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Care after hospital discharge

Looking for care? Call us on 020 3728 7577

As we get older many people may end up having a stay in hospital, whether for planned treatment like a hip or knee replacement or because of an emergency or an accident, like a fall. When the time has come to be discharged from hospital it is vital to your recovery that you have the right plan of care in place.

What is hospital discharge?

The process of leaving hospital is widely referred to as hospital discharge. Each hospital will have its own policy, which you should request as soon as you are able to after arrival in hospital so you can start planning your discharge with those responsible for your care.


Discharge planning for elderly patients

Most hospitals have a dedicated Hospital Discharge Planner whose responsibility is to ensure smooth transition from hospital back home ensuring the right on-going care package is in place if required. If you require care after hospital discharge, the provider you choose should be working closely with the discharge team at the hospital and other healthcare professionals involved in your care to ensure everything is in place for you when you leave.

Delays in hospital discharge

Frustratingly up and down the country there are countless delays to hospital discharge. This is when an individual is deemed medically fit to be discharged, but discharge cannot take place. Generally, this is because of delays in organising on-going post discharge care. This can cause considerable distress and a long hospital stay for someone who is well enough to go home. It is important that you plan what you will need in terms of care after hospital discharge as soon as you can and put plans in place to speed up your discharge when the time comes.

Care after leaving hospital

There are many options for care for the elderly after leaving hospital and returning home that you could consider:


Hourly care

If you just need some specific support during the day, for example getting up and dressed in the morning or having your meals prepared then hourly care could be considered. This is when a carer visits you at certain times during the day to provide care and support for everyday tasks.

Live-in care

Live-in care is when a professional carer comes to live with you to provide high-quality 24-hour care. This enables you to get support throughout the day and night, providing much-needed peace of mind and reassurance. They will be trained to support your on-going health and well-being needs significantly improving the time it takes you to recover or rehabilitate, also avoiding the need to move into a care home.

Respite care

Respite care can be used for a minimum of two weeks for a short-term care arrangement to get you back on your feet following hospital discharge. Respite care can be offered in a residential care home or in your own home and can be used to give a family carer a break from caring for their loved one. If you have respite care at home it enables you to try home care, to see if it is right for you if your care needs may change in the future.

Convalescent care

Convalescent care is suitable for those who have received hospital treatment following surgery or an acute illness and need care and support to rest, recover and rehabilitate. Post-operative rehabilitation and convalescent care is focused on making you comfortable to enhance your recovery, whilst supporting you to rebuild life skills, confidence and independence.

Nurse-led care

If your hospital stay has resulted in you needing care of a complex condition, then nurse-led care can be provided at home. Nursing care is clinical care provided to an individual to support them through illness to improve their overall health and well-being. There are number of tasks a nurse will undertake, that with the right training, support and medical equipment can be delivered by a professional carer providing nursing care at home.

OT-led care

Occupational Therapy (OT) care at home can help people to overcome the challenges posed by permanent or temporary loss or lack of physical, sensory or communication function. An OT will assess you in hospital prior to discharge to assess follow up care after hospital discharge. They will put in place a comprehensive plan of care and advise on any equipment or home adaptations that will improve overall quality of life.

Why consider home care after hospital discharge?

Many people believe that when they need follow up care after hospital discharge, they need to receive this in a residential care home or a hospice for those requiring palliative care. It is widely recognised by the medical profession that receiving care at home has far reaching benefits to an individual’s recovery, overall health and well-being. Home care delivered by a trained and professional live-in carer, supported by clinical experts is a real alternative that allows a person to be cared for on a one-to-one basis in the comfort and familiarity of their own home with their family around them for support.

Choosing care after leaving hospital

Choosing care after leaving hospital

You will need to understand from the healthcare professionals looking after you in hospital what level of on-going care you will need, with an idea on how long care will be required to support your rehabilitation and recovery. Once you know what you require, then you will need to decide whether you want to receive care in the comfort of your own home, or move into a care home to get the care you need. There are many compelling benefits of live-in care, not least that you will have the peace of mind that your carer will be there for you around the clock providing all the support you need preventing unnecessary hospital re-admission. One-to-one care simply cannot be provided in a care home.

