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Diagnostic Monitoring
& In-Home Services

Bringing clinical-grade monitoring to the patient — reducing distress, improving adherence and enabling continuous oversight of recovery.

For patients living with an Acquired Brain Injury, attending clinical appointments at hospitals or outpatient departments carries a significant burden that extends well beyond physical difficulty. Environmental unfamiliarity, sensory overstimulation in clinical settings, the disruption to routine, the physical and cognitive demands of transit, and the psychological distress of busy waiting rooms can all precipitate behavioural episodes, acute neurological fatigue and physiological instability.

Our in-home diagnostic and monitoring service removes these barriers entirely. Our registered clinical team attends the patient’s home, supported living setting or residential care facility, delivering the same clinical standard that would otherwise require an outpatient visit — and crucially, observing and documenting function within the patient’s own environment, where behaviour and cognition are most accurately and representatively assessed.

The resulting report is detailed, evidence-based, and written to the standard required by the Court of Protection, case managers, solicitors, and rehabilitation teams.

In-home clinical assessments

  • Full clinical observation and physical examination at the patient's location
  • Comprehensive neurological assessment — orientation, memory, executive function, cranial nerves, reflexes
  • Cardiovascular and respiratory system examination
  • Pain assessment using validated tools (NRS, PAINAD for non-verbal patients
  • Pressure area and skin integrity assessment
  • Nutrition and hydration status evaluation including MUST screening
  • Falls risk assessment — clinical observation and environmental review
  • Behaviour observation and structured documentation for MDT and legal reporting
  • Cognitive function assessment using standardised tools as clinically indicated

In-home monitoring capabilities

  • Blood pressure monitoring — manual, automated, and orthostatic lying/standing protocol
  • 12-lead ECG using portable medical-grade equipment
  • Pulse oximetry and continuous oxygen saturation monitoring
  • Blood glucose testing and trend analysis
  • Urinalysis — dipstick and mid-stream specimen collection
  • Wound and pressure ulcer assessment and photography for clinical record
  • Weight, height and body composition measurements
  • Medication administration observation and blister pack/MAR chart review
  • Phlebotomy for laboratory analysis

Recovery milestone tracking and structured reporting

At each visit, the clinical team produces structured documentation of the patient’s progress against their established care and rehabilitation goals. Reports are formatted for case management review, Court of Protection reporting, rehabilitation team coordination and deputyship oversight. Monthly summary reports collating all visit findings are produced as standard for patients on scheduled monitoring programmes.

Care home & residential facility visits

Regular scheduled visits to residential care and nursing home settings — supporting facility care staff with clinical oversight and ensuring the patient’s medical needs are proactively managed. Clinical liaison with the facility’s registered manager and care team is included as standard. Staff clinical education available on request.

Urgent clinical review visits

Where a patient deteriorates between scheduled appointments, our team can attend for an urgent in-home review, assess the clinical presentation, implement immediate management within scope of practice, and coordinate onward escalation where required — reducing unnecessary 999 calls, ambulance attendances and emergency admissions.

Post-discharge monitoring

Structured clinical monitoring in the immediate weeks following hospital discharge or transfer from inpatient rehabilitation — a high-risk period for ABI patients. Medication reconciliation, wound checks, early identification of post-discharge complications and GP liaison are included.

IN-HOME CLINICAL VISIT

From £TBC

Per-visit pricing or scheduled monitoring package rates. Travel within [X] miles included. Extended radius: mileage supplement applies. Package discounts for regular weekly/fortnightly bookings.
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Frequently Asked Questions

Our FAQ section is here to answer the most common questions about this service and help you feel fully informed before getting started. If you don’t see the answer you’re looking for, please don’t hesitate to get in touch—our team is always happy to help and provide clarity where needed.

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Why is in-home clinical monitoring better than outpatient attendance for ABI patients?

There are two distinct clinical advantages to in-home assessment for ABI patients. First, the practical and psychological burden of hospital or outpatient attendance — transit stress, sensory overstimulation, disrupted routine, unfamiliar environments — can precipitate behavioural episodes, acute neurological fatigue and physiological instability that compromise both the patient’s wellbeing and the validity of the clinical assessment. Second, observing a patient in their own home or residential setting provides a more accurate and ecologically valid picture of their actual function, cognition and behaviour than is possible in an artificial clinical environment.

