When you have an elderly family member who is leaving hospital, the discharge process can often be a worrying time for the patient and their families. Whether your family member is returning home with care or is facing the possibility of going into a care home, it can be difficult to navigate the system, with many people feeling pressure to accept an option they may not feel comfortable with or do not fully understand what they are signing and the implications.
What should happen
There are a number of issues that it is useful to consider as part of the discharge planning process.
Mental capacity: Firstly, it needs to be established whether an individual being discharged from hospital has the mental capacity to be able to make decisions about their future care. This involves being able to understand, retain and weigh-up information. If a mental capacity and best interest assessment is required, this should take place in hospital.
If the individual has put in place a Lasting Power of Attorney for Health and Welfare, their designated attorney may be responsible for make the decision on their behalf. The Mental Capacity Act 2005 must be followed and the aim should be to make the right decision so the individual concerned is given the most appropriate care from the outset.
For more information on best interest and mental capacity, click here.
Multi-disciplinary assessment: This assessment should include professionals from the hospital and local authority identifying the person’s care and support needs that are required to be met before deciding on whether the person should return home or move into a care setting after discharge.
Have your say: The person requiring care, where possible, should also be empowered to make the decision on where they will live and how they will be cared for as well as the involvement of a relative, carers and any other professionals involved in the person’s care. It is important that the person receiving care is able to express their choices and not feel pressured into accepting a care home option or a return to live at home which they are not happy with.
The type of assessment will depend on the person’s needs and based on this their eligibility for the following may be considered:
- Reablement/intermediate care/aftercare: This is temporary care to help a person to stay independent and get back to normal. It is free for a maximum of 6 weeks.
- NHS continuing healthcare funding: If a person has a high level of healthcare needs, they should be considered for full NHS healthcare funding. An assessment will take place to determine the level of needs and if a person is found eligible, their care will be fully funded by the NHS. To find out more about free NHS continuing healthcare funding, click here.
Discharge to assess: The new Discharge to Assess model states that the assessment should no longer take place in hospital but in the person’s home or a care home. This is to effect timely discharges for those people who no longer need the support of an acute hospital.
The discharge arrangements must be lawful and safe. Sometimes however, a person may be discharged from hospital to a care home which is unnecessary or not ideally suited to their needs. If the hospital discharge is delayed when somebody is asking to leave or has become medically fit, this may amount to a deprivation of liberty. Please contact our health and community care team if you feel you have a loved one in this situation.
The treatment and care plan: Central to the delivery of effective and timely discharge planning, clinicians are required to work collaboratively with the multi-disciplinary team to ensure a person’s treatment plan and potential care needs are reviewed regularly. A timely discharge should not result in discharges that are unsafe, ie happening overnight or people not being fully informed as to the next stages of their care. NHS Continuing Healthcare teams must work closely with community health and social care staff in supporting people on discharge pathways to ensure appropriate discussions and planning concerning a person’s long term care options happen at the appropriate time on the discharge pathway. This may mean an estimated discharge date may vary.
If you need ongoing care, check that you have received a clear written plan and that you understand it eg. how many care visits you will receive each day, what the care staff will support you with etc. Any medication supply, transport home and practical measures such as shopping and turning the heating on should be organised and co-ordinated by the case manager.
The financial costs of care: Sometimes, particularly in view of current pressures, decisions regarding discharge are made swiftly and families may not fully understand the financial implications regarding the package of care or the long term costs of a care home. Local authorities do not now need to carry out financial assessments before moving people into a care home and sometimes the assessments are completed weeks, if not months, later. That means that some people discover the care arrangements are not sustainable long term and as a result may face having to move homes because the first home is found to be too expensive once the assessment has been completed.
Charges and financial assessments for care and support can be complicated. It is important to ask for full information about the costs of any proposed care. We would recommend you seek independent advice BEFORE committing to a legally binding contract.
What should I do if I’m not happy?
For many people, the pathway into care follows a hospital discharge which can often be a stressful and worrying time. Trying to navigate the care system for a loved one’s future care and support can be challenging. Some elderly people are being failed as a result of being rushed out of hospital into care settings that are not right for them and we are regularly contacted by family members raising concerns such as:-
- My Dad has been quickly moved into a care home and I feel pressured to accept this as he wasn’t offered the right support to enable him to return home which I know was what he wanted
- My Mum was moved into a care home which is a long way away from my family which makes it difficult for us to be able to visit her.
- The discharge planning process recommends my Mum returns home but I’m really worried about this and would feel it would be safer for her to be in a temporary or longer term placement.
- My family believe that we can look after Dad when he is discharged but he has been quickly moved into a care home instead.
- The care home that my Mum has been discharged to is not able to cater for her specific healthcare needs.
How we can help…
Judy Timson is our clinical advisor, with over 30 years as a registered nurse and previous hospital discharge co-ordinator. If you have any concerns about someone’s hospital discharge, please contact Judy who can help you navigate the process, co-ordinating with families, care homes, the local authority and hospital teams.
Judy, alongside the health and community care team provide advice to people and their families supporting them in ensuring they receive the care and support they are entitled to.
Further info/Helpful Links...
**For the duration of the current UK COVID alert level 4 period, health and social care staff and agencies can reduce the choice available to people on discharge from hospital.**