How do you arrange care after hospital discharge? After hospital care for the elderly comes with certain challenges, that include devising a robust care plan, facilitating a safe transition to the home environment, and ensuring that the patient remains independent at home, and not back in the hospital. Care at home after the hospital needs to be supervised closely and the home made safe. If you're looking for home care after the hospital, please contact us to discuss your requirements.
It can be difficult to know what to do when organising care after leaving the hospital. Know how to plan before, during, or after a hospital stay.
If a loved one is due to be released from the hospital, you may find yourself under pressure to find care in a short period. This can be stressful, particularly if care at home is not usually in place.
Care arrangements before leaving hospital
It's worth knowing that discharge shouldn't take place before all of the following have been covered:
- You are considered "medically cleared" - typically a senior medical staff member will have made this decision
- You have been given a written care plan that sets out the support you’ll get to meet your needs
- You have undergone an assessment to look at the support you need to be discharged safely
- It is safe for you to be discharged and the care plan has been implemented
While these criteria may have been met, if your loved one has a relatively mild condition or they're likely to be accompanied by family members, they may not be eligible for NHS respite care after a hospital stay or social services funding following hospital discharge.
Every hospital has its own discharge policy and discharge planning coordinator. Typically, there will be a senior nurse who will be coordinating discharges and bed occupancy in most NHS hospitals. Please ensure you check your local NHS hospital discharge policy before considering a discharge.
What is an unsafe discharge?
An unsafe discharge from the hospital is when the patient is cleared without a proper home care plan. It is because of the lack of coordination between the hospital and community health services, often leaving the patient without help after hospital discharge.
The usual problems seen with unsafe discharge are:
- If the patient is discharged too early when they are not medically fit, it can lead to emergency readmissions, often seriously compromising the patient’s well-being. In the worst-case scenario, it may even lead to death from potentially avoidable causes.
- Before leaving the hospital, the patient is not properly assessed in terms of mental capacity. The patient may seem medically fit, but they may not be mentally capacitous or ready for care at home after hospital discharge. Sending the patient home without being able to consent properly before the arrangement of hospital aftercare may lead to readmission or confusion at home.
- Sometimes, the patient is discharged without involving their loved ones in any decision regarding aftercare at home. This is also an unsafe discharge.
- Keeping patient unnecessarily at the hospital, because of unavailability of care after leaving the hospital, is also a part of an unsafe discharge strategy. For example, time spent in a hospital can lead to muscle degeneration and loss of muscle strength. Such "delayed discharges" are also unsafe.
How to avoid an unsafe discharge?
The first and foremost step before getting home after a hospital stay is to plan your homecare. Discuss your loved one’s situation with the treating team and the care provider you have chosen.
Make a proper plan that covers all the aspects of your loved one’s care, with the advice of the health care professional and after hospital care provider, in order to anticipate challenges and for effective implementation of the plan, so as to avoid any adverse outcomes.
Some simple aspects that an effective after hospital care plan should cover are:
- Recognise the important role of family and caregivers in the provision of care after hospital discharge. They are treated as a part of the healthcare team and their opinions should be included in the hospital discharge care plan.
- The coordination and communication between the hospital and community-based service providers are robust so that the patient gets the care they need.
- Before leaving hospital, transitional care services and polices should be well-understood by the patient and their family.
- The availability of nursing care after discharge from the hospital is ensured, for example liaison with district nurses.
What is discharge planning?
Dicharge planning a process in which appropriate measures are taken beforehand when there is a transition from hospital to home care. The plan is made with the involvement of a team, consisting of a doctor, family members, patient, and care provider. Respite after hospital stay starts with:
- Evaluation of both medical and emotional well-being before the patient is declared fit for the discharge.
- Discussion about all the relevant details of the care after leaving the hospital.
- Planning with all family members and clinical professionals regarding details about home care after the hospital stay.
- The anticipation and acknowledgment of difficulties that could be faced by the care recipient and the caregiver.
- Referral to a high quality home care agency and providing support and training to the caregiver.
