Leaving hospital

About the range of services we provide

Leaving hospital


You may feel concerned about how you'll cope after you're discharged from hospital. Many people worry they'll be a burden on their family, but there are many people who can give different kinds of support.

You may need equipment, rehabilitation or support, or help with everyday chores. You may need medical help to change dressings and give injections, or you may need more personal care to be able to wash and dress. Many people may simply need emotional support or someone to talk to.

Your needs will be assessed in detail by a team of professionals including a ward nurse. This includes details about the support you'll receive at home including where and how often you'll receive it, contact details for all health professionals involved and who to contact in emergencies.

What does the service offer?

If you're having problems with daily activities like washing, dressing, getting to the toilet or preparing meals you may need help from a care worker.

We work with a number of suppliers to provide care and support for those who need it.

How can I access the service?

In most cases we'll undertake an assessment, which will involve someone talking to you about your care needs, taking into account family and community support.

Our assessment will allow us to find out if you need care in the home. 

How do I contact the service?

To request an assessment, get in touch with our Initial Contact team.


We want to support you to live safely in your home. However, in the situation that this isn't possible we will discuss with you and your family what the options might be.

Where it's felt that a care home is the best way to meet your needs we'll help you to identify a suitable care home.

How to access the service

The decision to recommend a move to a care home will follow an assessment by a member of the Health and Social Care Partnership (HSCP) staff.

You can also be referred for an assessment by a: doctor, member of hospital staff, local housing officer, welfare rights officer, Citizens Advice worker, relative, or a carer.

Even if you plan to arrange and fund services yourself, it's still a good idea to get an assessment of your care needs to ensure all your care needs are identified and that you're aware of any help that may be available to you from your local council or the NHS.

What is available?

The type of care home will depend on the support you need, which will be agreed through the assessment. There are 2 types of care homes for older people:
 

Residential

Care homes that provide personal care such as washing, dressing and giving medication.

Health support can also be provided from members of the visiting health care team such as a doctor, community nurse or physiotherapist.

Nursing

Care homes that provide personal care, but have at least one qualified nurse on duty 24 hours a day to carry out nursing tasks.

How do I choose a care home?

There are 14 care homes in East Renfrewshire. 

If you're thinking of moving into a care home, you've the right to visit the care home before moving in.

Care homes should have their own brochure describing their services, which you can request at any time.

How much does it cost?

The costs for a care home depend on the services provided. There will be a financial assessment undertaken by the HSCP assessor.

 

Who we are

The Community Rehabilitation Team is a multidisciplinary healthcare team comprising:

  • Physiotherapists
  • Occupational Therapists
  • Rehabilitation Nurses
  • Dietitians
  • Assistant Practitioners
  • Rehabilitation Support Workers
  • Speech and Language Therapy

We're based within East Renfrewshire HSCP and have two teams which cover across Eastwood and Barrhead localities.

We aim to maximise independence and function for people following illness, injury or a decline in their health. Rehabilitation goals are made jointly with the patient and carer where appropriate.

Who we see

Adults over the age of 16 (over age of 18 years for adaptations) who are:

  • At risk of emergency admission due to a decline in mobility and function
  • Experiencing issues with mobility, falls, and activities of daily living
  • Requiring advice and support to manage the effects of a long term/ progressive condition and require rehabilitation to maximise their independence
  • Recently discharged from hospital with ongoing rehabilitation and reablement goals
  • In need of equipment and/ or adaptations to their home environment to maximise function and safety
  • Who are temporarily or longer term housebound, or who require an assessment of their home environment.

How can I access this?

The Community Rehabilitation Service operates an open referral system. This facilitates self/carer referral and referral from GPs, hospital staff, health care professionals, Social Work Services, housing, other community organisations, with the agreement of the individual.

For any further information, contact can be made with the Initial Contact Team on 0141 800 7850 which is the single point of access for any health, wellbeing and/ or social work queries in East Renfrewshire.

Other useful information 

Find out about help available if you or a family member have had a fall or are at risk of falling


Find out about end of life and palliative care, which offers people the choice to remain in their own homes as they near end of life.

End of life care - what's available?

  • An experienced district nursing service who work 7 days from 8.30am to 4.30pm
  • An evening service district nurse who'll work from 6.30pm to 10.30pm
  • Marie Curie services including night sitting, are available for end of life care to give support to carers in the home

Who can access the service?

Anyone who requires nursing care in the home and are nearing the end of their life.

You can self refer or be referred by:

  • your doctor
  • hospital
  • a relative
  • a carer
  • palliative care nurse specialists

What is palliative care?

Palliative care is a part of end of life care for critically or terminally ill people and their families. It includes physical, emotional and spiritual care.

What's available?

  • A full assessment from a district nurse and ongoing support for you and your family
  • Referral to the Prince and Princess of Wales Hospice or Accord Hospice for support at any stage of your illness
  • Referral to a local outreach clinic in the Eastwood Health and Care Centre for expert advice, knowledge and support

Specialist palliative care

Specialist palliative care is also offered by the following charities by the Prince and Princess of Wales Hospice and Accord Hospice.


Technology Enabled Care (TEC) is the umbrella term to describe how technology can be used to support health and wellbeing. This includes Telecare, Telehealth and digital health and care.
 

Service information

Use this service to contact the Technology Enabled Care (TEC) team to apply for a telecare alarm or additional telecare equipment.

A telecare alarm provides a link from your home to our 24 hour response centre, SafetyNet.
 

Eligibility criteria

Telecare is open to East Renfrewshire residents who live at home and would benefit from the service.
 

Before you start

If you're making an application on behalf of someone else then you must have power of attorney, guardianship rights or their permission to continue.
 

How to apply

Apply online

Home Safely is available to East Renfrewshire residents who are returning home after a stay in hospital. Over a period of 8 to 10 weeks, a trained volunteer will assist individuals to help them work towards achievable goals considering interests, physical and mental well-being.

The volunteer starts with short visits at home to build up trust and confidence. When the referred person is feeling able to do so, we can support them with getting out to the shops, help with transport to exercise classes to improve strength and balance and assist in accompanying the supported person to clubs of interest.

The objective is that following the Home Safely program, the supported person feels they've gained independence and are more confident about accessing information and activities within their community on their own.

Contact the Community Hub on 0141 876 9555 or complete a self-referral form on Talking Points: The Community Hub East Renfrewshire.

 

 

Last modified on 14 March 2024