Helping you to understand the correct discharge process and the key points to be aware of.
Discharge from hospital can be a bewildering time, especially when Health and Social Services may have a muddled approach to the discharge process and may not always follow the correct procedures. When the hospital talk to the patient or their family about “needing the bed” it is not uncommon to feel pressured into making a decision that you aren’t yet ready to make, such as deciding to move into Residential care on a permanent basis. This factsheet has been compiled to help you understand the correct discharge process.
If it is decided that an individual lacks the capacity to make a decision about their needs and if no one has been appointed to act on their behalf (i.e. Lasting Power of Attorney for Health & Welfare, or someone else they have given their express written permission) , Health and Social Services must act in the persons “best interests”. This should involve a Best Interest meeting in which family or close friends (i.e. people that have a genuine interest in their welfare) are invited to attend.
When an individual does not have any family or close friends, Health and Social Services have a duty to appoint an Independent Mental Capacity Advocate (IMCA) to act in the person’s best interests. This person should help put forward the patient’s views and wishes in the discharge process.
One of the first assessments to be done should be a Continuing Healthcare assessment. This is to assess whether an individual’s needs are of a primary health care nature. Needs of a primary health nature mean that the NHS will pay for the care in full under NHS Continuing Healthcare funding (CHC). CHC funding is irrespective of setting and, as such, a person who meets the eligibility criteria can have their care funded whether they are resident in a Nursing Home, Residential Home, or even if they are being cared for in their own home.
In the first instance, a NHS checklist will be undertaken to see if the person should be put forward for the more comprehensive CHC assessment using a Decision Support Tool (DST). A comprehensive CHC assessment should ideally include a representative from Social Services to form part of the Multidisciplinary Team (MDT) along with a lead Nurse Assessor from the NHS and other key healthcare professionals who are involved in the person’s care. In hospital this is likely to include the nurse in charge of the ward, the consultant, etc. A Health Needs Assessment (HNA) is sometimes used to facilitate the completion of the DST.
A CHC assessment should always be undertaken before a person is discharged from hospital (Intermediate Care is the only exception to this rule).
If a person’s condition is deteriorating quickly and they are nearing the end of their life, they should be assessed under the NHS continuing care fast track pathway so that an appropriate package of care can be put in place without any delay.
Government guidance says that care should be put in place within 48 hours of someone being found eligible under the fast track pathway.
After a CHC assessment is carried out an NHS Funded Nursing Care (FNC) assessment should be done (in practice we often find that this is done at the same time as CHC assessment). This assesses whether a person will be entitled to payments from the NHS for “nursing” care. This is a contribution from the NHS of £109.79 per week and is only payable to care homes registered to provide nursing care. The NHS pays this directly to the nursing home.
This will be completed by the representative from Social Services (i.e. the Social Worker). Local authorities have a duty to assess a person’s needs when services are required following a stay in hospital (i.e. after a serious illness or due to disability, either physical or mental) or because of old age, etc. Community Care can provide a range of services including adaptations to properties, care at home and residential care (including nursing homes).
A care needs assessment and resulting support package should address an individual’s psychological needs as well as their physical needs as part of the overall support framework. Consideration should be given to whether an individual will be able to return home or whether they will need residential care. However, consideration should also be given to whether a period of rehabilitation, either whilst in their own home or in a residential setting (on a temporary basis), would be of benefit to help a person to maximise their potential to enable them to live at home as independently as possible.
To enable a person to live at home an Occupational Therapist might be needed to visit their home to see if adaptations are required to the property to enable the person to live and manage safely at home. They will also look at whether any equipment is required.
This is a package of care designed to try and prevent unnecessary admission into long term residential care or further hospital admissions. The primary aim is to help a person to maximise their potential for full recovery with a view for the individual to maintain or regain the ability to live at home. Intermediate Care helps to facilitate a timely discharge from hospital and prevent unnecessarily prolonged stays; a CHC assessment need not be done until after the period of Intermediate Care. Usually Intermediate Care is for a maximum of six weeks and can be provided in a person’s own home or during a temporary stay in residential care. Care services provided in that time should be provided without charge (Intermediate Care is free).
Intermediate Care can be funded solely by the NHS or jointly between the NHS and Social Services. After the period of Intermediate Care is over, an individual’s needs should be reviewed and this should include a CHC assessment and a new Care Plan.
This package of care is coordinated by Social Services and is usually to support an individual within their own home for a limited amount of time, the idea being to support and help the individual to re-learn essential daily living skills and to rediscover the individual’s capabilities. Often Social Services confuse Intermediate Care for a re-ablement package and subsequently a person is charged for care that should otherwise be free. Local authorities were issued with guidance in 2010 which made it clear that a person should not be charged if their re-ablement package meets the definition of Intermediate Care.
Rehabilitation will often begin in hospital and will continue after discharge. It can include a package of care involving help/support from various health care professionals. For example:
Rehabilitation is usually provided by the NHS and as such the package of rehabilitation will usually be organised and funded by the NHS, sometimes forming a joint package with Social Services.
Sometimes the correct discharge process is not followed and a person or their family can find themselves being hurried to make a decision as soon as the hospital says that they are ready for discharge.