Factsheet: Safe Discharge from Hospital

1. Hospital discharge – key points
2. Mental capacity issues
3. Different types of assessments
4. Different types of funding for different types of care
5. Packages of care
6. Potential problems

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 you or your 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.

Common concerns:

• What support is available after discharge from hospital?
• Will you have to pay towards the cost of any care/support provided?
• What is respite care and will you have to pay for it?
• What is intermediate care and “re-ablement”?
• Long-term or short-term care?
• Should you be getting NHS or Social Services funding?
• Have your needs been properly assessed?

Hospital discharge – key points

• You should not stay on an acute hospital ward any longer then absolutely necessary
• Discharge from hospital can only happen when a clinician has decided you are medically fit for discharge. However this does not mean that you are now “well” or now have no medical conditions
• In addition, Health & Social Services must be satisfied that the discharge would be safe – which means that there is an appropriate care and support plan in place. This aspect is sometimes missed out
• Hospital staff should be able to estimate the expected date of discharge (EDD). In practice this often has to be changed/reviewed and any reviews which have an effect on your EDD should be shared with you or your representative
• Discharge from hospital should be timely and informative. Information should be given to explain how the discharge will be managed. A discharge coordinator should be appointed and this should be the point of contact for your family. It is the coordinator’s job to organise assessments of needs and “coordinate” the process, i.e. bring the relevant health and social care professionals together, give timescales etc.
• Before discharge, health and social care assessments should be undertaken to identify your needs and whether you will require further care and support after discharge. This process should include an NHS Continuing Healthcare assessment, which should be undertaken before an assessment for NHS-Funded Nursing Care (FNC) or a Community Care Assessment. A needs assessment should always be completed before Social Services undertake a financial assessment. This is because you have a right to an assessment of your needs regardless of whether Social Services will be funding care or support or you will be funding it privately
• Your authority/consent (or that of your representative) should be sought before carrying out an assessment of needs
• An assessment of needs will help to identify your ability to manage on leaving hospital and options should be explored and agreed with you or your representative
• A Care Plan should then be drawn up. This should detail the help and support that is needed and confirm how the care will be delivered
• Your ability to pay for or contribute to any “Social Care Services” should then be undertaken (i.e. a financial assessment)
• If a relative or friend is to provide care upon your discharge then the relative/friend will be entitled to a carer’s assessment
• All options must be explored with the objective being to maximise your independence

Mental capacity issues

If it is decided that you lack the capacity to make a decision about your needs and if no one has been appointed to act on your behalf (i.e. Lasting Power of Attorney for Health & Welfare, or someone else you have given your express written permission) , Health and Social Services must act in your “best interests”. This should involve a Best Interest meeting in which family or close friends (i.e. people that have a genuine interest in your welfare) are invited to attend.

When you do 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 your best interests. This person should help put forward your views and wishes in the discharge process.

Different types of assessments

NHS Continuing Healthcare

One of the first assessments to be done should be a Continuing Healthcare assessment. This is to assess whether your 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, if you meet the eligibility criteria you can have your care funded whether you are resident in a Nursing Home, Residential Home, or even if you are being cared for in your own home.

In the first instance, a NHS checklist will be undertaken to see if you 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 you are discharged from hospital (Intermediate Care is the only exception to this rule).

CHC Fast-track Assessment

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.

NHS Funded Nursing Care

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 you will be entitled to payments from the NHS for “nursing” care. This is a contribution from the NHS of £155.05 per week and is only payable to care homes registered to provide nursing care. The NHS pays this directly to the nursing home.

Community Care Assessment (Social Care Services)

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 your psychological needs as well as your physical needs as part of the overall support framework. Consideration should be given to whether you will be able to return home or whether you will need residential care. However, consideration should also be given to whether a period of rehabilitation, either whilst in your own home or in a residential setting (on a temporary basis), would be of benefit to help you to maximise your potential to enable you to live at home as independently as possible.

To enable you to live at home, an Occupational Therapist might be needed to visit your home to see if adaptations are required to the property to enable you to live and manage safely at home. They will also look at whether any equipment is required.

Different types of funding for different types of care

1. Packages of care funded by the NHS, include the following:

• NHS continuing Healthcare: a package of care that is arranged and funded by the NHS. Not means tested
• NHS funded nursing care: a weekly contribution from the NHS of £155.05 to cover the cost of meeting your nursing care needs. (Only payable to Nursing Homes)
  
• Rehabilitation
• A joint package of care with Social Services

2. Packages of Care Funded by Social Services (i.e. your Local Authority) include the following:

• Social Care (otherwise known as Community Care). This is means tested
• Re-ablement services
• Joint packages of care funded by the NHS and Social Services

Packages of care

Intermediate Care

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 you to maximise your potential for full recovery with a view for you 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 your 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, your needs should be reviewed and this should include a CHC assessment and a new Care Plan.

Re-ablement Services

This package of care is coordinated by Social Services and would usually have the purpose of supporting you to live within your own home for a limited amount of time, the idea being to support and help you to re-learn essential daily living skills and to rediscover your capabilities. Often Social Services confuse Intermediate Care for a re-ablement package and subsequently you could be 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 your re-ablement package meets the definition of Intermediate Care.

Rehabilitation

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:

• Physiotherapists to help improve your mobility and strength;
• SALT (speech and language therapist) who help with diet issues related to swallowing difficulties, or choking, aspiration problems when feeding;
• Occupational Therapist to help with mobility issues and advise on adaptations to properties

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.

Potential problems

Sometimes the correct discharge process is not followed and you or your family can find that you are being hurried to make a decision as soon as the hospital says that you are ready for discharge.

If you have concerns or are uncertain about your options, contact us today on 01273 609911, or email info@ms-solicitors.co.uk.