Importance of discharge planning
Discharge planning includes preparing the details of after hospital care at home. It is essential because:
- It helps in the recovery of the patient.
- Proper home care after hospital discharge decreases the need for readmission.
- The carer ensures the correct administration of the medicines at their prescribed time and correct dosage.
- The carer helps in taking care of all the basic daily life activities of the patient.
- Risks such as falls and manual handling challenges can be properly addressed and mitigated
- The carer provides well-rounded support, whether it is emotional, medical, or physical support for the patient.
Planning care before going to the hospital
HomeTouch can provide emergency carers that can be booked within hours.
The availability of appropriate care is necessary not only to avoid readmission but also for a quick recovery. Therefore, it is best to make necessary arrangements for care after the hospital, to avoid undue stress for both the patient and yourself.
“How long does it normally take to arrange care?” This is one the most frequently asked questions, that worries many patients and their families. However, reliable home care can be arranged typically within 48 hours with the best providers. Hometouch makes finding care after discharge from the hospital easier and accessible.
Discharge Planning for Elderly Patients
Another question that arises after a hospital stay is, how to get released from the hospital safely? With elderly patients being discharged from the hospital, extra steps will be taken by the treating team to ensure that the discharge planning is safe and the patient is ready to go home. The clinical team will be doing their best to avoid the unsafe discharge from the hospital.
For example, an occupational therapy assessment may be needed to assess the elderly person's activities of daily living. If there has been a fall, a home assessment may be needed to ensure that the home is free from trip hazards and other causes of falls. Additionally, elderly patients in hospital are prone to becoming disorientated.
Private hospital care for the elderly is a good option in this case. It may also be appropriate for the doctors to carry out a mental capacity assessment before leaving the hospital. In cases where the elderly patient is in need of further care after leaving the hospital - 6 weeks free care after hospital care - which is known as "reablement", is often offered to reduce the risk of readmission to hospital.
After discharging elderly patient from hospital, family members may need to contact a elderly care provider to fulfil all the needs of their loved ones.
Additionally, the may be discussions with the family concerning the choice of residential care or whether different forms of home care such as live in care are appropriate.
Ongoing care after leaving hospital
Self-care can be a challenging after leaving the hospital. When mobility is limited, trips to the bathroom can be a struggle, which can lead to dehydration or discomfort. Standing for long periods can be risky, which means getting a balanced diet can be a problem. Seeking help to overcome these challenges is vital and live in care can help. Live-in convalescent care makes daily life activities easier for your loved ones and provides them with a sense of confidence and independence.
Care after a fall
Your loved one may be unsteady on their feet and at risk of a further fall on returning home. Often it can be useful to have a carer to assist with helping them to get mobile, and with light household duties. This will prevent your loved one from taking on too much too soon.
Your loved one may need additional support for a few days following a surgical procedure. Good in-home care after surgery helps in prompt recovery.
If you or your loved one had a minor surgical procedure done, you can hire short term care after surgery. For major debilitating operative procedures, services such as convalescent care after surgery are a preferred option. After surgery, home care for a number of different services are available. Usually, 6 weeks free care after a hospital stay is provided by the NHS. Do you get 6 weeks' free care after a hospital stay? You can check with your hospital staff to get an answer to this question.
Care following hip or knee operation
Your loved one may be immobilised, on bed rest, or not be able to move around the house following a significant operation. A carer can help with daily activities, like cooking healthy meals, housework, and getting mobile. Before coming out of the hospital, it is important to have a carer available for these bedridden patients to provide respite care after surgery.
Spending time in the hospital can be tiring and disorientating, and returning home may be stressful without additional support. A home carer can help your loved one to transition from full-time nursing care to independence. Live-in convalescent care, therefore, helps in restoring the confidence of your loved one.
Home help for a parent with dementia
Dementia is often diagnosed for the first time in the hospital. If you're looking for help for your mum or dad with dementia, you may want to find a carer with special dementia training and credentials. These carers are particularly trained to provide nursing at home after a hospital stay to dementia patients. They can be approached through a care package from the hospital.
