The period immediately following a brain injury can be a frightening and confusing time for many people. This might be your first experience of brain injury, and you might have lots of questions about what is going on and what to expect.
Regardless of the exact type of injury sustained, many people with a brain injury will spend some time initially being treated in hospital.
This section offers information on hospital systems and treatment at the early stage of brain injury and gives guidance on how you can best support yourself and your loved one through this period.
More detailed guidance on hospital treatment and early recovery from brain injury is available on Treatment and rehabilitation.
Understanding hospital systems
Understanding the different stages of hospital treatment and care can be confusing, as they will vary depending on the type of brain injury that a person is being treated for. Treatment pathways will also vary depending on the severity of injury.
Mild brain injury/concussion
Someone with a mild brain injury/concussion might attend a hospital Accident and Emergency department (A&E) for a brief period of assessment and monitoring before being sent home. They should be provided with information on managing their symptoms upon discharge.
The person should be supervised for at least 24 hours after leaving hospital, and it may be that you are the person responsible for supervising them.
Visit Concussion for more information on this, including symptoms for you to be aware of and directions for what to do should your loved one’s condition worsen.
Moderate/severe brain injury
In the case of very serious injuries, a person will normally be taken to the nearest A&E, where they will be assessed and their condition stabilised. They should then be transferred to a neurological center if it is considered appropriate and there are beds available. If not, they will be admitted to a general hospital and may be treated on a non-specialist ward.
It is very important that the person who has sustained the injury rapidly receives the best specialist care possible. If the treatment is provided in a general hospital, then the doctors there should consult with neurologists and neurosurgeons at a nearby neurological center.
The hospital stage can sometimes be more distressing for family and friends than it is for the person with the injury (who might be unconscious or have no awareness or memory of this period).
You will probably want definite answers in the early stages, which medical staff often can’t provide. Rest assured that, if this is the case, you are not being deliberately kept in the dark. Rather, it can be difficult to predict what the outcome of the injury will be. Clinicians might also be focused on their immediate priority of stabilising and managing your loved one’s condition.
In the early stages it really is a matter of taking each day as it comes. It is important to ask the consultants questions, but try not to feel too frustrated if they don’t have all the answers.
Headway's Emergency Fund
Find out more about how our Emergency Fund can help you during this difficult time.
How to help your loved one
It is normal to feel helpless when your loved one is in hospital and to feel desperate to be able to do something constructive. There are many factors involved in the treatment of different kinds of brain injuries, so we can’t advise on specific activities here, as some things may be beneficial in some instances but harmful in others. Helping your loved one can take many forms and the following can all make valuable contributions.
Communicate as much as possible with the nursing staff and therapy team. They will be able to suggest any appropriate ways for you to help and keep you informed of your loved one’s condition. Ask hospital staff if you can be involved in meetings about your loved one so that you are kept up-to-date about their treatment and the next stages of their care.
Organise visiting hours with a small number of family and friends that your loved one knows well. It is important to keep this number small so that you provide enough support without overwhelming them or causing disruption to their treatment and recovery. Having a small number of people visiting can also avoid confusion and maintain your loved one’s dignity.
Provide interesting things and stimulation for your loved one. Just talking to them about familiar things can help, as does showing them or reading to them from books or magazines of their interest.
Help with your loved one’s personal care under the advice and supervision of nursing staff. This can help you to feel close to them, especially if they are in a coma or a prolonged disorder of consciousness.
Your loved one may need rehabilitation. Consider asking staff involved in their rehabilitation if there is any way that you can get involved, for example by helping with activities and exercises outside of therapy sessions.
Keep your loved one’s employer and friends informed of their situation.
Do not feel like you have to talk for long periods when visiting – sitting quietly will offer reassurance and comfort, without overwhelming your loved one or causing fatigue.
How to help yourself
This is a time during which you will probably have to do a great deal of re-organisation in your daily life and it is very important to remember to look after yourself. The following suggestions are worth keeping in mind.
Lean on others
Get help and support from professionals and services available at the hospital. This could include staff involved in your loved one’s care, advisory services, a social worker or the hospital chaplaincy. You can ask at the hospital reception about services available if you are not sure who to contact.
Contact our nurse-led helpline. The helpline team may be able to answer questions, explain what is going on, direct you to sources of support and offer emotional support.
Talk to other families on the ward in similar situations if they seem willing and comfortable with talking. Do remember that everyone’s situation is different, and some families may not want to talk about their circumstances.
Be very clear and assertive in telling people in authority what you want and what you need from them.
Get practical help and support from relatives, friends and neighbours, such as getting lifts to and from the hospital, asking them to look after young children or pets, or asking if they will cook a meal for you.
Involve all the family in taking on household tasks so that you are not having to do this by yourself.
Rest, take breaks and make time for yourself
Do not feel that you have to spend every moment sitting at your loved one’s bedside. You will cope best if you are able to go home for a while and get as much sleep and rest as possible.
Try to make time for activities that can help you to relax, such as going for a walk or listening to music.
Remember to eat a healthy, balanced diet and make time for exercise.
See your GP with any health concerns of your own, including if you are having difficulties with sleeping or your mental health.
Make financial arrangements
Talk things through with your bank in order to reschedule any debts and budget for your new circumstances.
