Community care after discharge: nasogastric-tube care, residential homes and community support
Needing care after discharge is generally assessed and referred by a medical social worker or the Social Welfare Department's Standardised Care Need Assessment Mechanism; applying for subsidised long-term care goes through that assessment. Community care includes the Community Care Service Voucher, home-based care and elderly day care; for residential care, subsidised places are queued through the assessment mechanism and private homes must be licensed. For nursing skills such as nasogastric-tube care, ask the ward or medical social worker before discharge.
Needing care after discharge — who do I ask first?
Before discharge you can raise your care needs with the ward or the hospital's medical social worker; medical social workers provide social-work services such as case assessment, counselling and referral (Social Welfare Department). Applying for subsidised long-term care generally goes through the Standardised Care Need Assessment Mechanism for Elderly Services, which assesses whether you are suitable and for which type of service (Social Welfare Department).
What community-care options are there?
For care at home or in the community, the SWD's elderly community care has several options; for details and applications, ask SWD Elderly Services or a medical social worker.
| Service | Roughly what it is | Who to ask |
|---|---|---|
| Community Care Service Voucher for the Elderly | A voucher letting eligible elders choose community-care services by need | SWD Elderly Services / medical social worker |
| Home-based elderly community care | Home and personal care and nursing support delivered at home | SWD Elderly Services / medical social worker |
| Elderly day care centre / unit | Daytime care, nursing and rehabilitation services | SWD Elderly Services / medical social worker |
How is a residential place arranged?
A subsidised residential care place provides accommodation and care for elders assessed under the Standardised Care Need Assessment Mechanism as suitable and unable to care for themselves, queued through that mechanism (Social Welfare Department). Private residential care homes must be licensed (SWD's licensing scheme), and a list of licensed homes is available; the Residential Care Service Voucher is another route. Which type suits and how to apply is advised by the assessment result and the medical social worker for your situation.
Where do we learn nursing skills like nasogastric-tube care?
If family will do daily care such as nasogastric-tube feeding after discharge, ask the ward nurse or medical social worker before discharge which service or organisation can teach you and your family the relevant nursing skills and provide daily-care support; the SWD's community-care services also provide nursing support. Confirm the actual arrangement with the hospital and SWD.
Related guides
What records to collect at discharge (discharge summary, medication, follow-up): see which discharge records to get.
A companion sitting in and collecting reports: see preparing for a first doctor's visit.
Frequently asked questions
The patient needs residential care after discharge — where can we get information and help?
Subsidised residential places are assessed and queued through the Standardised Care Need Assessment Mechanism, and private homes must be licensed with a list available (Social Welfare Department); ask the hospital's medical social worker or SWD Elderly Services for information and the application route.
Family will need to use a nasogastric tube after discharge — where can they learn the care?
Before discharge, ask the ward nurse or medical social worker which service or organisation can teach you and your family the nursing skills and provide daily-care support; the SWD's community-care services also provide nursing support. Confirm with the hospital and SWD.