Care after hospital
Post-Hospital Recovery
Post-Hospital Recovery brings together three connected care pathways: clinical transition at home, focused rehabilitation after hospital, and broader functional recovery. Start with the care that fits your needs now.
Where should I start?
You do not have to complete one service before entering another. Choose the description closest to your current needs; intake can help if the fit is unclear.
I still need clinical care after hospital
Hospital-to-Home
Nursing treatment, monitoring or clinical review may still be needed as I settle at home. Essential mobility and safety needs can be assessed as part of the transition.
I am medically stable but below my usual physical capacity
Post-Hospital Rehabilitation
I need physiotherapy-led help to rebuild strength, mobility, endurance or everyday function after a hospital stay.
I need broader or ongoing rehabilitation
Rehabilitation
My recovery goals need a broader or longer plan. I can begin here directly or continue after another care episode.
Post-Hospital Recovery
How post-hospital care can connect
Care can begin at the point that fits your needs now and change as your situation changes.
An example of continuity · your starting point is individual
- 01Hospital-to-Home
Nursing-led clinical transition
Continue required clinical care after discharge and establish the person safely at home.
Clinical goal: Sufficient clinical stability for nursing-led transition care to step down or hand over.
- 02Post-Hospital Rehabilitation
Physiotherapy-led recovery
Identify physical capacity lost around hospitalisation and work towards meaningful strength, mobility and everyday function.
Clinical goal: Recover as much useful physical capacity as reasonably possible.
- 03Rehabilitation
Broader or continuing rehabilitation
Pursue functional goals that need a broader or longer rehabilitation plan, whether care starts here or continues from another service.
Clinical goal: Progress towards broader functional goals, with the plan reviewed as needs change.
Not everyone needs every stage. You can enter directly where care fits, remain with one service, or move between services after clinical review.
Tell us what has changed
Share the discharge information, current clinical care needs, usual function before hospital, what has changed and the activities you want to work towards. You do not need to choose a discipline before contacting intake.
Clinical suitability, the first appointment, care setting, funding and availability are confirmed for each person. A referral does not replace hospital discharge instructions or urgent medical review if health deteriorates.
Questions about recovery after hospital
Do I have to start with Hospital-to-Home?
No. If you are medically stable but have lost physical capacity after hospital, Post-Hospital Rehabilitation may be a suitable direct starting point. Intake can help determine clinical fit.
Can nursing and physiotherapy both be involved?
Yes, when assessment shows both are needed. Hospital-to-Home can include physiotherapy for essential mobility or safety while required clinical care continues. A separate rehabilitation episode may follow if rebuilding physical capacity remains a goal.
Is Rehabilitation only for people leaving hospital?
No. Rehabilitation can also begin directly for broader recovery or functional goals after illness, injury, surgery or other changes in mobility and capacity.