14. Discharge planning

14.1 LMO RESPONSIBILITY FOR DISCHARGE PLANNING

DVA recognises that discharge planning has a fundamental bearing on the quality of health care veterans receive after leaving hospital, and that it is essential in achieving their long-term health care goals. It is the Repatriation Commission's policy that multi-disciplinary integrated discharge planning is encouraged for veterans.

LMOs:

  • are responsible for providing advice to relevant hospital discharge planning staff concerning their veteran patients if they are managing their patient's hospital care;
  • may be required to provide advice to relevant hospital discharge planning staff concerning their veteran patients, when other health care professionals are managing their patient's hospital care; and
  • are responsible for continuing the medical management of veterans following their discharge from hospital.

DVA's Discharge Planning Package

DVA has developed a Discharge Planning Package that is intended to:

  • improve the quality of care for veterans following discharge from hospital; and
  • encourage veterans to take a greater role in the discharge planning process.

The package recognises the particular roles played by hospital staff, specialist medical practitioners, LMOs, allied health professionals and community support services. In particular, it identifies the LMO as the most appropriate post-discharge care coordinator.

It comprises two publications directed at:

  • staff in hospitals and day procedure centres involved in discharge planning; and
  • veterans and war widows/widowers.

DVA has published an updated resource kit, A Discharge Planning Resource Kit for Hospitals and Day Surgeries, on its website. This kit sets out the Repatriation Commission's expectations and requirements for discharge planning and provides additional and detailed information on DVA health care services and how to access them.

DVA also produced a factsheet, Tips to assist with hospital admission and discharge - A checklist for veterans, carers and other entitled persons (HSV74) for use by veterans or war widows/widowers who are to be admitted to a hospital or a day procedure centre. It replaces the brochure, Planning Your Discharge from Hospital. The factsheet provides information on the major issues to be considered in discharge planning and is intended to encourage veterans to take a greater part in their own discharge planning process. It prompts entitled persons and their carers to identify issues that concern them about being discharged from hospital or day procedure centre, and to communicate these issues to hospital staff, so that appropriate actions can be taken before they leave hospital.

14.2 COMMUNITY SUPPORT SERVICES

Community support services may also help to provide veterans with appropriate care in the post-acute phase of their treatment. The major community services are provided through the Home and Community Care (HACC) program. There are numerous local organisations that provide various other forms of community support services. In most instances, community support organisations require a contribution toward the cost of their service. The Repatriation Commission does not cover the cost of this contribution.

Veterans may be eligible to access support services provided under the Veterans' Home Care program (see section 18.1).