Specialist community care lawyers in Sussex and Surrey answer the most frequently asked questions about being discharged from hospital.
CQC: Care Quality Commission
NHS CHC: NHS continuing healthcare (funding)
Discharge Process: Transition planning for the patient’s discharge from a bed-based healthcare service
EDD: Estimated date of discharge.
IMCA: Independent Mental Capacity Advocate
LA: Local Authority
MDT: Multidisciplinary team of health and social care professionals involved in the care and assessment of patients.
CCG: Clinical Commissioning Group
Representative: The patient’s family, next of kin, advocate or other named representative.
Self funder: A person who meets the full cost of their social care needs, either because their assessable capital exceeds the current Social Services threshold of £23,250; or they or their representative choose to pay for their care or refuse to have a financial assessment. Or do not qualify for NHS CHC
Social Care Assessment: Under the NHS & Community Care Act (1990) all adult patients are entitled to an assessment of their social care needs.
SW: Social worker or care manager Adult Services.
Social Work teams based in hospital offer support to patients to identify a suitable care home or package of care and to assist with discharge from the hospital setting. This is regardless of financial status. The only exceptions are Continuing Health Care (CHC) patients who may not be known to Social Services; the care planning function should then be supported by the NHS CHC Team.
Your father is going into temporary care so any assessments can take place at the nursing home while he is in rehabilitation. You should argue that this rehab placement is “Intermediate Care” and that he shouldn’t be charged.
If your mother has mental capacity to decide where she lives, the choice is basically hers. If she lacks capacity on this issue, it is much more complicated. In either case there are a range of assessments that should be undertaken by Health and Social Services to consider both her care needs and funding options. What remains the most important factor is that your mother’s best interests remain at the centre of any decision-making.
Tell the hospital you want to attend all assessments. If your father has mental capacity to give consent to you being his representative, then he can do so. Consider whether your father may need to make Lasting Powers of Attorney to prevent this problem occurring in the future if he loses mental capacity. If your father has already lost mental capacity to consent to you representing him, this will need to be delayed on a Best Interest basis while you consider longer term options – seek advice.
No – this is an incorrect approach by the NHS. However, it can take weeks for the full NHS CHC assessment process to be concluded; and because of this you or your mother may feel that it is better for your mother to get out of hospital and to have the NHS CHC assessments later – at home or in a care home. If your mother is going into temporary care at a nursing home she can be assessed there.
Even if the NHS CHC assessment process has been delayed, the rules about safe discharge from hospital require Health & Social Services to make sure that she has a safe package of care (even if who funds that has not yet been determined).
Do not be pressured into moving your relative or agreeing that they be moved until the proper assessment process has taken place. Do not be pressured into signing anything. The duty of Health & Social Services is to ensure that your relative has a safe hospital discharge, which normally includes setting up a care package at home or in a care home. If they have a shortage of beds available then that is a problem for them, not for you or your relative.
Be aware that communication about hospital discharge can be very poor.
Don’t be pressured into a quick discharge from hospital.
No one who needs any kind of ongoing care should be discharged from hospital without a proper assessment of their needs and without an appropriate l package of care in place. There needs to be a placement available as soon as they are discharged. There should be no gap in care.