer. In some cases an occupational therapist will get involved to provide a specialist assessment of your home and decide if you need any equipment or adaptations.

A variety of gadgets called telecare can improve your safety at home. They can detect falls, inactivity or movement, smoke, flooding, gas or extreme temperature through sensors that trigger an alert at a 24 hour call centre.

Social care appsSocial care has gone digital and you will find information on social care apps on our website.

Social care apps can help with daily tasks such as:

• Remembering to take medications

• Recording coping strategies and managing anxiety

• Supporting memory by reminiscence and connecting with family

• Managing personal affairs through to do lists and prompt sheets

• Helping to find and coordinate care

• Resources for carers to manage someone’s care

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Help if you are unable to return home

If it isn’t possible to return to your own home, we will discuss with you other options including, flexi care, residential or nursing care homes. – Flexi care offers you the privacy of your own home with support

on site. – Residential care homes provide personal care and social support

and some specialise in supporting people with dementia. – Nursing homes look after people who need constant nursing care.Whether you are funding the care privately or require support from us, we can offer information and advice to help you and your family find a suitable care home. See www.carechoices.co.uk or phone their helpline on 0800 389 2077.

Continuing Health CareIf you have complex medical and care needs arising from a disability, accident or illness, you may be eligible for NHS Continuing Health Care (CHC). The full assessment for NHS Continuing Health Care will usually take place following your discharge from hospital.

NHS Continuing Health Care is arranged and funded solely by the NHS so there is no cost to you. NHS Continuing Health Care can be provided in a variety of settings such as a residential or nursing home or your own home.

For further information about Continuing Health Care, speak to the ward staff or visit NHS Choices website at www.nhs.co.uk

End of life careIf you have a terminal or life limiting condition you can discuss palliative care with the medical team or with your GP. Planning your future care, is a booklet produced by the National Council for Palliative Care available at www.ncpc.org.uk

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When your discharge is delayed

We will always do our best to make sure that your discharge is timely. We work hard to arrange care, support and accommodation in the community without any delay but sometimes things don’t go according to plan.

Occasionally, the discharge is delayed because the necessary care, support, equipment or accommodation is not available. For example there is no vacancy in a care home, a home care service is unobtainable or specialist equipment is on order.

We will make every effort to speed things up and keep you informed of the progress.

Carer’s assessment

When the person you are caring for is in hospital, we would like to speak to you about the care you provide and the help that you may need when they are discharged.

If you are caring for someone living in Hertfordshire you are entitled to a carer’s assessment by Hertfordshire County Council. It is an opportunity to discuss how caring for someone affects your life and consider the things that are important to you.

We can discuss the support to balance your caring role with other responsibilities and help you to draft a contingency plan, so that you have a backup should you suddenly be unable to care.

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We can advise you about welfare benefits and support in the community, meeting other carers and having a life of your own.

You can discuss a carer’s assessment with the social work team or call us on 0300 123 4042 or visit www.hertfordshire.gov.uk/carers to complete an assessment online.

You can also contact Carers in Hertfordshire on 01992 586969 to discuss their services for carers.

Your finances and benefits

Paying for careYou may have to pay towards the cost of your care. Some services in the community are free whereas others are chargeable. We will discuss this with you in detail.

You will never be expected to pay more than you can afford. We will tell you more about this when we meet with you and make sure you know where to get the right financial advice including claiming any benefits you might be entitled to.

For more information visit www.hertfordshire.gov.uk/adults or call HertsHelp on 0300 123 4044.

Staying in hospital and benefitsWhen you or a member of your family stay in hospital as an inpatient for a period of time, the welfare benefits you get may change. Some benefits stop being paid or are reduced whereas others are paid in full.

You should tell whoever pays the benefit, for example the Department for Work and Pensions (DWP), Jobcentre Plus,

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the Pension Service, HM Revenue and Customs or local authority benefits department as soon as you go in to hospital. They can then adjust your benefits so that you are not paid too much, or too little.

If you move from a care home in to hospital, you also should tell the people paying your benefits straight away as the rules for hospitals and care homes are different. If you need advice on benefits telephone the Citizens Advice Bureau on 03444 111 444 or refer to the Money Advice factsheets on www.hertfordshire.gov.uk/benefits.

Help and support in the community

There are lots of options to help you when you leave hospital. You can find out about them by searching our Hertfordshire Directory www.hertfordshire.gov.uk/directory or by contacting HertsHelp on 0300 123 4044, or email info@hertshelp.net.

Services to help you remain independentAge UK provides practical and emotional support to help you settle at home. They provide information about local services and benefits and help with everyday tasks. Telephone Age UK on 0300 345 3446 or visit www.ageuk.org.uk/hertfordshire.

Ensuring you have food and groceries when you go homeEating well is important and can help you recover after your illness.You can apply online for Meals on Wheels delivered to your home by Hertfordshire Independent Living Service. Breakfast, a hot or cold lunch and tea can be provided including meals catered for a wide range of cultural and dietary requirements.