Our in-home clinical team can carry out a comprehensive range of assessments including full physical examination, neurological assessment (orientation, cognition, cranial nerve examination, reflexes), cardiovascular and respiratory examination, blood pressure monitoring (including orthostatic protocol for dysautonomia), 12-lead ECG, pulse oximetry, blood glucose, urinalysis, wound assessment, nutritional screening, falls risk assessment, medication administration review, and venepuncture for laboratory blood tests. The visit is tailored to the clinical requirements of the patient’s care plan.

Yes, and this is one of the most frequently requested settings for our in-home service. We visit residential care homes, nursing homes, supported living settings and brain injury rehabilitation units, providing scheduled clinical monitoring visits and — where required — unplanned urgent review visits. We liaise directly with the facility’s registered manager and care team and provide written clinical summaries following each visit. Facility staff are not expected to have clinical training to support our visits — we bring everything we need.

Visit frequency is agreed at the point of referral based on the patient’s clinical needs, the case manager’s requirements, and the complexity of the care plan. Common arrangements include weekly, fortnightly or monthly scheduled visits, with additional urgent review visits available on request. For patients with rapidly changing clinical presentations or those in the post-discharge period, more intensive initial monitoring schedules are recommended. All visit schedules are reviewed at each clinical summary meeting with the case manager.

If a clinician identifies a clinical concern during an in-home visit, they will manage it within their scope of practice, document it thoroughly, and initiate the appropriate escalation pathway. This may involve calling 999 for a medical emergency, contacting our supervising clinician for advice, arranging a same-day Remote GP consultation, or contacting the case manager with an urgent clinical update. We do not leave a patient in an unstable condition without an escalation plan in place. All escalation actions are documented in the visit record.

Yes. Our registered nursing staff can administer medications in-home where this is part of the patient’s prescribed care plan. This includes intramuscular injections (testosterone, antipsychotic depots, vitamin B12), subcutaneous injections (weight management medications, insulin, LMWH anticoagulants), and observation of oral medication administration to verify adherence. All medication administration is documented on a Medicines Administration Record (MAR) and a copy is available to the case manager.

Each clinical visit generates a structured visit record documenting: presenting observations and examination findings, any clinical actions taken, medication administration where applicable, a comparison with previous visit findings to identify trends, clinical concerns or recommendations, and any escalation actions taken. Monthly collated summary reports are produced for case managers as standard on monitoring programmes. All documentation is produced within 24 hours of the visit and delivered via secure transfer.

Regular proactive monitoring allows us to identify early warning signs of clinical deterioration — rising blood pressure, changing glucose levels, infection markers, wound breakdown, deteriorating cognition — before they reach a threshold requiring emergency intervention. Early identification and management of these signs, combined with rapid access to our Remote GP service for same-day clinical advice, significantly reduces the likelihood of avoidable emergency admissions. For ABI patients, who are at high risk of complications from hospital admission including delirium, falls and infection, preventing unnecessary admissions has direct clinical and quality-of-life benefit.

Yes. The period immediately following discharge from a hospital or inpatient rehabilitation unit is one of the highest-risk periods for ABI patients. We offer a structured post-discharge monitoring programme that typically begins within 48–72 hours of discharge and includes medication reconciliation, wound or surgical site review, blood pressure and cardiovascular monitoring, and a clinical assessment of how the patient is settling into their home or residential care environment. A post-discharge summary is produced for the case manager and the patient’s GP within 5 working days.

In-home clinical visits are funded through personal injury settlement budgets, Court of Protection deputyship funds, and NHS Continuing Healthcare where eligible. We provide fully itemised visit invoices — specifying the clinical activities undertaken, the duration of the visit, and any laboratory or equipment costs — suitable for case management and deputyship audit. Regular monitoring packages carry a cost advantage over individual ad hoc visits. A full fee schedule is available on request.