On this page you can find out more about what colleagues across the system do to support people and their families.
There’s also a story from a person who has received care.
Senior Sister, Elgar Enablement Unit, Southmead Hospital
Our ward is for older people who are ready to leave hospital, but need additional care in place to make sure that happens safely.
Elgar Enablement Unit is a sub-acute enablement unit, where people are well enough to be discharged from hospital, but are waiting for plans to be put in place to support their move from hospital to the community. This could be for help with social care, complex health and social care funding, or awaiting a discharge to assess pathway.
The multidisciplinary team (nurses, physiotherapist, occupational therapists) carries out assessments and completes a transfer of care document (ToC Doc). This is then reviewed by the community hub, who advise on the most appropriate pathway to meet the patient’s care and support needs. Once a discharge support pathway is identified and confirmed by community teams, we communicate with the patient and family members about the next steps and what to expect on discharge.
Communication is everything – with colleagues, patients and next of kin. We present all the discharge support pathways to patients and their families, so they have as much information as possible. We use information leaflets provided by community service providers, to help keep messages consistent. If someone is able to be supported on pathway one, we always advocate a home-first approach.
My role involves being the interface with the community services. I’m regularly part of complex multidisciplinary meetings to plan for discharge. We also meet together as hospital and community colleagues to develop discharge plans with patients.
There’s a lot more to discharge planning than just how a person can function and carry out activities of daily living. There are many complex social and family needs to consider too. It’s here that we access voluntary services such as Red Cross and other partners to support patients at home following discharge.
It’s not just filling in forms and referrals. It’s keeping the patient at the centre of the care planning and considering available care options with patients and family members, and all working towards a safe discharge from hospital and a safe transition to the community setting. I feel confident when patients are discharged to a discharge to assess pathway, as I know community partners will continue care and support for the patient.
I make a point of ensuring patients and their families are updated, even if there’s no outcome or discharge date known. It’s important for families to know we’re still working on a plan to get their loved one back home or to a community setting.
We’re in a unique sub-acute setting, therefore our focus is enablement and things that enhance patients’ hospital experience. We try to de-hospitalise the environment so they can enjoy their time with us. We run activities like dance and music; we have dogs visit. We want to make a difference for patients at the end of their hospital stay.
The best thing about my job is when people leave with support in place and are looked after with a community set-up that will allow them to thrive and avoid being readmitted. That’s a success for us.Bethany poster
Rehabilitation support worker, Sirona
As a rehabilitation support worker, I review and assess how people are managing with activities of daily living after they’ve left hospital – this might be at home, or in other community settings.
This includes things like personal care, medication, meal preparation, mobility, exercise, transfers (bed/chair/commode/toilet), and issuing and assessing equipment.
The tasks are delegated by the lead therapist. The therapist completes the initial assessment and develops a personal care plan with the person’s support needs.
I support people to carry on their rehabilitation after hospital admission by helping to find ways for them to self-manage at home after their illness, and if they are not able to, to refer on to the appropriate service.
I also complete falls assessments, clinical observation (blood pressure, pulse, temperature, SATs, respiratory), ECG, wound care, venipuncture and blood glucose.
The people I work with used to be independent. For that to be taken away from them is a big deal. My main aim is for people to return to being independent if they can.
I don’t look at my visits as a task, I look at them as going to support people who, if they were able, wouldn’t need us. I go in to make a difference for the person and help them to do the type of activities they used to do. They are so very grateful for that.
One person I supported had a fall and fractured her hip while she was in her greenhouse. She was able to manage things like personal care and meal prep. But she was used to being active, so was very down. I was there to help her regain her confidence.
I was able to identify additional equipment she needed to be able to get back outside. Things like grab rails and a built-up step.
Decisions were made around her wishes. I might see something, but she might feel differently. It’s about making sure she’s at the centre of what we do.
My job is rewarding because I have a positive and effective relationship with the people I support and with my coworkers. I also find my job to be very flexible, which helps with my work/life balance.
There is a lot of observing, but I look at it all as ongoing therapy. We’ve even changed the name of the visits we do from ‘care calls’ to ‘rehab visits’, which helps staff and patients look at it differently.
I think about it from the person’s point of view and how they must feel about their situation.Cynthia Brown poster
David Bailey and Rachel Lennon
Acute Discharge Case Managers, Southmead Hospital
We work with the most complex patients where more specialist support is needed. We also support ward colleagues to manage timely and safe discharges for all patients.
