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Evaluating the discharge planning process

Barriers, challenges, and facilitators of timely and effective discharge for people with disability and complex needs
Supported accommodation Housing for people with disability National Disability Insurance Scheme (NDIS) People with disability Health services administration Australia

The pathway from hospital to the community for people with disability and complex needs is characterised by delayed discharges and prolonged admissions. Due to the challenges and lengthy processes associated with securing supports to re-enter the community, people with disability are at risk of entering Residential Aged Care (RAC) at the point of hospital discharge. Hence, improving the pathway from hospital to the community is the key to reducing the number of younger Australians stuck in hospital and/or discharged to RAC.

Three studies were initiated to explore and identify barriers, challenges and facilitators of timely and effective discharge for people with disability and complex needs. Firstly, a research project collecting Hospital Discharge Trajectory (HDT) data including length of stay, health and NDIS timeframes, delays to discharge and discharge destinations, was conducted. Secondly, a survey was distributed amongst clinicians working across the hospital discharge trajectory to gather their experiences of facilitating hospital discharge. Finally, routine service data were collected from the Housing Brokerage Service (HBS), a service providing secondary consultation to support teams of NDIS participants stuck in hospital due to a housing barrier.

Lengthy and unpredictable timeframes associated with the approval of NDIS funding for supports and housing contributed significantly to discharge delays. Without the timely allocation of funding, clinicians were unable to facilitate efficient discharge planning for participants. Additionally, despite timeframes decreasing, the identification of NDIS participants and submission of Access Request Forms (ARF) by hospital clinicians remained lengthy. Finally, clinicians described thin housing markets, a lack of specialised support providers and challenging stakeholder interfaces to affect the achievement of timely discharge. Securing housing and supports that met the participant’s needs and preferences frequently contributed to discharge delays across all studies.

Ultimately, hospital discharge occurs in a highly pressurised environment. Efficient discharges are necessary to prevent disruptions to patient flow and poor health outcomes for patients, yet delays to discharge are prevalent, placing people with disability and complex needs at risk of being discharged to RAC. When comparing the Australian aged care and NDIS support provision trajectories at hospital discharge, the differences are substantial. Aged care systems are positioned to provide comprehensive 24-hour support and housing promptly and efficiently (i.e., often within 3 days), whereas accessing housing and support through the NDIS is typically a lengthy and complex process. To improve outcomes for people with disability and complex needs in hospital, health teams should be supported to initiate early applications for NDIS funding and complete early assessments of housing needs and preferences. The NDIA should provide timely funding decisions to allow discharge preparation to commence early so that individuals can leave hospital once medically cleared to do so.

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