Discharge from a mental health hospital
If you or the person you care for is discharged from a mental health facility there may be specialist support that is available to them in the community. This may include involvement from the home treatment team, or allocation of a care coordinator. You will also be able to find carers with mental health expertise on the main HomeTouch directory.
What is intermediate care?
Intermediate care is aftercare that one receives after hospital admission, that is, care after discharge from the hospital. It is free homecare that entails intensive support from a number of relevant professionals. It is offered to:
- Provide respite care after a hospital stay
- Avoid unnecessary stay at the hospital
- Provide nursing care after hospital discharge
- Provide a sense of independence and confidence to the patient as they stay at their own place
What types of care are available at hospital discharge?
The types of support available will depend on the assessed needs:
- Reablement - a focused, time limited care package to get you back on your feet.
- NHS continuing healthcare.
- Other NHS services, such as rehabilitation or palliative care.
- Assisted living aids such as wheelchairs, specialist beds, or aids and adaptations such as stairlifts.
- Voluntary organisations such as Age UK provide companionship and home support.
- Private or self funded care. This may be an option you aren’t eligible for help from the local authority.
Hospital discharge checklist
It is a part of the hospital discharge care package that on the day of discharge, the person coordinating the discharge should make sure that:
- You have a copy of the care plan
- Transport such as a taxi is arranged to get you home
- Your GP is notified in writing and later with a discharge summary
- You have any take-home medication
- You’ve been trained how to use any equipment, aids or adaptations needed
- You have appropriate clothes to wear
- You have money and keys for your home
Being discharged from hospital
Each hospital will have its policy and arrangements for discharging patients. Normally, when you arrive in hospital, the professionals in charge of your care will develop a plan for your treatment, including your discharge or transfer. It is called a hospital discharge care plan. This is usually done within 24 hours of your arrival. You will be able to discuss arrangements for your discharge with staff. This will help to ensure that you have everything you need for a full recovery when you return home.
Your discharge or transfer date will be affected by:
- How quickly your health improves while you are in hospital
- What support you will need after you return home
If you are unhappy about your suggested discharge or transfer date, raise your concerns with the hospital staff. If you have a query like ‘can you discharge yourself from the hospital in the UK’ it is your right to know that during your stay in the hospital, you have the right to discharge yourself from the hospital at any time. When you leave the hospital you will be given a letter for your GP, providing information about your treatment and future care needs. Give this letter to your GP as soon as possible. After discharging yourself from the hospital, you will also receive 6 weeks of free care services by the associated welfare organizations.
Returning home with a carer
If you are returning home, make sure you have everything you need for your recovery. Usually, 6 weeks of care after a hospital stay is free. It may be helpful to get a friend or relative to stay with you or visit you regularly or to purchase ad hoc temporary home care.
Carer involvement in hospital dischargeIf someone you know is in hospital and about to be discharged, you should not be put under pressure to accept a caring role or take on more than you’re already doing if you are already their carer. You should be given adequate time to consider whether or not this is what you want, or are able, to do. If necessary, you should ask for other arrangements to be made while you are reaching a decision. Hospital staff usually contacts a carer for 6 weeks free respite care. If you decide that you are going to provide care for the person who is being discharged from the hospital, you're entitled to your own carer’s assessment from social services. It is possible that your carer’s assessment will be done over a period of time, beginning before the person you're looking after is discharged from the hospital and continuing once they are home.
Becoming a family carer after hospital discharge
It may be the first time you have had to care for someone after they have been in hospital. It may be that you're bringing home an older relative who previously lived alone.
Switching to caring at home from hospital care services can be challenging. You may be facing questions about how to care for this person on your own, and wondering what resources are available to you to provide respite care for the elderly or dependent or ongoing support after hospital discharge. Equally, you may have been caring for a relative, and the effects of their condition and being in the hospital have now exceeded your ability to cope. The Care Act 2014 now allows you to receive a care assessment from the Local Authority and possibly receive extra support. Don't leave it, and don't feel bad if you need it.