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Post-Hospital Nursing Support for NDIS Participants
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Experienced Registered Nurses dedicated to your success.
Proven results that speak for themselves.
Safe nursing support when returning home from hospital
Leaving hospital can be a significant change, particularly when a participant has new nursing needs, changed abilities or additional risks.
Loica Care provides planned Registered Nurse support to help NDIS participants safely transition from hospital to their home, supported accommodation or another community setting.
Support may begin before discharge, where appropriate, and continue after the participant returns home.
Loica Care does not decide when a participant is medically ready to leave hospital. The hospital remains responsible for medical treatment, discharge planning and ensuring that the participant is safe to leave.
What is post-hospital nursing support?
Post-hospital nursing support helps put the participant’s discharge instructions and disability-related nursing supports into practice after they leave hospital.
Depending on the participant’s needs, Loica Care may assist with:
- Reviewing discharge information before nursing services commence
- Communicating with hospital staff and other providers, with consent
- Completing an initial nursing visit after discharge
- Assessing new or changed nursing needs
- Implementing nursing instructions provided by the hospital or treating team
- Developing or updating participant-specific nursing care plans
- Monitoring the participant’s condition and recovery
- Identifying gaps, risks or unclear instructions
- Providing education to the participant and family
- Providing participant-specific training to support workers
- Escalating concerns to the appropriate healthcare professional
- Arranging ongoing disability-related nursing visits where clinically required
The service is individually planned. Not every participant will require every type of support.
Who may benefit from this service?
Post-hospital nursing support may be appropriate when a participant:
- Has developed new disability-related nursing needs
- Has experienced a significant change in their functional abilities
- Requires wound or pressure care after returning home
- Requires catheter or continence support
- Requires skin-integrity monitoring
- Has new or changed medication-administration requirements
- Requires clinical observations under an established plan
- Has new equipment, treatments or nursing procedures
- Requires an updated nursing care plan
- Needs support workers to learn new participant-specific procedures
- Has difficulty understanding or following discharge instructions
- Has complex communication or cognitive needs
- Has several providers involved in their care
- Is at increased risk of deterioration, medication error, skin breakdown or readmission
- Requires evidence about changed disability-related support needs
The nursing service must be clinically appropriate, within Loica Care’s scope and supported by adequate information, equipment, staffing and funding.
Developing or updating nursing care plans
A hospital discharge summary may provide essential clinical information, but it may not contain all the practical instructions required by support workers or family members.
The care plan must be based on adequate clinical information and direct assessment. Loica Care will seek clarification from the treating team when instructions are incomplete or outside the nurse’s authority.
Our 72-hour service target
For planned, non-emergency referrals, Loica Care aims to:
- Review the referral within 72 hours of initial contact
- Identify missing information or clinical instructions
- Confirm whether the requested service can be safely provided
- Arrange or commence nursing support within 72 hours of discharge or receipt of all essential information, whichever occurs later, where clinically appropriate and available
When a formal nursing assessment or report is included in the agreed service, Loica Care aims to complete it within 72 hours after the assessment and receipt of all required evidence.
The target depends on:
- The participant’s discharge date
- Participant location and availability
- Clinical urgency
- Nurse availability
- Receipt of the discharge summary and clinical instructions
- Availability of products and equipment
- Consent
- Funding and service arrangements
- The complexity and risk of the required care
Hospitals, support coordinators and families are encouraged to refer before the planned discharge date.
The 72-hour target does not replace emergency, acute-care, hospital-in-the-home or specialist services and does not guarantee that a hospital discharge will occur within 72 hours.
Request post-hospital nursing support
NDIS participants, nominees, families, hospitals, support coordinators and providers can contact Loica Care before the planned discharge date.
Loica Care will review the referral, explain the information required and determine whether we can safely provide the requested nursing support.
Ready to book?
Loica Care — helping participants return home with clear plans, safe nursing support and continuity of care..
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