Continued Care Services

Hospital discharges for people with severe acquired brain damage

This service concerns the methods and procedures for the transition from hospital to society at the end of rehabilitation. The measures developed ensure care and rehabilitative continuity together with the national health service and social services. The main objective is to reduce the gap between health and social rehabilitation, ensuring early interventions that are developed in a progressive manner (post-acute, early, late, outcomes) as needed. Through this service the cooperative supports individuals and their families and defines the needs and available resources in order to set a discharge project.

Intervention

 Progettazione offers:

• Support to individuals and their families when discharged from hospital;
• Help organising their return home;
• Links with social services and specialised facilities;
• Planning in collaboration with providers of post-hospital healthcare activities;
• Links with family doctors for discharge-supporting actions;
• Monitoring the path for a patient’s social reintegration with rehab facilities.

Thanks to this service, our cooperative has already signed a deal with the PapaGiovanniXXIIIHospital in Bergamo.