i) key decisions have been made about the provision of any care needed and the source of that care agreed.
ii) funding of all required resources or accommodation after discharge has been established.
Discharge from hospital should be planned and arranged by a team which will include, or have links with, Social Services and Health (the PCT). There may be a specific member of Hospital staff acting as a Discharge Facilitator (or co-ordinator).
‘The Patients Charter’ provides for you and your carer(s) to be consulted at all stages regarding any arrangements made for you. However, there is intense pressure on hospital beds and hospital discharge may not always be properly organised. If you are funding and arranging your own post-hospital care, the pressure may be particularly acute!
Hospital discharge Procedure
Intermediate care may be available to bridge possible gaps between the services provided by health and social Services. It is designed to help those people leaving hospital, but not able to manage independently in their own homes. It would include physiotherapy and/or occupational therapy, where needed. This type of care may be provided in a nursing home, or in a person’s own home. It would normally last for six weeks, but local variations will apply (see below).
There are guidelines and check lists for all aspects of discharge procedure. Here is an outline of what you might expect:
Date of discharge
Patients and carers should be given adequate warning of the precise date and time of leaving hospital. There should be contingency planning for Friday afternoon or weekend discharges.
Appropriate transport should be organised, including an escort if necessary.
The home of a patient living alone should be properly prepared for their return. Unfortunately, this is often neglected.
You should be provided with a hospital contact telephone number in case of medical difficulties following discharge.
You and/or your carer should be provided with precise information concerning rest, diet, medications and follow-up appointments. This information should be provided in a form appropriate for people from ethnic communities, those with learning disabilities, or those with sensory impairment.
Support services such as domiciliary care, district nurse or meals on wheels should be initiated or re-established, to start on the required date. Any necessary home aids and adaptations should be supplied with full use instructions for you and your carer(s).
Written discharge information should be sent to your GP within 24 hours of your leaving hospital. Advice of all follow-up hospital appointments will also be forwarded.
On-going Care Plans should be provided for all patients transferring to care homes.
Intensive Support/Palliative Care
When necessary, this might entail further NHS inpatient care, placement in a care home, or an intensive support package at home. Palliative care, where people with a life threatening condition no longer respond to medical treatment, also comes into this category.
The diagnosis of life-threatening illness brings with it a transformation of life – where emotional, physical and specific medical needs will need to be met. For those suffering such conditions and their families, it is comforting to know that a wide range of specialist support is available to accommodate changing circumstances and preferences.
From first diagnosis of conditions such as cancer your specialist hospital team, in conjunction with your GP, will be the fulcrum which activates all available aspects and sources of hospital and home care. The objective will be that all your wishes as regards treatment options will be taken into full account at all times – within an appropriate programme for every stage of your condition.
There comes a time, however, when you may be told that further treatment or surgery will not help. It does not mean that nothing else can, or will be done for you. There will certainly be treatment available that will be able to control the symptoms caused by your deteriorating condition. This type of treatment is termed Palliative Care. It focuses on controlling pain and symptoms – and meeting the social, emotional and spiritual needs of you and your family.
Targeted at the point of requirement
Palliative care may be provided by Macmillan nurses employed by NHS Community Trusts; home care nurses, doctors or other health professionals from voluntary or NHS hospices or specialist Palliative Care Units; Marie Curie nurses; and a wide range of other voluntary and statutory services.
These professionals are highly skilled, widely experienced and sympathetic in managing patients’ needs and changing circumstances. Palliative care can be provided in your own home, a care home, in an NHS hospital or, indeed, in a hospice.
Eventually, someone whose illness is becoming progressively worse may need 24 hour attention and care, may be offered a place in a Hospice – where the objective will be to provide the most appropriate care, all necessary medications and, with that, the very best quality of life. Hospice staff are specially trained to advise on pain and symptom control and to give emotional support to patients, their families and loved ones – during illness and after bereavement.
It should be understood also, that some Hospices offer their services to patients who are not terminally ill, but would benefit from sessions of palliative care – or to those whose families might need respite.
The Hospice service is completely free of charge and often provides a wide range of on-site facilities, which might include specialist physiotherapy, aromatherapy, reflexology and a day visit centre.
For more information on UK hospices/palliative care services, contact the Hospice Information Service. Tel: 020 8778 9252.
Intermediate care is targeted at people who would otherwise face unnecessarily long hospitals stays, or inappropriate admission to acute hospital care or long term residential care.
When Intermediate Care is part of the overall care plan you should not be charged for the services. Intermediate Care is varied to suit your needs and could involve active therapy, medical treatment or the support of your recovery time. Many of us might understand the whole concept better by thinking of a traditional ‘convalescence’ provision.
Intermediate Care will be provided with an objective in mind – such as enabling you to resume living independently at home. The plan will be reviewed within a six week period and then decisions made concerning possible longer term rehabilitation needs, or specific home care.
For more information about local Intermediate Care and how you might qualify, contact your local NHS body, your GP or NHS Direct on 0845 4647
Discharge to a Care home
If your post-hospitalisation needs are such that it is no longer viable for you to live at home, the local authority may arrange for you to move to a care home on a more permanent basis. Even if you are assessed as having to meet the whole costs of this yourself, the authority may still help you to find a suitable home. In either case, it is important to note that you have a choice.
Do not feel obliged to make a quick decision. When beds are scarce hospitals may try to hurry you along. If this happens, exercise your right to choose which home you are to move to. Read our sections on Care Homes and Funding Your Choice.
Having come to a decision you will then be ‘means tested’ on your ability to cover all or some of the costs from the capital and income you have. Full details of Funding your Choice of home care and supported accommodation are included elsewhere in this site.
Scottish readers will find the Alzheimers Scotland web site to be extremely useful reference to that country’s particular welfare, benefits and legal technicalities. Go to www.alzscot.org.
In summary, the fundamental objective of a hospital discharge service is that you should receive all the information you will need to make key decisions – about the continuing care needed and the likely cost, if any, to you of any option you might consider. Sadly we are well aware that hospital discharge is frequently much more haphazard than the planned process we have described.