Going Home

The Local Integrated Team is made up of health and social care staff who work together to provide your care at home or another place of care. 

Care at home

Carers will visit you at home to support you with daily living tasks.

This can include: 

• support with personal care, such as washing, showering, dressing and going to the toilet

• support with preparing meals

• support with leaving hospital and your recovery

• support from a therapist to regain your independence. This will be assessed at the start by our team 

Carers will not support with tasks like housework and laundry. 

Another place of care

The team will provide short-term care to help you become more independent so you can return home when possible. 

Short-term care can be provided in:

Housing with Care

• You will have your own flat with staff there to help you. 

• You will be given a list of items that you need to take with you. 

• If you can’t shop or cook for yourself, the team will discuss help that is available. You may need to pay a charge.

OR

Residential or Dementia residential care home 

• You will have your own room in a care home, and staff will be there to look after you. You may get support from therapists depending on your needs.

• Carers will help you with daily tasks, like washing, showering, dressing and using the toilet. 

• You will need to bring your own clothing and toiletries.

Recovery 

We are a team who encourage you to be as independent as possible with our support.

Your care and therapy will be reviewed regularly. This is to make sure your needs are met, and you’re being supported to regain your independence.

This support is for six weeks, but you may require this for less time. We’ll discuss this with you.

We’ll discuss your options with you if your needs cannot be met at home. We’ll discuss options that may prevent you coming back to hospital.

Assessment

We’ll assess your care and support needs. It’s possible there may be costs from the first day of your social care assessment.

You’ll receive help with a financial assessment and a member of the team will explain help that’s available.

Contact information

Local Integrated Team: 02476 83300

Why plan before you leave

You’ll leave hospital when you do not need hospital care. We’ll discuss and decide with you when you’re ready to leave. The time when you leave hospital is called being “discharged.”

We help you plan now so that you’re ready to leave. This helps make sure you’re safe and any care you need is ready for when you’re discharged.

What to expect from hospital staff

During your hospital stay, we’ll discuss and plan with you:

• what is going to happen during your hospital stay

• how we decide when you’re ready to leave

• when we think you’ll leave (date of discharge)

• whether you’ll return home or somewhere else

• care or support you may need

• transport you may need

• if you want family or carers involved

Care after you leave

You may need more care now than before you came into hospital. This care can be for your recovery or short-term needs. 

Most patients go home or return to their care home. Sometimes patients need care provided by a place in the community. 

Rehabilitation at Hospital of St Cross, Rugby

If you need short term physiotherapy or occupational therapy as an inpatient, we may move you to Hospital of St Cross, Rugby. Rugby Rehabilitation has a therapy gym and assessment kitchen which will help your recovery. This service is not available at University Hospital, Coventry.

We must use our hospitals in the best way we can. This is so we can care for new patients who are very unwell. 

Leaving day (day of discharge)

You’ll wait in the hospital discharge lounge until it’s time to leave. If required, we’ll arrange your transport and order your medicines while you wait. This helps us welcome new patients to the area where you received care. 

You’re ready to leave hospital

You no longer need hospital care. Together, we have agreed that you’re safe to leave hospital. This will help your recovery.

A place in the community has been arranged for you, free of charge for a limited time, to support your recovery. If you decide not to accept this care, you will not be able to stay in hospital. A member of staff will respond to concerns, offer advice and support you to make a decision about your next steps.  

Why it’s better for you to leave hospital

Staying in hospital for longer than you need to:

• increases the risk of you getting an infection

• causes you to lose muscle and strength

• makes it harder for you to do things on your own

This means it’s better for you to leave hospital with a plan ready to meet your needs. 

Care after you leave

The level of care, support, and therapy you receive will depend on your individual needs.

During your stay, the community team will assess your ongoing needs. They will discuss the timing of this assessment and any future costs with you.  

What is Health Funded Care?

Health Funded Care supports patients to move safely from hospital to a preferred place of care. This is for patients who are becoming more unwell and are not expected to get better. Care may be given at home or in a care home placement.

Funding

The funding of your care or placement (package of care) is provided by Continuing Healthcare (CHC) for 12 weeks. Any changes to your care and funding will be discussed with you.