Organise personal finances and payment of bills. This can be a particular issue if your loved one was previously responsible. If possible, arrange for a willing and responsible friend or family member to take on the duty. Alternatively, contact your local Citizens Advice for advice on local sources of support.
Start to research the welfare benefits that you may be entitled to when your loved one returns home. You might not need to apply for these, but it can be helpful to be aware of what financial support is available if you need it, for instance, if your loved one is unable to return to work. Be aware that if your loved one was on benefits before going into hospital then these may also be affected.
Check any insurance policies your loved one has, particularly medical insurance.
Talk to your loved one’s employer to find out if they have an occupational pension which is initiated following serious injury.
If your loved one has been in an accident you may be able to take legal action against the person or organisation responsible through a compensation claim. Although it may not be your priority at this stage, it is important to bear in mind that there may be time limits within which the claim needs to be made.
Consider applying to become your loved one’s deputy if they are lacking capacity and need best-interests decisions to be made on their behalf. You might already be their registered lasting power of attorney (POA). These arrangements will allow you to have access to bank accounts of your loved one and manage financial decisions on their behalf. Do note however that you should not rush into doing this. Deputyship can take several months to arrange, during which time your loved one’s condition may change and the application might no longer be appropriate. It also involves a fee. A letter from the hospital, confirming your loved one’s inability to act for themselves, may be enough for some creditors/service providers to engage with you – however banks will not do so without POA/deputyship.
Make arrangements with employers
Keep both your own and your loved one’s employers informed about the situation.
Check whether your employer has a scheme for compassionate leave. Your contract of employment or company handbook should contain details of this. Be aware that if your contract has no provision for compassionate leave then your employer has no legal obligation to grant you time off, so it is especially important to be as communicative as possible to help them understand your situation.
If the situation with your loved one is causing you to feel stressed or anxious to the point of needing to take time off work, consider asking your GP for a sick note so that you can take sick leave.
Be aware that your loved one might be entitled to a minimum of 28 weeks statutory sick pay, or more if allowed in their employment policy. For the employer to consider dismissal, they must have excellent medical grounds to say your loved one will not be capable of returning to the job in any capacity.
Consider contacting the Advisory, Conciliation and Arbitration Service (ACAS) for any concerns regarding employment matters.
lf your loved one is self-employed you may need to check if they are insured for accidents or illness. If not then you will need to make arrangements to ensure that tax is paid and that any business associates or clients are informed of the situation. You might want to appoint a willing and trusted friend or family member to deal with these matters. Your local Citizens Advice can offer assistance and signpost to local sources of support.
Keep records
Try to keep details and records of key events, such as the date and time of the injury, the treatment your loved one receives and the professionals involved in their care. This might be useful at a later date, as it can be very difficult to remember everything accurately if it isn’t first written down.
Ask for a copy of any letters the hospital sends to your loved one’s GP. These can provide valuable supporting evidence for benefits and compensation claims.
NHS patient support services
England and Wales
In England and Wales, the Patient Advice and Liaison Service (PALS) is a source of advice and support at every NHS hospital. PALS can help to deal with any concerns you have about your loved one’s treatment and help to arrange meetings with consultants. You can find details of your local PALS service at the hospital reception desk or website. Alternatively, you can search for a PALS service in your area on the NHS website.
In Wales, Llais Wales can also provide advice and support.
Scotland
In Scotland, the Patient Advice and Support Service (PASS) can offer information and be contacted through your local Citizens Advice.
Northern Ireland
The Patient and Client Council (PCC) in Northern Ireland offers support for concerns or complaints, and you can discuss issues with their Patient and Client Support Officers (PCSOs).
Channel Islands
The Patient Advice and Liaison Services (PALS) is also available in Jersey. In Guernsey, the Customer Care Team is the first point of contact for giving feedback on Health and Social Care.
Isle of Man
On the Isle of Man, Manx Care Advice and Liaison Service is available for concerns and queries about health and social care.
Emotions during hospital stage and early recovery
It is important to remember the following points:
There is no right and wrong way to feel at a time like this and ALL reactions can be considered completely natural. Feelings such as shock, numbness, anxiety, fear, guilt, denial, anger and depression are all very common things to experience at this stage.
Coming to terms with a loved one’s injury is a complex and ever-changing process. Feelings change rapidly at this time and it can be impossible to predict the stages of your emotional reactions.
Don’t expect everything to make sense initially. Speak to other carers and families who have been through a similar situation, or other families on the ward. You can also use our Headway services or online communities to connect with others who have been through similar experiences.
It will be difficult to take information in at first, but it will gradually start to sink in. Try to keep returning to any written information you have been given.
Your GP may be able to refer you to counselling for emotional or psychological support if you are struggling with your emotions or mental health.
The issues facing young children and their emotional reactions can be particularly challenging. If you have children, or there are children in the family, our guidance on Children may be helpful.
Leaving hospital
Once your loved one is medically stable and any physical injuries have been treated, they may be ready to be discharged from the hospital. Where they go next will depend on what their ongoing needs are. Next steps can include being discharged to a rehabilitation unit, a residential or nursing facility, or returning home with arrangements made for ongoing support if needed.
More guidance on these stages is available on our pages Rehabilitation and The discharge process.
Guidance on assessments and funding of care is available on Assessment and funding of care after brain injury.