This is often people with mental ill health, dual diagnosis, drug and alcohol addiction, homelessness or social admissions.
We identify patients early, at the front door, to enhance patient experience and communication. It allows us to manage expectations and reduce length of stay, as well as maximising community services and increasing ward staff’s clinical capacity.
In addition to admission avoidance, we assist with rapid discharge for end-of-life patients, providing equipment, care and financial advice.
We work in different parts of the hospital. Rachel, a physiotherapist, works at the front door, where the focus is on avoiding admission by working with partners to identify a suitable non-hospital pathway as soon as they’re medically ready. David, an occupational therapist, works on MSK and neuro wards. Discharge case managers support each hospital ward.
When we have patients where the pathway doesn’t provide the specialist support that’s needed, we’re involved with community multidisciplinary meetings to find a suitable solution.
We recently discharged a vulnerable 69-year-old who was sofa-surfing, with no fixed address. He had a complex background, including drug abuse, possible undiagnosed learning difficulties, poorly managed diabetes and his family reported he was being financially abused.
The proposed option for him to be discharged to a hostel would have increased his chances of coming into contact with drugs, which could ultimately have increased risk of death. We worked with Bristol City Council social workers and housing teams, drug and alcohol services and Sirona community services to consider all the options.
Through this, he was discharged to extra care housing with a care package in place to support him. This was a really positive outcome for the patient.
We also see social admissions – for example, where couples are admitted together because the person who needs medical attention cares for their partner, who can’t manage without them. We then find ways to support the vulnerable partner, for example, through temporary respite care.
Another focus of our role is educating our colleagues as we have extensive skills, knowledge and expertise in discharge. We lead training about things like mental health capacity, homelessness and how to complete the Transfer of Care Document (ToC Doc).
We don’t get a lot of feedback, but the nicest we’ve had tends to come from the homeless community. They’re thankful for our support and feel listened to. One chap sent a message to say he’s got a job and a flat. That’s a great outcome.
We have a privileged role, stepping into a patient or family’s life and having a chance to make a difference.David Bailey and Rachel Lennon poster
CToCH Discharge Case Manager, South Gloucestershire
A lot of people don’t know what CToCH is; we’re the Community Transfer of Care Hub. We are the lynchpin between the acute setting and community services.
If you have gone into hospital and you have needs that would be unmet when you got home, we can arrange further support for you.
We have three pathways – pathway 1, 2 or 3; they are the different packages of support. Pathway 1 is home with community rehab team input, pathway 2 is an inpatient rehab bed, and pathway 3 is needing more support than can be provided at home and that’s in a care home type environment.
I am a registered nurse by background. I have worked in an array of posts, some of those in an acute setting. My first job was as a theatre recovery nurse which I loved, but it didn’t fit with my family life; I had four small children at the time. I took a job as a staff nurse on a community inpatient ward and then community became my real love. I have done a bit of district nursing, worked in a rapid response team, I worked in a palliative care support team, and had a short stint as a clinical lead in a nursing home which gave me a different perspective.
On a typical day, if I’m coordinating, I log on and look at who is leaving hospital, I then phone the community teams and the rehab units to check their capacity and make sure there aren’t any staffing issues we need to resolve to make sure planned discharges can go ahead. I then check for messages from the acute trusts to check there’s no issues; maybe someone is more unwell than expected. If that’s the case we work with hospital staff to see if there is any other option for that person rather than staying in hospital. If their medical condition does mean they need to stay in hospital bed we try and find someone else to fill their slot to keep things flowing. Then I go through the waiting lists to line up people for the next few days.
Our team reviews the form called the ToC Doc; that’s a Transfer of Care Document, which the ward staff fill in when a patient needs further support. It’s so important we get all the information we need in that form so we can arrange the right care for people to keep them safe.
We take a holistic view of the person so it’s really helpful to know not just what the person is like now, but what they were like before and what they could be like – their potential. We also need things like what support they have at home, for example, I had a person where the ward had said they needed care four times a day, but it was only needed to administer their Parkinsons medication. That’s really hard to get a care package for. But it turned out that person lived in the annexe of their daughter’s house and she could support. That information wasn’t on the ToC Doc so I would never have known. We would always encourage colleagues to pick up the phone to us and talk though any issues; sometimes that’s so much quicker and simpler.