Why choose The Good Care Group for care following hospital discharge?

We have been providing high-quality, live-in care following discharge from hospital to many families across the country for over 10 years. At the heart of our care of the elderly after hospital discharge service is enabling people to live well in their own home with the medical care and support they need from a carefully well-matched, trained professional carer who provides a better quality of life for those receiving care, whilst families receive a fully managed and regulated service that they can trust and rely on.

There are many other compelling benefits to receiving follow up care after hospital discharge from The Good Care Group:

Clinical care developed and supported by experts in their field

Supported by our specialist in house nurse, Dr Jane Pritchard and our central senior management team, many of whom are nursing professionals our professional care teams can support people with nurse-led care in the comfort of their own home. All our professional cares are qualified to manage and administer medications, and support with several complex medical interventions.

We understand that medical care can require equipment and other adaptations to the home. Our dedicated Occupational Therapist (OT), Jackie Cooper will not only liaise with doctors, district nurses and NHS OTs and physiotherapists, she is also on hand to be able to conduct a thorough OT assessment to facilitate fast and discharge from hospital if required and will co-ordinate any requirement for equipment, so you can get home as quickly as possible to be cared for comfortable in familiar surroundings with all the care you need. These specialists ensure our professional carers are focused on and supported to deliver a holistic and multi-disciplinary approach to caring for your loved one.

A perfectly matched care team

A live-in care arrangement usually involves two carers working on a two-week rotation. They will be carefully matched working with you and your family to ensure they are able to meet not just your care and support needs, but are closely aligned with how you wish to live your life, sharing common interests, personalities and backgrounds. In the rare situation, the match does not work out we will happily work with you and your family to find the care team that does.

Expertly trained care teams

Our industry leading training programme completed by our care teams has been created with leading charities and clinical experts and goes well beyond industry standards. This enables our professional carers to support a range of conditions affecting older people, including complex conditions that require more monitoring, care and support. From training, through probation, into placement and beyond our carers never stop learning new skills that ensure they can deliver the quality care our clients should expect, whilst finding new ways to further enhance the level of care they provide.

Innovating care delivery through technology

Unlike any other live-in home care provider in the UK, we have invested in creating our own market-leading technology to further enhance our service. Through the development of an online community for our clients, their families and our professional carers, we are proactive and responsive to emerging issues, whilst enabling the softer social benefits that technology brings. The secure platform is focused on ensuring our carers are equipped to effectively deliver the high-quality care our clients should expect, whilst delivering improvements in health outcomes. Our families can access important information about the care of their loved one, providing a reassuring window into the care they are receiving.

Our professional carers use a dedicated community through a Chromebook to complete daily care records, update care plans, monitor nutrition and hydration and manage medications proactively with safety features ensuring accurate administration. This allows us to effectively monitor the health outcomes of our client’s care, so we can prevent and respond to incidents and ensure the very highest quality of care is always provided. The online community also allows our professional carers to network, support each other and share best practice, whilst facilitating a connection which is so important for a remote workforce.

Improving health outcomes

At The Good Care Group every decision is driven by delivering improved health outcomes for our clients. Through our dedicated and committed approach to providing high quality care to our clients and the use of our market-leading digital technology, we see significant improvements in our clients’ overall health and well-being every year.

Unique to the live-in home care market, the technology enables us to digitally monitor health outcomes allowing us to effectively predict risk and shape the care we provide. We know, for example that urinary tract infections (UTI’s) are one of the leading causes of hospital admissions for our clients, so we equip our carers with handheld testing kits to proactively monitor our clients for infections. We then benchmark our data to demonstrate how effective our care is in improving the quality of our client’s lives in the context of other types of care provision, for example care homes.

