A question we are frequently asked is what happens when Mum, or Dad, is in hospital, has received all the acute care they need and is ready for discharge. One of the aims of the Care Act 2014 is to ensure that people do not remain in hospital when they no longer require care that can only be provided in an Acute Trust.
Finding appropriate care on a hospital discharge is almost always urgent, with the hospital seeking to free up the bed for another patient, the person due to be discharged, keen to be away from the acute environment and family wanting their loved one to be safe and secure.
Many of our clients who contact us for help when they have a loved one in hospital and an imminent discharge date, have never faced the situation before, have no idea of what to do and have very limited support from anywhere.
As an example, we had a call from one gentleman whose father was in hospital following a fall, his mother was at home, living with dementia, and her main carer was her husband. The family had been given a list of possible homes, but needed care for Mum that day and Dad, in the same home, within a week! The Discharge Assessment hadn’t been released to the family, so they were approaching the situation blind. Care Home Finder sourced a care home, that day, which could provide care for both parents, carried out an emergency assessment and took Mum in immediately. Dad followed a few days later, on his discharge from hospital.
The arrangements for discharging patients who are likely to have on-going care and support needs have been designed to encourage acute trusts to plan for discharge in advance of the patient no longer requiring acute care. These are managed by the Discharge Team. Your loved one and/or you, should be involved in this process, which includes the Discharge Team liaising with Social Services, who will be involved in the care needs assessment and carry out a financial assessment, if they have not already done so.
To help in understanding what is involved in hospital discharges, we have prepared a simplified overview of how the system is intended to work. If you would like a chat about any aspect of the Discharge process, please call us on 0345 853 0300.
Arranging care before leaving hospital
If you or someone you know goes into hospital, help and support should be arranged before you go home (are discharged).
- Any extra help is arranged, such as visits from a district nurse or paid home help.
- Any equipment is fitted, such as a raised toilet seat.
- Any home adaptations are made, like grab rails in the bathroom.
What happens while you’re in hospital
- Hospital staff should contact social services to arrange a discharge assessment. This is so they can find out what help you need when you go home.
- It doesn’t matter if your hospital stay was planned or an emergency.
- The assessment can happen in hospital, or they might visit your home.
- It helps to have a key safe at home, or to leave keys with family or friends.
- Speak to staff in charge of your discharge to make sure you have everything you need. This includes a date, care plan and equipment.
- You’ll be involved in the assessment and agree a care plan together.
This should include things like:
- Treatment and care when you get home.
- Who’s in charge of your care and how to contact them.
- When and how often you need care.
Preparing to leave hospital
Hospital staff should make sure:
- You can get home.
- You have your care plan and your care home has a copy, if you live in one.
- You have any medicine you need and know how to take it.
- you can use new equipment, such as crutches.
- Your GP knows you have been discharged.
- You know how to get help from a district nurse if you need it, or when to expect a visit when you get home from hospital.
- If you have had a short illness or an operation, you might only need care for a short time to get back to normal. This is called intermediate care, reablement or aftercare.
The aim of this type of short-term care is to help you:
- Look after yourself rather than having someone care for you.
- Stay as independent as possible.
- Avoid unnecessary hospital stays.
- Intermediate care is free for a maximum of 6 weeks. Most people receive this care for around 1 or 2 weeks.
Soon after you leave hospital, social services will check if your care plan is right.
If you’re likely to need care for longer than 6 weeks, they’ll work with you to put a care plan in place. This care isn’t free.
Care plans are checked once a year, but if at any time you feel your care isn’t right, contact social services and ask for a review.
A system of notifications is necessary for alerting community and social services to the likely need for services post-acute discharge and the forward planning for discharge through expected dates of discharge.
The first notification, is an Assessment Notice, which gives notice of a patient’s possible need for services on discharge.
Following this there is a second notification requirement – Discharge Notification. This gives notice of the date the person will definitely be ready for discharge.
The timescales laid down for services to be put in place are:
A Minimum of three days from the day the assessment notification is sent or the day after the proposed discharge date, whichever is the later.
Decisions on long-term care should not be made in an acute setting.
The Care Act is clear that decisions should be made in a way that a person’s preference is central and needs to be undertaken in a way that empowers and involves the person at every stage. Therefore, doing this once the person is home, with short term support, is more likely to allow the person and their family (if appropriate) to make an informed, timely decision about how and where they would like to live.
Decisions about long-term care, either to a care home, or at home should not be made in an acute setting. The majority of people should be supported to go home with a short-term package that supports recovery, reablement and rehabilitation.
What to do if you’re unhappy with your hospital discharge
You can complain if you’re unhappy with your hospital discharge, or the discharge of someone you know.
For example, if:
- The hospital plans the discharge before you think it’s safe.
- You don’t think the discharge assessment was done correctly.
If you are unhappy, speak to the hospital staff who arranged the discharge.
Finding the Right Care
When a loved one is in hospital, it is a very stressful time anyway, with so much to do, think about and potentially life changing decisions to be made. Hopefully, this brief overview will explain the process and take some of the mystery away.
As we said, the individual’s wishes are at the centre of planning for post hospital care and, at Care Home Finder, we have a great deal of experience of working with people who are being discharged from hospital and/or their families and advisers. So, if you would like a chat about anything in the Blog, or any other matters relating to care, please call us on 0345 853 0300, or send us a note to firstname.lastname@example.org.