Bridging the gap between a patient's recovery in hospital and at home

Last updated 13 July 2023

From making checks at home before a patient is discharged to keeping in touch once they're home, our home care services help to bridge the gap between hospital stays and at-home recovery

Carrying out home checks after a patient has returned home, collecting their medication and helping with their shopping are all important in bridging the gap between the care a person receives in hospital and their continued recovery at home. 

“Our service is essentially split into two parts: before someone is discharged and after they are discharged,” says Sam, the British Red Cross’s independent living coordinator for Kings College Hospital in South London. “Our support is meant to last from four to six weeks, but it often lasts a lot longer.” 

Invaluable support at a crucial time

“After someone goes home, we help with their shopping, collecting medication, that kind of thing. We signpost people to further services if we get referrals from people who might need long-term support that we can’t offer.”

That support is invaluable to people like Val and Brian. Both in their 70s, the couple have lived in South London their whole lives, but have no immediate family to support them. 

Their son sadly passed away in 2021 and Brian was recently diagnosed with cancer. After Brian was discharged from hospital in October 2021, they decided to accept help from the British Red Cross. 

“I was ready to leave hospital mentally – I was wandering up and down the ward with a walking stick,” says Brian. “But when we got home, things were hard. The last time I went downstairs, it took me an hour and a half just to get back up the stairs again.” 

Since Brian’s recent discharge from hospital after a blood transfusion, Asia has been visiting the couple once a week. She picks up supplies for them and runs errands. 

“Without the Red Cross I honestly don’t know what we would have done or how we would have coped,” says Brian. “I didn’t know the Red Cross did this sort of work. You see campaigns on telly but I thought they mainly worked in other countries. It was a surprise to find out they could help us.”

Val says Asia has been a godsend. “It’s a big relief having Asia come round, she is so helpful,” says Val. “We do put a lot on her and we are just so grateful.” 

 

 

Focusing on the needs of patients first

Asia provides similar support to many others who find themselves in the same situation as Brian and Val.

“One gentleman I supported was completely blind,” she says. “He came to us because he needed escorting to an eye appointment. Soon after, he signed up for befriending and I started calling him every week. He used to ask, ‘What is the weather like today, is it sunny?’ I loved talking to him. It was like he was seeing the world through my eyes.” 

The befriending service is self-explanatory: people can sign up to have regular chats with a British Red Cross volunteer if they’re feeling lonely or just want to hear a friendly voice. 

Sam and Asia are always focused on the needs of the people they are working with. There is no ‘one size fits all’ approach to their work: instead they will present people with a range of options, in the hope it allows them to take control of their own recovery. 

“We have a case at the moment, a gentleman with MS, he’s mute and he wants befriending,” says Sam. “This particular case has been challenging and we have spent a lot of our time just researching, calling people and looking for services that are suitable. We are not a long-term service, so we aren’t really suitable to befriend in a case that is quite complex like this.” 

“What we can do is research, make use of our contacts and present him with some options. Ultimately, it’s his decision as to what support he chooses to accept long-term.”

A physical and complex job

Trish and Sue are part of the the British Red Cross's patient transport team at Kings College Hospital. They play an important role in making sure patients are safely discharged from hospital. 

“Dynamic risk assessment is what we are very good at. You have to think a lot on your feet,” says Sue. “The physicality of getting someone home can be more complex than ‘take this person home.’ Sometimes one job can take three hours. We might be given a code to the key safe, but it might not work.” 

"You have to paint a little picture of the conditions in that home before you even start. It’s for that person’s safety and your wellbeing also,” Sue says. “They have spent all this time getting better, it would set them back for us to leave them in a cold, empty house. Humanity-wise, that doesn’t sit well with us, and it’s why we do this job.” 

Trish knows that NHS staff have their own pressures but that there is a gap between a person being discharged and that person going on to receive long-term support, which needs to be plugged. The eyes and ears of our teams extend beyond the hospital walls, so they can develop a good understanding of a patient’s long-term needs.

“Hospital staff they have their own pressures. They set up a package of care and make all the arrangements, but it’s that limbo time where it’s fundamental for us to step in,” says Trish. 

• Learn more about how to get support when returning home from hospital