After a stay in hospital, being discharged can be a worrying time for patients and their families. Sometimes, patients feel ready and able to return to live at home. However, some often find that their health has deteriorated significantly since they were last living at home and despite receiving treatment, they feel unsure or even afraid to return home. This is especially the case for those who live alone, whether or not they have help from family, friends or professional carers; because the level of care they now require has increased.
Before being discharged, there are a number of assessments and discussions that hospital staff must undertake with a patient in order to ensure that they are not only medically fit for discharge, but that they can be safely discharged. Patients should always be asked about what they would like to happen and given a choice as to where they would like to be discharged to, if there are options available. A person cannot always be discharged back into their own home – sometimes other locations are identified as being safer – after a stroke or a fall, the patient may benefit from time in a rehabilitation unit. Other patients may benefit from a re-ablement package or intermediate care (such as a temporary placement in a care or nursing home).
Promoting independence can be achieved through a care at home package or through intermediate care – much will depend on the patient’s diagnosis and needs; and their potential for recovery. If a patient wants to return home but is advised or told that this is not safe, then the patient should be given further information about this, particularly if the patient would be at risk of harm. The hospital discharge team will normally need to arrange an assessment of the patient’s home environment before the patient is discharged to find out if they will be able to manage. An Occupational Therapist normally carries out these assessments and reports back, looking at whether the patient will have difficulty mobilising around the home (particularly if there are stairs) and what adaptations may be required. The discharge team also need to find out what level of support the patient has from relatives and friends, if any, and if the patient already receives care from a care agency (either privately or funded through Social Services). Informal or unpaid carers (usually family and friends) and/or the care agencies would also have to reconsider the person’s needs to decide whether they can safely meet their needs, or whether they need to set up a new care package before the person return home.
There are occasions when people are effectively forced into a placement that they do not want to go to and they are not offered the choice of being cared for in their own home. There are vulnerable people whose voices are not being heard and they may be robbed of their dignity and independence. It may be necessary to consider whether poor quality care is a safeguarding concern.
At other times, people are sent home without adequate support, which can mean that they are at risk of harm or further deterioration. If this happens, the person has not been given a safe discharge from hospital. Unfortunately this sometimes occurs for people who are vulnerable and less able to express their wishes. Whilst decisions would have to be made in a person’s Best Interests if they lack mental capacity to make their own decisions, sometimes people who have capacity are not given a proper opportunity to have their say. This is particularly the case for those whose family and friends are excluded from the hospital discharge process, or for those who simply do not have anyone else to look out for them. An example of an unsafe discharge can be found in our case study of a 90 year old widower who was discharged from hospital to his home without realising that he would not have 24 hour care. If this has happened to you or a person you know and you would like help as to your next steps, please contact us on 01273 609911 for advice and assistance.