Hospital Discharge
The Hospital Integrated Discharge Team support adult residents of Croydon who are in hospital and may require care and support (or a change in care and support) upon discharge.
This applies to Croydon residents admitted to:
- Croydon hospitals; and
- Out of borough hospitals.
Discharge to Assess
Discharge to assess (D2A) supports people to be discharged from hospital, when safe and appropriate to do so, and continuing their care and assessment out of hospital. They can then be assessed to establish if they have reablement potential to get them back to the level of function prior to hospital admission or determine if they longer-term health and social care needs.
Discharge to assess (D2A) has three main pathways:
Pathway one
Assessment and support is provided by the health and social care community team in the patient’s own home. Once discharged, the resident is assessed within 24-48 hours from discharge by a community worker to determine their reablement potential.
Support is provided by a commissioned care provider or Croydon’s in house community reablement service. Support is provided for up to 6 weeks.
Pathway two
Assessment and support is provided by the health and social care community team in a residential intermediate assessment setting. This includes community support beds in the expected maximum assessment period is 14 days.
Pathway three
Assessment and support is provided by the health and social care community team for people who initially require 24-hour residential/ nursing care. The expected maximum assessment period is 20 days.
All Pathway three requests must be discussed in the daily Placement in Principle panel to discuss the need and ensure this pathway is the least restrictive option for individual and in their best interest.
A person may be stepped up or stepped down between the pathways as appropriate to their needs.
The support provided may involve rehabilitation (a therapy/nursing-led service) and/or reablement (a social care-led service).
