Planning for discharge should occur as early as possible. Discharge planning should be person-centred and undertaken with the patient and their family and carers, as appropriate.
- Aim to create person-centred discharge plans that our patients and significant others understand and support
- Understand our patients’ normal daily routines and living arrangements and what supports they will require after discharge.
- Provide referrals to appropriate community services and equipment providers for older people who require assistance with self-care or who may be at risk of falls post discharge
- Consider referrals to community services if premorbid mobility and self-care levels have not been attained by discharge.
- Identify people at risk of becoming isolated on discharge because of immobility or changes in mobility. Encourage them to remain socially connected, for example by contacting their local library, council, Neighbourhood House or Men’s Shed as sources of neighbourhood activities.
- Provide appropriate written resources and ensure our patients and their significant others understand the resources.
- Encourage and facilitate physical activity beyond discharge.