Ongoing care

Where next?

Where a brain injury survivor goes after being discharged from hospital will depend on what their ongoing needs are. They may be discharged to a rehabilitation unit, a residential or nursing facility, or return home with arrangements made for ongoing support if needed, for instance from a community neurorehabilitation team or from local social services. 

The sections below describe these care services in more detail.

Rehabilitation unit

The brain injury survivor may be referred to a rehabilitation unit for further specialised rehabilitation, such as physiotherapy, speech and language therapy or occupational therapy. 

There are many rehabilitation services across the UK, run by the NHS or private firms. Choosing which rehabilitation unit to refer someone with a brain injury should involve the clinical team, the patient and their family. The patient’s needs will be assessed to determine what level/type of rehabilitation is required, and decisions will be primarily based on this - this may mean the most appropriate type of care is not the closest to home.

Once a referral has been made, the rehabilitation unit will usually carry out an assessment to make sure their service is suitable.

Availability and funding for places vary. However, most units, including private ones, accept NHS referrals and may be funded by the NHS. Other possible sources of funding include the local authority, medical insurance, compensation claims and self-funding.

The hospital discharge team are often involved in submitting funding applications, and rehabilitation units can often provide guidance on the process. It is important to make sure that whoever is likely to have to fund the rehabilitation is aware that a referral has been made. The rehabilitation service will not be able to accept an admission until funding has been authorised.

Many services accept referrals from outside their own area, but there are often limited places available and long waiting lists. Specific details about the referral process, availability of places and funding options will be available from the unit.

Taking up a rehabilitation placement is an important commitment, and it is wise to explore all the options, visit different rehabilitation settings, and ask as many questions as possible before a placement is confirmed.

Visit Rehabilitation to find out more about this stage.

Residential/nursing

If your loved one no longer requires intensive rehabilitation, but isn’t able to return home, they may be assessed as requiring long-term residential care or an interim placement. Funding for this will be means-tested, so the survivor may need to contribute some of the costs themselves. However, if they are entitled to nursing care then this should be funded by NHS.

There are residential care homes that specialise in caring for people with brain injuries. These units provide long-term rehabilitation services and enable people with brain injuries to continue to maximise their potential for improvement, so it is important to access one of these units if possible.

There are a number of search and comparison websites for residential units and other care services, and some of these will have search filters for ‘acquired brain injury’ or specific types of brain injury such as stroke, head injury, etc to help you with your search.

You can also search for units from the websites of their respective inspecting and regulating bodies.

Search the Headway Approved Provider directory to find Headway approved units near you. Do note that this list is not exhaustive, and you may find alternative units by searching other sites.

Return home with arrangements made for ongoing support

At the discharge meeting, it might be decided that a survivor is ready to return home. However, it is important that the survivor and their family do not feel rushed into this before they are ready.

They should not feel under pressure from anyone. This includes families feeling pressured by the survivor, who may be very keen to get back to familiar surroundings.

A proposed discharge date should only be accepted when everyone involved is certain that the necessary assessments have taken place, that they have sufficient support and that all necessary equipment is in place at home. Further guidance on this is available on Discharge from hospital. 

Intermediate care

A brain injury survivor might be eligible for short-term support at home to help them with regaining independence after they are discharged from hospital. This is known as intermediate care. It usually lasts for a maximum of 6 weeks. It can include support from a paid carer, therapy goals being set, adaptations being made to the home or provisions of equipment being made.

Many areas have NHS community rehabilitation teams - a referral can be made prior to discharge, however if this is not undertaken, the patient’s GP should be able to refer into the local service. The teams usually offer physiotherapy and occupational therapy, some will also provide further services such as neuropsychology or speech and language therapy.

Hospital staff should discuss these arrangements with the brain injury survivor before they leave hospital. A home assessment can also be arranged with an occupational therapist (OT) to identify any home adaptations that need to be made or equipment that needs to be accessed, such as handrails, ramps or perching stools. They can discuss this with a hospital OT before being discharged, or apply for a home assessment from their local council.

Visit the NHS website for more information on intermediate care.

Needs assessment

All brain injury survivors are entitled to a care needs assessment from their local authority’s social care team if they need help to cope on a day-today basis. This can be asked for at any time by contacting the patient’s local adult social care team. Therefore, even if they have been at home for a while, they can ask for an assessment.

A needs assessment can be completed to access help such as adaptations being made to the home, provision of equipment, access to day centres and practical help from a paid carer.

Local authorities throughout the UK should complete an assessment for anyone who needs it. The brain injury survivor’s wishes and preferences should be taken into account when deciding on the services they receive.

Families caring for the survivor are also entitled to assessments to identify their needs – this is called a carer’s assessment. More information on this is available on Looking after someone with a brain injury.

Funding of ongoing care

If a brain injury survivor has ongoing health and social care needs, they may be eligible to have some or all of this funded by NHS and/or local authority social care services.

A package of care for adults with ongoing needs funded entirely by NHS is called NHS continuing healthcare. It can fund care in a variety of settings, such as the person’s own home, a care home or other community-based settings.

Money from the NHS to fund ongoing healthcare needs is called a personal health budget. Money from local authority social care services to fund ongoing social care and support needs is called a personal budget. Money for both healthcare and social care needs together may be provided through an integrated personal budget.

These budgets may be managed directly by the NHS or local authority on the person’s behalf. In this case, the NHS team/social care team and brain injury survivor (or their representative) will discuss what the care and support needs are, what budget is available and how this will be spent. This will then be set out in a document called a care and support plan.

Alternatively, the budget can be paid directly to the person (or their representative) so that they can choose and manage their own care and support arrangements. This is known as ‘direct payment’. It is vital that the money given through direct payments is spent on the person’s health and social care needs as set out in the care and support plan.

More information on personal health budgets and personal budgets is available on the NHS website.

Further detail on how these budgets are assessed for and arranged is available on Assessment and funding of care.

Needing help or care in the future

A brain injury can affect people for months and years rather than simply days and weeks. Some of the effects of brain injury do not develop or become obvious until the person has left hospital and returned home. Often, it is only when survivors are attempting to adjust to regular life that they realise the full impact of injury.

If you are needing help or care months after your injury and you are no longer in contact with the hospital or rehabilitation team, you can still request this from your GP or your local authority’s adult social care team (depending on the type of care you require). Your GP may be able to make referrals or direct you to services that can help, while your adult social care team can arrange for you to undergo a needs assessment any time after your injury (see above).

You can contact our nurse-led helpline any time after your injury to find out about the support available to you from Headway and other services.