Care service
Post-Hospital Rehabilitation
Rehabilitation support after discharge, with practical attention to mobility, function, confidence, and returning home safely.
Lead pathway
Transition pathway
Care settings
Clinics GRPCare, governance and continuity
Who it suits
Who this pathway is usually for
- People returning home after surgery, acute illness, falls, fracture, or deconditioning
- Families seeking help to bridge the gap between discharge and stable day-to-day function
- Hospital discharge teams looking for a responsive community pathway
- Clients who may need combined physiotherapy, remedial massage, nursing, exercise, and review
How care is delivered
What care usually looks like in practice
- Mobility assessment, exercise prescription, transfers, stairs, and fatigue pacing
- Home or clinic follow-up based on the safest and most practical recovery setting
- Communication that supports continuity across carers, referrers, and care teams
Funding
Common access pathways
- Support at Home (SaH)
- Commonwealth Home Support Program (CHSP)
- Medicare
- Private Health Insurance
- NDIS
- Self-funded
Frequently asked questions
Common questions about post-hospital rehabilitation
How soon after hospital discharge should support begin?
Usually as early as practical. Early follow-up helps prevent recovery from losing momentum and can reduce confusion after discharge.
Can care be provided at home first and later move to clinic?
Yes. Some people start at home and later transition into clinic once mobility, transport, and confidence improve.
Can a discharge planner refer directly?
Yes. Hospital teams can use the referral pathway directly when community follow-up is needed.
Next step
Start with intake and we will route the person to the right setting
If someone is preparing to leave hospital or has recently returned home, contact the team early so the transition plan can be put in place.