Pathway 1
Person at home
- Person experiences health crisis and requires hospital admission
Person goes to hospital
- The person presents at Accident and Emergency and is medically assessed. Staff explain to the person and/or carer that hospital admission is required.
Person is admitted
- The person is admitted to an inpatient ward. Discharge planning begins, multidisciplinary team (MDT) assessments commence, and information and advice given to person and/or carer.
- Transfer of Care Referral Form completed for assessed provision.
Person is discharged home
- Suitable provision is sourced
- Person is discharged home with support with any required therapy support requested
- Care Act, section 9 assessment to be completed within four weeks post discharge.
Pathways 2 and 3
Bedded Pathways are where the person is discharged from hospital to nursing or residential care.
Pathway 2 – rehabilitation or short-term support | Pathway 3 – longer-term support
Person at home
- Person experiences health crisis and requires hospital admission
Person goes to hospital
- The person presents at Accident and Emergency and is medically assessed. Staff explain to the person and/or carer that hospital admission is required.
Person is admitted
- The person is admitted to an inpatient ward. Discharge planning begins, multidisciplinary team (MDT) assessments commence, and information and advice given to person and/or carer.
- Transfer of Care Referral Form completed for assessed provision.
Person is discharged to care home
- Suitable provision is sourced
- Person is discharged to a care home setting for up to four weeks waiting assessment of ongoing needs with any required therapy support requested.
- Care Act, section 9 assessment to be completed within four weeks post discharge.