I really like my job. Sometimes you get a ToC Doc through for a person’s situation that is so complex and it’s lovely to get it right; to get that person home with the help and support they need in a timely way; so they’re not delayed leaving hospital
We’re reviewing lists all the time, we’re really doing everything we can to keep all the bits of the system going as safely as possible.
The patient doesn’t even know we exist in most cases, but that’s not a bad thing. For them, it just needs to be a nice smooth process from the hospital to home, or wherever they go, we just oil the wheels.Emily Richards poster
Social Prescribing Link Worker, Southern Brooks
My role is to be someone who is not a clinician; is not in scrubs or a uniform, who, in a busy hospital, just has a little more time to sit and chat with patients.
We try and draw out a more holistic picture of what is going on. When people are in hospital, they are medically unwell, but once that aspect is fixed, they need to get out of hospital because it isn’t the right place once they’re well. But it’s not always that simple.
That’s where we slot in. Talking to people, getting to know them, building that relationship with people and finding out what’s important to them. We try and really put them in charge of their care; how they see their life and how they see any problems they have or solutions they need, we work with them to draw that out.
This role is about building people up and nurturing something a little bit more long term. It can be a bit confusing being in hospital; you’re unwell, you’ve got lots of different people coming to see you, so we just try and keep it really simple, talk to them about what they need and build that relationship.
I feel like I’m supporting the clinical team, but also filling a really specific gap where there are people coming into hospital and the things that are stopping them leaving – which can be really small things – are not covered by other services. Someone just might not have any food in at home, but that’s stopping them being able to go home safely. Usually, it’s not a massive amount that’s needed to help most people get home.
We can help by telling people about local groups or charities that can help and supporting them in a more long-term way by connecting them with their local community. We stay in touch with people after they have been discharged too to make sure they have the right support in place long term. I think the role will actually help make communities stronger and more resilient in the long run; and that’s so important in improving things for everyone.
I hope people feel listened to, and helped and understood in a way they might not have been previously.Freddie Bouchier poster
Senior Physiotherapist, Sirona
I see people through three routes – Discharge to Assess, planned therapy or urgent therapy.
With Discharge to Assess (D2A), I visit when someone comes home from hospital to make sure they are safe at home. I carry out a functional assessment to check they can get washed and dressed, they can get to the kitchen to make food, access their bathroom and get upstairs. I also check they can take their medication.
The D2A pathway helps to improve the person’s experience. It makes assessments more meaningful for them; ensuring they receive the right care at the right time in the right place. It puts people and their families at the centre of decisions, respecting their knowledge and opinions and working alongside them to get the best possible outcome.
During the initial visit, we create a support plan which sets out what the person needs in the next couple of days. We also talk about what they want to achieve.
It’s usually the little things that are most important to people.
We focus on reablement, which means we encourage people to do things for themselves, so more of a supervision role to make sure they can do things safely.
Recently, I had a patient with a fractured hip who couldn’t walk upstairs. I set him up for downstairs living, then worked with him for the next week to build his strength so he was able to go back upstairs to use his own bathroom and sleep in his own bed.
People improve better in their own environment. It’s more realistic. They feel more relaxed and have family and friends around them.
Helping someone walk is bigger than just walking. It means they can access their wider community – whether that’s going to the shop or to their local knitting group; whatever makes them happy.
We work with charities and community organisations that provide additional support. For example, the Red Cross organises food shopping deliveries when people first come home, We Care Home Improvements assists with equipment like grab rails or deep cleans, and Age UK offers a befriending service.
Seeing people in their own homes and helping them work towards goals that are important to them is a really rewarding aspect of the role. And the people we see appreciate us helping them to be at home.Gwen Davies poster
Acute Occupational Therapist, North Bristol Trust
Occupational Therapy generally is about being person-centred and helping people to achieve meaningful goals. We look holistically at the person, not just looking at their medical condition, but looking at their mental health, the people around them, their home environment and their whole situation.
What we do is different for everyone, we have to be so individualised; we have to be really good at talking to people and listening to them. We take the time to build that relationship, to understand how their mind works, in order to help us develop individualised treatment plans and rehab plans that are meaningful and useful to that person.
