Hospital Discharge & Transition Support
A safe, supported transition from hospital to home.
What is Hospital Discharge?
Leaving hospital can be a stressful and uncertain time, especially for people with disability. Without the right supports in place, hospital discharge can lead to readmission, deterioration or unsafe living situations.
Together in Motion Services works closely with hospital discharge planners, social workers, allied health teams and NDIS support coordinators to ensure every participant has a safe, well-planned transition out of hospital and into appropriate accommodation and supports.
We can arrange Medium Term Accommodation, in-home supports, daily living assistance and community participation supports to be in place from the day of discharge — so there is no gap in care.
Is this support right for me?
This support may be right for you if:
- You are an NDIS participant currently in hospital or about to be discharged
- You do not have a safe home to return to after hospital
- You need supports in place from the day you leave hospital
- Your support coordinator or hospital team has referred you to us
- You are a hospital social worker or discharge planner seeking a provider
Not sure if this is the right support? Talk to our team — we will help you work it out.
What we can support you with
Here is what Hospital Discharge & Transition Support support from Together in Motion Services can include:
Hospital liaison
Working directly with discharge planners, social workers and allied health.
Accommodation arranged
MTA or in-home supports ready from the day of discharge.
Personal care support
Daily living and personal care from day one after discharge.
Coordinator liaison
Active communication with your support coordinator and the NDIA.
Transition planning
Goal-setting and planning for your long-term living arrangement.
Rapid response
We prioritise hospital discharge referrals and respond quickly.
What could this support look like?
Every person's support is different. Here is a realistic example of what a day with Together in Motion Services might look like.
Pre-discharge
Our team liaises with the hospital discharge planner, social worker and your support coordinator to understand your needs and have everything in place before you leave hospital.
Discharge day
We are there on the day — whether that means meeting you at the hospital, having your accommodation ready, or having a support worker at your home when you arrive.
First weeks home
We provide intensive support in the first weeks after discharge, reviewing your needs daily and adjusting your supports as you settle in and recover.
Your choice and control
Even in a hospital discharge situation, your preferences matter. You decide where you want to go, what your home looks like and how your supports are structured. We plan around your goals — not just your clinical needs.
How is the support personalised?
Every hospital discharge is different. We work with you, your family, the hospital team and your support coordinator to understand your specific situation — your health needs, housing situation, support requirements and goals — and build a transition plan around that.
Where is this support available?
Together in Motion Services provides Hospital Discharge & Transition Support across six states and territories. Capacity varies by location — check your state below before referring.
Current Capacity by State
Accepting ReferralsCapacity for this support varies by state. Check your state below before referring.
Capacity is subject to staffing, location and participant needs. Contact us to confirm before referring.
How do I get started?
Getting started is straightforward. Here is what to expect:
Contact us early
The earlier you contact us, the better. We can begin planning while you are still in hospital.
We liaise with the hospital
With your consent, we work directly with the hospital discharge team to understand your needs and timeline.
Arrange accommodation and supports
We arrange MTA, in-home supports or other accommodation depending on your situation.
Discharge and settle in
We are there on discharge day and provide intensive support in the first weeks to ensure a safe, smooth transition.
Frequently asked questions
Common questions about Hospital Discharge & Transition Support support from Together in Motion Services.
Interested in Hospital Discharge & Transition Support?
Our team is here to help. Refer a participant, ask a question or book a call to discuss your needs.
Related Together in Motion Services services
Many participants use a combination of supports. Explore what else we offer.