Our health measures are focused on achieving the following:

  • Promoting well-being, independence and enjoyment
  • Reducing behaviours that challenge through implementation of psychosocial techniques
  • Reducing and eliminating antipsychotic drug use
  • Promoting excellence in nutrition and hydration
  • Reducing and preventing falls in the home
  • Reducing hospital admissions and re-admission
  • Reducing UTI’s and chest infections
  • Reducing carer stress

We are proud to be transforming health outcomes for those who require care at home. In 2020 our care teams achieved the following outcomes for those they cared for:

Infection Prevention

Proactive Monitoring of Chest Infections

Our vigilant carers manage early signs of illness, such as chest infections enabling timely intervention to avoid unnecessary hospital admissions. This has resulted in a 28% reduction in chest infection hospital admissions.

Reducing urinary tract infections (UTI’s)

Through enhanced training our professional carers can perform urinalysis tests. This means they can provide timely information to GP’s, enabling a quick diagnosis and treatment. 80% of our clients were diagnosed in 2020 using urinalysis kits. Through the introduction of testing, our clients are three times less likely to require emergency interventions involving a 999 call or ambulance call out when a urine test is completed.

Unrivalled falls prevention programmes

In England alone, 30% of people over the age of 65 fall at least once a year and for those 80 and over it is 50%. By comparison, only 7% of our clients aged 65 and over fell at least once, and that was only 6% for those aged 80 or over.

Our clients are six times less likely to suffer a serious injury as a result of a fall than residents living in a residential care home. This is a result of our quality one-to-one care, which just cannot be achieved in even the very best care home, and our effective personalised falls management programmes.

Working with our in-house Occupational Therapist, we identify clients who are ‘frequent fallers’ and through an intensive and personalised approach to falls management resulted in  50% of our clients never falling again.

A specialist pathway for palliative care at home

For those with a life-limiting illness or a terminal condition, most of us given the choice would wish to end our days in the comfort of our own home. However, the percentage of people in the general population who can do that is as low as 19%. By comparison, our approach to one-to-one palliative care at home has enabled 81% of our clients to pass away in the place they love most – their own home.

Effective pressure sore management

Our high-quality home care provided by dedicated and professional carers has seen a staggering reduction in pressure sores in those we care for when compared to both hospital and care home settings. Comparative data shows that you are 13 times less likely to acquire a pressure sore in The Good Care Group's care when compared to a hospital and 26 times less likely when compared to care home rates.

Efficient management of medications

Our digital technology is used proactively to effectively support safe administration of medications, which has seen error rates of 2.4% compared to a 22% error rate in care home settings.

Reducing the use of antipsychotic medication for those living with dementia

The use of antipsychotic medication to treat dementia symptoms has been increasingly challenged over the last ten years, as they have been shown to be harmful for people living with dementia and are at times prescribed unnecessarily. Through our approach to professional and specialist one-to-one care for those living with dementia, and the use of our market leading digital technology (eMAR) our clients are four times less likely to be prescribed antipsychotic medication than residents of care homes.

Peace of mind and reassurance

Rated ‘Outstanding’ by the Care Quality Commission (CQC)

The Good Care Group is the only dedicated live-in care provider in the UK to achieve an ‘Outstanding’ rating by CQC across all five categories – safe, effective, caring, responsive and well-led. We know this provides families with peace of mind that their loved one is receiving the best possible care.

Fully managed and regulated care following hospital discharge

We provide a fully managed and regulated home care rafter hospital discharge service which offers families reassurance at a time they need it most. Unlike introduction agencies who are not regulated by CQC, all our professional carers are directly employed and managed by us. We ensure they are supervised by an experienced manager and supported by clinical experts – 24 hours a day, 7 days a week.

Local teams with national coverage

We operate nationwide with a local approach to management of our teams near you. Each dedicated care manager has as small portfolio of clients to support, enabling the care team to provide a tailored one-to-one approach with the highest levels of monitoring and support.

Talk to us about your care needs

To talk about your care needs contact one of our friendly advisors. Calls from landline are free.