The ‘occupation’ in Occupational Therapy refers to tasks; we look at what someone needs and wants to do. The physiotherapist might say you need to do these exercises to strengthen your leg. In comparison, we might come in and say how do we make these exercises meaningful – it might be we say you’ve got carers putting cream on your legs, if you do that yourself you can make sure you have the right amount on and you’re looking after your own skin. In doing it themselves they’re bending and stretching and doing the strengthening exercise, but through something that feels useful to them; they’re doing it without realising. That can be more motivating.
We are always looking at how we can get people home safely and manage things for themselves; making sure there are the services in place so the things they want to aim for are achievable for them. Toileting is a major thing. If someone can’t go to the toilet on their own, you know they will not be going home independently. It’s so important.
For us, we need the time to get to know people. We probably spend longer with the patient than most other professionals. We want to know, not only what their short-term goals are, but their medium and long-term goals too. Everyone else whips in and out; although we must be focused on discharge, and we are time pressured, occupational therapy is about individual holistic wraparound support.
I work with the amputee service. If people have had an amputation and are saying I am basically stuck in one room once I get home, we will get them home safely, but then make the right referrals to make sure they have what they need to not be stuck; housing referrals, adaptation referrals, referrals to wheelchair services, referrals to charities for ongoing support managing their condition, mental health support for them and their family, as well as referrals for ongoing physical rehab.
We don’t just think about the person in hospital, we think around them. Will they be able to do this in their own home, at their friend’s home, in their work environment, in their afternoon clubs? Hospitals have wide corridors and smooth floors; home just isn’t like that so we have to think about how it will be at home.
It is important to make sure people are linked in with the right services on discharge. For example, if you know they are desperate to get back to work but that isn’t going to happen quickly, we make sure the referrals are in place for someone who can help them work towards that. We make sure they are followed up appropriately; even if we can’t fix something right now, we make sure the referrals are in place for someone to help them with that longer term.
We have to be realistic too, we do manage expectations. For people who have had a major life event like an amputation or a stroke life really can feel like it sucks. From the hospital we are limited in what we can access and achieve, and discharge options are limited, which can really impact people’s mental health. Part of managing expectations though is also about giving realistic hope. If people say ‘I’m stuck in my house’ we might be saying that’s true right now, but not forever – there are lots of other options. If they have the motivation, there are always options out there.
What I really like about occupational therapy is you can make it what you want it to be; it is treating the whole person, using what works for them, to inspire and motivate them, which makes the biggest difference.
We really listen to people. When you are in hospital it feels like lots of people are doing things to you; whereas we do things with people. We work in partnership with people to achieve their aims.Jessica Cole poster
Hospital Link Worker, Age UK Bristol
Link workers are relatively new and have been brought in to help with non-medical barriers that have the potential to delay people being discharged from hospital.
We sit within the voluntary sector and know it well, so we can connect people with services and organisations to support their discharge. This helps staff who are otherwise having to problem-solve on the go.
We work with case managers and therapists to help people who need additional support that isn’t a medical need, but could be preventing them from being discharged home.
It’s such an overwhelming experience being in hospital. You’re given a lot of information and the first thing people think about is their medication, but it’s the other things they forget to consider.
Things like finances, benefits, power of attorney, home adaptations, support for carers, social activities transport, personal alarms, shopping and cleaning. These are things that can make all the difference in getting someone home on time and safely.
We also help prevent readmission by connecting people with their community once they return home, so they can benefit from other local voluntary services and social get-togethers. We have strong links with local voluntary organisations which can offer support. In some cases, they may already know the person and be able to visit them in hospital before they leave.
A hospital stay can be a major life event and might mean someone’s day-to-day living has changed. It’s easy to become more socially isolated. Especially if you live alone.
They may already have connections in the community, but we can support people to build on them, so they feel like they know where to go when they need support in the future as well as right now.
We also support families and carers.
People just don’t know what help is out there and are grateful for even the smallest bit of information or help.
We work with people to find out what their needs and wants are. Then we share our knowledge and make connections so they have control of their situation and are able to navigate where they want to go.
This way, people don’t need to research or panic. It takes the pressure off them and the case manager. They aren’t alone.Katie Hudson-Murt poster
Social Worker, South Gloucestershire in-reach hospital social worker team
I have conversations with people in hospital about their social care needs. I start by speaking to the person to find out how they are and what they can and can’t do and what they want to happen when they are discharged. Ordinarily, I then gather information from physio and occupational therapists, along with updates from the medical team, to better understand the current situation.
