Post No21…Discharging elderly patients from hospital into a care home

It is a very common scenario for an elderly person to be discharged from a hospital into a care home. This could be on a convalescent basis, enabling the person to recover their strength before going back home, or it can be for long term care. Either way this often causes some concern for families; who are tasked with finding a care home in difficult circumstances.

This post is designed to provide some information on the hospital discharge process; primarily in relation to discharing to care homes, with a few added tips that may help you better navigate the situation if it were to come to pass.

What is the hospitals process for discharging?

All acute hospitals will have a process for discharging patients, although each one may be slightly different from the next. More generally speaking, most hospitals have a discharge team, sometimes referred to as a brokerage team. The people who work in these roles are primarily tasked with helping the family, and the hospital, to discharge patients safely into the community.

A key part of the process is a person being deemed medically fit / medically optimised to leave the hospital. For this to happen, a person with the relevant authority would assess whether the patient still requires medical intervention, and if they do not, they are deemed medically fit to be discharged.

If a care home has been selected - what happens next?

When a person is deemed medically fit to leave the hospital, this is the time a care home will complete their own assessment of the persons care needs. The care home will not do this before the person is deemed medically fit, in case things change after the assessment, in which case it may need to be done again.

If the assessment is completed successfully, then the care home and the hospital discharge team will liaise with the family about a discharge date, although this will normally be ASAP to avoid a prolonged stay and / or bed blocking. Once the care home is ready, the patient is normally discharged via the patient transport system that is booked by the hospital.

If a care home has NOT been selected – what happen next?

If a care home has not been researched or selected by the point the person is deemed medically fit, the hospital discharge team will be ‘gently’ pushing the family to find a placement, and may be able to provide a list of local care homes.

The issue with this scenario is the hospital will be very eager to discharge at this stage, especially in the winter when hospital beds are scarce. The hospital will also fear the person may contract a Healthcare-associated infection (HCAI), which would prolong the stay further. Being in hospital is not always good for older people, and so prolonging the stay should be avoided if possible.

How do I avoid a prolonged stay?

One way of avoiding a prolonged hospital stay is to, if possibly, conduct your re-search before the person is declared medically fit for discharge. This gives you some more time to view care homes and make an informed decision, and as soon as the person is fit to leave the care home will assess. Even better would be to have a relationship with a care home prior to the hospital stay.

If you are looking for care homes it is always best to tell the hospital, normally the ward staff, that you are doing so. Although this is not always easy, it is a very important aspect of the process.

Can the hospital discharge without our consent?

This is one reason why having open communication with the hospital is so important, because in short, the answer is yes. However, without being over dramatic, there are often far more scenarios where the reverse happens and the discharged is planned.

Reasons hospitals may discharge without consent are quite limited, and normally happen if the hospital is desperate to discharge due to the over occupancy of hospital beds. If this does happen, in the current climate, the hospital will discharge on the D2A pathway and the home may not be what, or where, the family want it to be.

If a hospital is aware that the family are proactively seeking a care placement, the likelihood of them discharging without consent becomes very unlikely.

Summery

To summarise, it is worth noting that hospital discharging into care homes should be a three-way discussion between the family, the hospital, and the chosen care home. However, the process is often stressful due to tight time frames and the fact a loved one is in hospital.

The chosen care home can support the process by being in contact with the ward, or the discharge team, making sure that they know the home is ready to complete an assessment when the patient is deemed medically fit for discharge.

It is important to remember that speed is important here, and therefore the quicker the care home can assess and then admit, the better potential outcome for the person. Asking care homes about their availability and assessment timeframes is certainly a good thing to enquire about, and again this information can be passed back to the hospital to best plan the discharge.

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