hospital discharge Archives - Summer Foundation
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August 2022

Summer Foundation – La Trobe University Research Program 2021/2022

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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.


July 2022

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

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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.


May 2022

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

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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.


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.


DOCUMENT

January 2022

Pre Budget Submission (2022)

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Description:

More than 50 young people continue to enter aged care each month. Most young people enter aged care via hospital -they fall through the gap between the hospital and the disability sectors.
 
Additionally over 1,100 long stay NDIS participants are stuck in Australian hospitals at a cost of $860m per annum. People with disability remain in hospital for months after they are clinically ready for discharge because it takes the NDIA an average of 60 days to determine eligibility and allocate funding for supports in an NDIS plan. Funding for SDA can take much longer.
 
Many NDIS participants have to go to the Administrative Appeals Tribunal (AAT) to get the right SDA determination. This can take up to another year, costing the Federal Government $17 million per annum (reported by the NDIA) and causing undue stress to NDIS participants and their families.
 
Lack of disability housing is not the main barrier to hospital discharge. According to the NDIA, there are 3,000 vacancies in disability housing across Australia, 800 of which are new build SDA.
 
In 2016, the NDIS committed to providing $700 million per year to housing payments called SDA. Last year the NDIA only allocated 31% of the committed $700 million for SDA (the partial allocation of committed funding also occurred in prior years).
The Federal Government will not achieve its 2022 or 2025 YPIRAC Targets unless:
 

  • The NDIA steps up and matches the efficiency of the aged care system in the timely allocation of funding for housing and support, post receipt of all required evidence to make an SDA determination.
  • There is investment in better hospital discharge for people with severe disability


July 2021

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

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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).

 

Hospital discharge delays have compounding negative consequences for NDIS participants (hereafter referred to as ‘participant’ or ‘participants’) and families, NDIS and health systems, and the workers within these systems. Improvements in hospital discharge will reduce costs for both the NDIS and health systems and help fulfil the Younger People in Residential Aged Care Action Plan of no younger person (under the age of 65) living in RAC unless there are exceptional circumstances.

 

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.


Report cover

February 2021

Housing Needs and Preferences to Support Discharge

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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.


October 2020

Allied health housing assessments guide

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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.


July 2020

Capacity building framework training manual

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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.


June 2020

Urgent access request cover letter

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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


June 2020

Chris’s story – everything’s changed

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


June 2020

NDIS foundations training videos

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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


March 2020

NDIS secondary consultation framework

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Description:

This resource describes how an NDIS secondary consultation framework can guide health clinicians in sustainably building their knowledge and practice expertise, to achieve positive discharge outcomes for people eligible for the National Disability Insurance Scheme (NDIS).


March 2020

Internal and external escalation sample guideline

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Description:

This guideline is relevant for health services staff working in a health setting with people with disability aged under 65. When assisting people with disability, there may be circumstances where internal and/or external interface practice issues occur that require escalation. Download a Word document version of the flowchart


March 2020

Developing a safe discharge plan for people with disability in response to COVID-19

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Description:

The purpose of this resource is to assist health clinicians who are supporting a person with disability who is being considered for discharge as a result of COVID-19.


March 2020

Health service FAQs

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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.


December 2019

Sample interim NDIS plan

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Description:

An interim 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.


October 2019

Introduction to the NDIS for health professionals

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Description:

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


May 2019

Penny’s story

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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.


August 2018

Life After Discharge – from hospital to home

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Description:

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


August 2018

Discharge Planning from Hospital to Home

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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.


August 2018

Chris’s experience with the health system

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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”.


August 2018

Chris’s aged care story

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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.


August 2018

Danny’s story – with his brother Michael

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Description:

Danny has MS, he recently suffered an infection which resulted in a hospital stay, he was unable to return home. It is important to Danny’s family that he stays living on the northern beaches.


July 2018

NDIS readiness – a toolkit for hospitals

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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.


July 2018

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

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Description:

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


June 2018

Life in a nursing home

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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.


June 2018

Deborah’s aged care story

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Description:

It all started Christmas Eve 2015. Deborah went from thinking about what she was going to cook for Christmas Day, to being in intensive care with all her organs shutting down. That was the beginning of Deborah’s journey into aged care.


June 2018

Hospital discharge video resources

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Description:

Occupational Therapists share their experience of the hospital discharge process for people with a newly-acquired disability.


June 2018

Hospital discharge planning for young people with complex disability: Literature review

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Description:

The aim of the discharge planning process is to improve the coordination of a person’s services post-discharge and reduce the likelihood of unplanned hospital re-admissions. This review sought to explore the current evidence base for hospital discharge planning for young adults (aged 18-64) with disability and complex support needs. Successful discharge planning for this group is complex and requires effective cooperation between health and disability services.


Citation:

Knox, L., Symmons, M., Douglas, J., Hilton, G., Winkler, D. (2018). Summer Foundation.


April 2018

Discharge planning toolkit

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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:


November 2016

Vicki Wilkinson: Pathway into a Nursing Home

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If Vicki had more health support at crucial times following her injury her four year stay in a nursing home could have been avoided.