In this process of assessment, I also consult our recording system to see if the person is known to us, access the GP and other medical notes, and talk to the person’s family with their consent, to get a really rounded view.
Through this, I gain a sound understanding of what it was like just before the person was admitted, as well as the situation leading up to it (this could be months and years). Then, I work with everyone involved to look at the best way forward to facilitate discharge – does what the person want, along with their physical and cognitive presentation, match what we can recommend and offer?
We do have to manage expectations. Sometimes the person is, for example, able to walk and, on the face of it, able to go home, but this may be tricky in reality. For example, I had a person who lives in an old building with uneven flagstone floors – the walking aid they needed just wouldn’t work on that floor; they couldn’t get upstairs to bed; and because the house was listed a stairlift couldn’t be installed. It’s things like this we have to look at and, as part of a team, work as far as possible to overcome them. We are coordinators. That would be a better word for us.
We support a large number of people who are admitted with respiratory and urinary tract infections, as well as falls. There are also social admissions where one half of a couple has been looking after the other. For example, the husband, a carer, comes in with a heart attack, but his 90-year-old wife can’t manage alone. In such cases, he is being supported medically, but she is also, unfortunately, in an acute hospital bed when her need is social.
There are also situations when the person did not have formal care in place at home, but, when talking to their next of kin, we realise the person was just about able to live at home because their family members were supporting them with 24/7 care which is not sustainable.
I think we bring it all together. We listen to the person, involve them in decisions and, when appropriate, their family, so that together we can come up with a way forward that is hopefully sustainable.
We have those difficult conversations because there are difficult decisions to be made. There are some risks we can mitigate; things we can put in place or remove, but, in some cases, we have to make everyone, including families, aware of what the risks of different options are so they can make decisions.
Every case is so different, with so many moving parts. I never cease to be amazed by people. We see it from everyone’s viewpoint – from all angles.Luisa Covill poster
South Gloucestershire Hospital Discharge Social Work Team
If someone is admitted to hospital, from a care home and their needs have increased, I can visit them and carry out an assessment in hospital which may help prevent multiple moves and improve the outcome for the person. I might visit someone that has come from home, where they have had a package of care, but their needs have increased. In this instance, I can support with identifying alternative or increased care.
I will speak to the person and their family to understand what their goals and wishes are and what they need in terms of care. As part of our assessment we review medical notes, background information, previous support in place and how they were managing before admission. I involve hospital staff and other professionals and work in a multidisciplinary way to make sure we’re taking a holistic and person-centred approach.
Usually, a person and their family have lots of questions about the discharge process and services available. I can arrange meetings with the person, the family, and professionals to share knowledge and help reach decisions. I help people understand their care and support provision, how it’s going to work, including funding; there are lots of things to consider.
How do we make people safe? That’s my priority, alongside ensuring someone’s rights and wishes are upheld.
I worked with a person who needed nursing care; it took a long time to find the right placement that worked for him and his family that gave him the right level of support to keep him safe. He’s now in a good place, he’s not falling. When I saw his smile, I thought ‘we’ve got it right’. I had to give him and his family enough time to come to a decision; these are life-changing decisions people are making, where they will live, often for the rest of their lives, that’s totally life-changing.
We know that most people prefer to be at home, in their own environment. That’s what I try to look at what is possible to get people back to their home. I am always looking at what resources are available in the community; that might be family member support or the voluntary sector or community support. I understand that people want to live in their own community; be part of their community.
The first thing I always do is think how they can be at home safely; how can I meet their needs safely. We look at risk as well, what are the risks and how do we manage these?
I try and get a really good relationship with the person and their family, I always say to them ‘I’m here to help you’. I want people to feel safe and trust in me as a professional, so I can really understand what they need and how we can help. I want people to know I am there for them.
Social Worker, North Somerset Council
I give people without a voice, a voice.
Social work is about advocating for and supporting people when they’re struggling or things aren’t going as well as they could. We empower people to make decisions about their own lives.
As a safeguarding specialist, my role is to my role is to work with adults who have care and support needs who are at risk of abuse or neglect. We help keep them safe in line with their wishes and feelings.
There’s a school of thought that you’re born a social worker, you’re not made into one. That really resonates with me. Being a social worker is an identity. I believe it stems from the natural way we see the world, not how we have been taught to see it.