Hertfordshire Independent Living Service also can provide Home from Hospital food boxes for vulnerable people.

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Each box contains enough groceries and supplies to sustain a person for 24 hours to allow time for further provisions to be set up. Visit www.hertfordshire.gov.uk/mealsonwheels or call Hertfordshire Independent Living Service on 0330 200 0103.

There are commercial organisations providing frozen or plated meals including Wiltshire Farm Foods and Oakhouse Foods. Your local Food Bank can offer you short term support. Contact the Trussell Trust on 01722 580 180 or visit www.trusselltrust.org.

Ensuring you have transport to get homeFollowing a stay in hospital you may be unable to drive or use public transport. If your friends or family are unable to take you home then it is worth trying community transport schemes. For more information visit www.hertfordshire.gov.uk and search for transport. You can also telephone HertsHelp on 0300 123 4044.

If you are still very unwell or have complex mobility needs, speak with the ward staff regarding any assistance to transfer you home from hospital.

If you need help getting out and about there are services and schemes to help you. Applying for a Blue Badge will enable you to park in designated spaces making it easier to get to your destination. Look on our website for more information www.hertfordshire.gov.uk/bluebadge.

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Ensuring that your voice is heard

Making decisionsIn hospital you may be making decisions about your treatment and future care. It is important that your wishes are central and that you are consulted, and able to fully participate in such decisions. If we are concerned that you find it difficult to understand some decisions to be made, we will support you as much as possible. You and the people that know you and care for you will be fully consulted. If you have no one to support you, an independent advocate will be involved. Having dementia, for example, does not mean you cannot make decisions but it does mean that you may need some extra help to make them.

Returning to work after a stay in hospital

It’s normal to feel a little anxious about going back to work after being ill, especially if you’ve been in hospital. Your doctor can help you to have a conversation with your employer about your health by issuing a fit note. The fit note offers your employer advice about possible changes they could make to help you get back to work.

These may include:

• Returning to work gradually – a phased approach to increasing your work tasks and amount of hours you work.

• Altering the times you work – the number of hours or the times of day.

• Changing the tasks you do at work – either temporarily or permanently.

If you need advice visit www.acas.org.uk

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Have a question or need help - talk to HertsHelp

If you are concerned about going back home and would like to talk things through with someone call HertsHelp on 0300 123 4044. They will listen to you and can put you in touch with other helpful organisations and charities.

You can call HertsHelp whilst you are in hospital or when you return home. If needed, they can arrange for someone to speak with you face to face in hospitals across the county or in the community.

Who can look after my pet

If your family or friends cannot help with looking after your pet during your hospital stay, contact the Cinnamon Trust on 01736 757 900.

They may be able to find your pet a temporary home or help caring for it while you are recovering after your illness.

HertsHelp

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Useful resources

Acaswww.acas.org.uk0300 123 1100Advice on employment rights and problems at work

Age UKwww.ageuk.org.uk/hertfordshire0300 345 3446Information, advice and support for older people

Care Choiceswww.carechoices.co.uk0800 389 2077Information about finding care and support

Care Quality Commissionwww.cqc.org.uk0300 0616161Find out about care homes and quality of their care

Herts Carelinewww.care-line.co.uk0300 999 2 999Alarms to stay safe and independent in your home

Carers in Hertfordshirewww.carersinherts.org.uk01992 586969Information, advice and support for carers

Meals on Wheelshertsindependentliving.org0330 2000 103Meals delivered to your door

The Cinnamon Trustwww.cinnamon.org.uk01736 757 900Help to care for your pet

NHS Choiceswww.nhschoices.ukInformation on conditions, treatments and services

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Hertfordshire County CouncilAdult Care ServicesMarch 2018

Our website Information about adult social care – find out about care services, day centres and apply online for meals on wheels or a Blue Badge. You can also comment, compliment and complain. www.hertfordshire.gov.uk/adults

Hertfordshire Directory Find national and local community groups, charities and services. www.hertfordshire.gov.uk/directory

Call us For information on how to get care and support contact: Email: contact@hertfordshire.gov.uk Telephone: 0300 123 4042 Textphone: 01992 555506 www.hertfordshire.gov.uk/contactus

HertsHelp Independent information and advice on local community services and care funding. Telephone: 0300 123 4044 Textphone: 0300 456 2364 www.hertshelp.net

British Sign Language (BSL) remote video interpreting service is available via a link on our website.

Drop in To your local library – see www.hertfordshire.gov.uk/libraries

If you are worried that you or someone you know is at risk of abuse or neglect Call us on 0300 123 4042 (24 hours a day)

If you need help to read or understand this information Call 0300 123 4042 if you would like help to understand this information or need it in a different format. You can also ask to speak to someone in your own language.

Calls to 0300 cost no more than a national rate call to a 01 or 02 number

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