This page provides guidance on placement reviews where the person is discharged home (Pathway 1) or to a nursing/residential home (Pathway 3).

Review of care following Pathway 1 - discharged home

• If the person is able to be supported at home upon discharge, the hospital Social Worker makes any required changes to a reablement care package or existing care package and takes the carer’s needs into consideration.
• An annual review of care package, including the carer’s needs, is reviewed by ASC Neighbourhoods Team.

Review of care following Pathway 3 - person discharged to nursing/residential home

• In most cases, placements to either Nursing Home or Residential Homes from an acute hospital setting will be set up on an interim basis only.
• A placement review is carried out at 6 weeks by the Placement Review Team, and the needs of carers form part of that review.

Attached is a map showing a sequence of steps and decisions to take in a review of care following Pathway 1 and Pathway 3. 

Best Interest and Mental Capacity

• A Mental Capacity Assessment and Best Interest decision will have been completed by the Hospital Social Worker prior to the decision of the discharge destination being agreed.
• Best interest decisions can be made at any point in the person’s care journey regardless of whether the person is moved into residential care or returns to their own home other type of housing