Nursing care

• Nursing care in a care home placement is given by registered nurses in that setting.

• Nursing care in patients’ homes is given by community district nursing services or the community palliative care team.

If you decide not to accept the care options that you’re offered, you have decided not to accept Continuing Healthcare funding.

Contact information

District nurses: For general advice and questions, phone 0300 200 0011 

Continuing Healthcare: For questions or concerns about your package of care (home or care home placement), phone 02477 710970

Types of support

You might be a family member or friend. You may give care or support in person, or you might do this from a distance (such as by phone).

Care or support could be: 

• personal care, such as help with moving around, eating, washing, or getting dressed

• emotional support, such as helping someone with their anxiety or stress

• support with cooking or cleaning

• collecting items like medicines or shopping

• help with paying bills or paying for care

Carer’s assessment

If you need help, or cannot provide care, you have a right to a carer’s assessment. This is an assessment to see what might help you. 

You must contact your council or local authority for this. You can find their details at www.gov.uk/find-local-council 

Advice when giving care or support

• Tell your employer if you work. They may make changes to support you. 

• Tell your school, college, or university if you study. They may make changes to support your studies. 

• Ask hospital staff about groups that can help. There may be one that supports the type of care that you need to provide. 

• Visit the Carers UK and Carers Trust websites for support.

Carers Trust: www.carers.org or phone 0300 772 9600 (calls are free)

Carers UK: www.carersuk.org or phone 0808 808 7777 (calls are free)

• NHS and Care Volunteer Responders can provide help. 

Website: nhscarevolunteerresponders.org or phone 0808 196 3646

• Care for your own health and wellbeing. A good diet, sleep and physical activity are important. The NHS provides the Every Mind Matters website to support wellbeing 

• Write down what care or support you’re giving. This should include a diary of daily support that will help others to continue the care needed. Carers UK have advice on this (see Carers UK link above).

• Try not to do it all on your own. Tell friends and family how they can help.

Personal care

Mouth care 

Mouth care is important for comfort. It also helps the person to eat, drink and communicate. Mouths can become dry as we eat or drink less.

Support with mouth care will be provided at least once a day. But this can be more when needed. Providing a baby toothbrush can help as it’s small and has soft bristles. 

Appearance

We support personal care for dignity and comfort. Please help us by making sure items such as clothes, wash bowls, brushes and razors are ready for our visit.

Continence care

At first, we may provide incontinence pads. But these will then need to be provided by you. Incontinence pads can be bought, or you can ask us for a continence assessment. When a catheter is needed, this will be provided by our team. 

Beds, equipment and pressure sores

We’ll provide a hospital bed and mattress. We’ll provide equipment when it’s needed. There is a risk of pressure sores from lying down.

We’ll use equipment to reduce this risk, such as an airflow mattress or cushions.

Medicine

We may give you medicine to take in your home. This is to help with pain and agitation (feeling confused or upset).

These are some of the medicines we may give: 

• morphine for pain, shortness of breath, or both

• midazolam for agitation

• glycopyrronium for mucus (respiratory secretions)

• levomepromazine for feeling or being sick (nausea or vomiting)

Pain

Please look for signs of pain. These may be:

• frowning

• grimacing 

• groaning

• moaning

• whimpering 

Agitation

Please look for signs of agitation. These may be:

• pulling or plucking at clothes and bed sheets

• restless arms and legs (moving and cannot get comfortable)

• hallucinations (when someone sees things that are not there)

Please contact our team if you’re worried about pain or agitation.

Visits

Our visits to you can be 1 to 4 times each day. We cannot provide times for our visits. This is because we do not know how long each visit will take. 

Please call us if you need an extra visit between normal visits. Call us on one of the contact numbers. We’re here to support you.

Myton Hospices

The Myton Hospices are in Coventry and Warwick. Patients stay in a hospice where their care is provided. Please ask our team if you want to discuss hospice care. 

Contact information

Support is provided by the Community Palliative Support Team. Please contact our team for help or advice. 

General enquiries: Monday to Friday, 8am to 4pm - 02476 237056

Clinical support: Monday to Sunday, 24 hours a day - 07771 564474