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Specialist Program

NDIS Hospital Discharge Program

Helping NDIS participants with complex support needs transition safely from hospital into the right supported accommodation.

When a participant is ready to leave hospital but the community pathway isn’t ready yet, Hikma House can become involved early. We assess the participant’s support needs, review the available information, work with the treating team and identify what needs to be in place for a safe transition.

 

Discuss a Hospital Discharge

Get Hikma House involved early

A participant can be medically ready for discharge while the right accommodation and support arrangements are still being put in place.

There may be questions around funding, staffing, behavioural support, accommodation or the handover between the hospital and community team before a safe transition can take place. Hikma House gets involved early to help bring those pieces together. We work with the hospital team, participant, family, support coordinator and relevant professionals to understand the participant’s needs, assess suitability and establish what needs to be in place before discharge.

Our focus is on a safe, well-planned transition and continuity of care once the participant leaves hospital.

Understanding the support requirements

Every referral is assessed individually. We look at the participant, their support needs and the circumstances around their discharge before deciding whether Hikma House is the right fit.

The participant

Current presentation, behaviours, communication, support needs, risks and preferences.

The support required

Staffing ratio, staff capability, supervision requirements and any participant-specific training needed.

The accommodation

Existing SIL, SDA or MTA options, location and property suitability.

The information

Behaviour Support Plans, discharge summaries, risk assessments and other relevant documentation.

Discuss a Hospital Discharge

Hospital discharge pathways

Hospital discharge can lead to different community arrangements. Hikma House supports participants whose transition requires complex accommodation and support, with MTA and SIL being the pathways we most commonly provide.

Hospital to MTA

For participants who need a period of supported accommodation before their longer-term arrangements are ready. Hikma House provides MTA accommodation and support for up to 90 days, giving the participant time to settle into a community setting while longer-term SIL, housing or funding arrangements are being finalised.

Hospital to SIL

Where a suitable SIL arrangement is already available, a participant may be able to transition directly from hospital into their longer-term home. We prepare the support team before the move, including reviewing relevant information, matching staff to the participant and coordinating the hospital handover.

Our hospital discharge process

From the initial referral through to the participant’s move, we stay closely involved and work alongside the hospital and wider care team.

01 — Referral & Initial Assessment

We start by understanding the participant's circumstances, support needs and what is required for discharge. Where the relevant information is available, we can provide an initial response within 24 hours.

02 — Information & Planning

We review the relevant clinical, behavioural and functional information, including Behaviour Support Plans, discharge summaries, risk assessments and incident history.

03 — Accommodation & Support

We determine the accommodation and level of support that best fits the participant's needs. This includes identifying the appropriate staffing model, matching staff to the participant and arranging any additional training required.

04 — Hospital Handover & Discharge

We work with the hospital team to make sure important information, support strategies and expectations carry through to the community setting. Where appropriate, our team can be involved at discharge and help the participant transition into their accommodation.

05 — Settling Into the New Environment

The first few days focus on helping the participant feel comfortable, establish routines and build familiarity with their new environment. We maintain communication with the care team, document relevant information and respond to any concerns as they arise.

Don't Just Take Our Word for It

Here’s what our awesome community have to say about working with us:

Who We Support

We’ve worked alongside people living with a wide range of medical, psychological, and behavioural complexities. Here are just some of the needs we support.

  • Complex behaviours of concern
  • Restrictive practice requirements
  • High-intensity support requirements
  • Forensic backgrounds
  • Previous placement breakdowns
  • Mental health support needs
  • Hospital discharge transitions
  • Dual diagnosis
  • Acquired brain injury (ABI)
  • Schizoaffective disorder
  • Intellectual disability
  • Autism Spectrum Disorder
  • Schizophrenia
  • Post-Traumatic Stress Disorder (PTSD)
  • Diabetes support
  • Self-injury and suicidal ideation
  • Biploar Disorder
  • High-intensity medical needs
  • Down Syndrome
  • Parkinsons Disease
  • Cerebral Palsy
  • Huntington’s Disease
  • Complex and rare genetic disorders
  • Dementia

Planning a Hospital Discharge?

If you’re supporting an NDIS participant with complex support needs, speak with Hikma House about our transition from hospital and the supported accommodation options available.

Discuss a Hospital Discharge

Frequently Asked Questions

Yes. Early involvement allows us to understand the participant’s needs, assess suitability and begin preparing the accommodation and support arrangements ahead of discharge.

Yes. We can communicate directly with hospital staff and relevant allied health professionals and participate in discharge planning meetings, case conferences and handovers where required.

No. Hikma House specialises in complex behavioural and psychosocial support rather than complex medical care. We do not support participants who require complex medical care such as PEG feeding.

 

We look at the information available about the participant’s current presentation, support needs, behaviours, risks, funding and discharge requirements. This may include a Behaviour Support Plan, discharge summary, functional assessments, risk assessments and incident history.

 

 

We assess whether the available funding can safely support the level of care required. If there is a mismatch, we will raise this with the relevant team rather than proceeding with a support arrangement that does not adequately meet the participant’s needs.

 

Where SDA is appropriate, Hikma House can work with our established SDA provider network to help identify a suitable property alongside the participant’s support arrangements.