Social work is values-led. We tend to have a sense there’s injustice and a strong urge to address that and make society fairer.
We receive referrals for people who are going through or have been through the Discharge to Assess process and there might be risk of abuse of neglect at home, which could include self-neglect.
Unfortunately, social work – particularly safeguarding – is poorly represented and often still seen as scary – by both professionals and people. Depending on the circumstances, people don’t always welcome our involvement, but we tailor our language and approach to make it less scary.
Our work is about listening to understand what matters to people. Sometimes we have to meet in the middle, but we don’t ‘do to’ people.
We assess the risk, then work with people to make small steps to reduce or eliminate the risk, while respecting people’s choices and human rights. We support people to take positive risks. There is no point in making people safe if you also make them miserable.
As an example, someone who is self-neglecting might need a deep clean of their home to reduce the risk of fire or infestation. But they might not be ready to take that step, so we build a trusting relationship with them to make gradual improvements to them reach their goals.
The best thing about my job is supporting people from a wide range of backgrounds and building positive relationships with them. I also love multiagency working – everyone’s perspective is different.Ruth Speers poster
Patient case study – John
John’s 92, he’s my stepdad. He’s the only dad I’ve ever known. He’s made of strong stuff is John.
My mum and John kind of looked after each other; mum had diabetes and various health problems. Before she passed away, she had cancer. John looked after Mum and Mum looked after John.
My Mum passed away suddenly; it wasn’t expected. She had gone through all the treatment, then suddenly, one morning she got out of bed and passed away.
John has dementia and hydrocephalus – fluid on his brain. He was with Mum when she passed. He can’t really remember what happened; he doesn’t have good short-term memory.
It was all very sudden and left us in a position where John needed care. I stepped in and looked after him for a while; food, meals, I kept things ticking over. But as time went on, he had a few falls and became a bit unsteady. It got to the point where he needed more care. He had quite a bad fall and went into hospital, he came out with a package of care. He had carers coming in plus me and another carer.
We ticked along like that for another 12 months, but eventually he was having too many falls and just wasn’t safe to be at home on his own. He had quite a bad fall at home in the bathroom and had to go into hospital for a while. He got through all that and went to the Elgar Ward (a post-discharge ward at Southmead Hospital, Bristol).
The decision was it wasn’t good for him to be at home; we wanted him to come and live with us. He went in a Pathway 3 (care home) bed until we sorted things out. While he was there, he had another fall and ended up back in hospital. He came through that and came out of hospital to me.
We were issued with some extra equipment to help John move around. He lived with us for a week, but, unfortunately, he wasn’t safe here either. He was up all night every night, I still had two children at home. We really wanted him here, but we realised as much as we wanted him with us, it wasn’t sustainable. We didn’t feel like we could keep him safe. Although he came to no harm here, you had to watch him 24/7, through the night. It just wasn’t working, so it was arranged for him to go into a nursing home.
During our journey, we had various people come and help him with his movement and his swallowing – when he was at home, we had to make sure he wouldn’t choke on his meals. I feel like the right people did come in and help.
We had meetings with John, John was always involved with the doctors, the health staff, with our social worker. Everybody’s input was listened to by all of them and by me; that was useful, I knew I could understand what was going on.
The social worker really did help. I think I got quite stressed with him because he was the one there, I did apologise to him. I think having lost my mum and not expecting it, to then go straight into looking after John, I didn’t have time to process it all, it was all catching up. I felt I as if I was abandoning John. The fact he was able to come here, and I was able to try and look after him was brilliant. If I hadn’t tried, I would always have wondered if it could have worked, but I don’t feel that now, I feel at peace with it.
I just feel you have to follow your heart. You’ve got to communicate to the professionals how you’re feeling. The fact they don’t take offence when you do talk to them about it, it’s so good. I just wanted to keep him safe. You can feel a bit lost when you’re in the system, a bit overwhelmed. Having that anchor point of the social worker and other staff; people you can call if you need to ask anything; that was so helpful.
He’s now settled in his nursing home. He’s happy. He seems to be doing really well. It’s been a really emotional, rocky, terrible sort of time really. I felt like you don’t know the process until you’re in it. I didn’t know anyone who had been through it; it was such a steep learning curve. I just wanted him to be safe. I didn’t want him to go into a home, he didn’t want to, but now he’s in one he’s happy, we’re both settled.John poster