Post Hospital Discharge Supportβ Home, Safely, on Time
Coordinated, compassionate NDIS hospital discharge support β from planning and home readiness through to immediate care on your first day home. Typically within 1β3 weeks.
For NDIS participants, leaving hospital is rarely as simple as it should be. Communication gaps, uncoordinated funding, home readiness issues, and delayed care arrangements keep medically ready people in hospital longer than necessary.
Pacific Community Care’s hospital discharge service cuts through those barriers. We coordinate every aspect of your transition β from the discharge planning meeting to your first morning home β so you arrive safely, on time, with the right people already in place.
NDIS hospital discharge support bridges the gap between leaving hospital and having full NDIS supports operational at home. It involves discharge planning coordination, home readiness assessment, care plan development, transport, and immediate care delivery β all joined up by one consistent team.
Pacific Community Care acknowledges all referrals within 24 hours and typically facilitates discharge within 1β3 weeks for medically ready participants.
- NDIS participants being discharged from acute hospitals, rehabilitation units, or sub-acute care
- People with acquired brain injuries or neurological conditions transitioning from hospital to home
- Participants with complex physical health needs requiring high-intensity care on discharge
- NDIS participants being discharged from mental health wards or psychiatric facilities
- Individuals transitioning from hospital directly into SIL or other supported accommodation
- Hobart
- Melbourne
We assist participants transitioning from hospital, rehabilitation, mental health units and residential care settings back into the community by providing:
Safe discharge planning
Active participation in discharge planning meetings with hospital teams, social workers, and NDIA
Mental health recovery support
Post discharge support in mental health recovery and psychosocial support
Shopping and meal preparation
Full care support for shopping, meal preparation, and nutrition support
Community reintegration
AHPRA-registered nurses providing clinical care at home post-discharge
Medication reminders and support
Support with complex post-discharge medication regimes
Daily living assistance
Immediate in-home personal care from your first day home
Appointment attendance and transport assistance
Transport from hospital to home and for post-discharge appointments β arranged in advance
Coordination with allied health teams
Coordinating OT, physiotherapist, speech pathologist, and GP post-discharge
Ongoing reviews
Regular structured reviews and NDIS documentation management as recovery progresses
01
Referral and assessment
We acknowledge every referral within 24 hours and immediately begin assessment of your needs and home environment.
02
Planning and protocol development
We attend the discharge planning meeting, develop your care plan, and train support workers before discharge day.
03
Safe arrival home
Transport arranged, support workers ready, equipment in place β care commencing from your first moment home.
01
24-hour referral response β always
Every referral is acknowledged within 24 business hours. Every day in hospital unnecessarily is a day away from home.
02
A complete discharge solution
We provide coordination, direct care, and clinical nursing β one consistent team handles everything, no gaps.
03
Prepared before day one
Your care protocol is complete and your workers are trained before your discharge date. Nothing is improvised.
Our team is ready to discuss your needs, answer your questions, and help you take the first step.
How quickly can discharge be facilitated?
Can you support discharge directly into SIL?
What if my home needs modifications before I can return?
Our home readiness assessment identifies required modifications. We work with your OT to arrange everything before discharge.
Do you attend discharge planning meetings?
Community Nursing
Clinical nursing care that is often the critical link making safe hospital discharge possible. Learn more
Supported Independent Living
Transitioning from hospital directly into SIL? We coordinate the entire process. Learn more
Support Coordination
Expert coordination to navigate discharge funding and connect all post-discharge supports. Learn more