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Hospital discharge and carers

If the person you are looking after goes into hospital you may have concerns about what will happen when they leave, especially if it seems they may need more care than they did before their hospital stay.

A person shouldn’t be discharged from hospital until all of the following criteria have been fulfilled:

  • they are medically fit (this can only be decided by the consultant or someone the consultant has said can make the decision on their behalf)
  • they have had an assessment to look at the support they’ll need to be discharged safely
  • they have been given a written care plan that sets out the support they’ll get to meet their assessed needs
  • the support described in their care plan has been put in place and it’s safe for them to be discharged

Each hospital has its own discharge policy. You and the person you care for should be able to get a copy of this from the ward manager or the hospital’s Patient Advice and Liaison Service (PALS).

The hospital’s discharge policy should follow government guidance on discharge of patients, which emphasises the importance of involving patients and their carers in hospital discharge planning. As a carer, if the person you look after gives their permission, you should be kept informed throughout the process, and have your views and concerns listened to. You should also have a choice about whether you’ll provide care when the person you look after leaves hospital.

The guidance says that you and the person you care for should “be involved at all stages of discharge planning, given good information, and helped to make care planning decisions and choices”.

If the person in hospital does not want you to be involved in decisions about their future care you should be told about this. This will limit your ability to be involved in planning for their discharge from hospital, but it doesn’t affect your right to an assessment of your own needs if you’ll be caring for them.

If the person you care for has limited capacity to make their own decisions, the Mental Capacity Act will apply.

Click on the bars below for more information about the hospital discharge process and your involvement as a carer.

Planning at an early stage

When someone is getting hospital care that’s been planned in advance, planning for their discharge should start before they go into hospital. For unplanned admissions, such as emergencies, discharge planning should begin on the day that the person is admitted to hospital.

You should usually be given an estimated date of discharge within 24 to 48 hours of the person you care for being admitted to hospital. Their progress will be reviewed and, if there’s likely to be a change to their discharge date, you should be kept updated. You can read more about hospital discharge in our page about What happens after surgery.

Someone who is responsible for co-ordinating the discharge of the person you care for should be available each day. Both you and the person you are looking after should be given their name and details of how to contact them. They are sometimes called "discharge co-ordinators" or "ward co-ordinators".

Discharge assessment and care plan

A discharge assessment looks at the needs that someone is likely to have when they are discharged or transferred from hospital. Many people only need a small amount of support when they leave hospital, but others will need a more comprehensive package of care.

If the person you care for is likely to have ongoing health and social care needs when they leave hospital, the assessment may be carried out by a multidisciplinary team of health or social care professionals. Depending on their needs, the multidisciplinary team could include a social worker, physiotherapist, occupational therapist, speech therapist, mental health nurse or dietitian.

The person you care for should be fully involved in the assessment process, and their views should be listened to. With their permission, you should also be kept informed and given the opportunity to contribute as their carer.

If you or the person you look after would like help putting your views across, an advocacy organisation may be able to help. You can find local advocacy services by speaking to a Carers Direct adviser, or searching the online directory of local carers' services.

Care plan

The next stage is to draw up a care plan detailing the health and social care support that will be provided to the person you look after. Again, you should both be fully involved. Your views and concerns should be taken into account, including whether you’re willing to provide care when the person you look after leaves hospital and, if so, how much.

The care plan should include details of:

  • the treatment and support the person you care for will get when they’re discharged
  • who will be responsible for providing support, and how to contact them 
  • when, and how often, support will be provided
  • how the support will be monitored and reviewed
  • the name of the person who is co-ordinating the care plan
  • who to contact if there’s an emergency or if things don’t work as they should
  • information about any charges that will need to be paid (health services provided through the NHS are free, but local authorities can charge for community care services)

What might be in a care plan

The types of support in someone’s care plan will depend on their assessed needs and preferences. A care plan could include:

  • Community care services from the local authority. An assessment for these must be arranged if it seems that the person you care for may need them. See "Community care services", below for more information.
  • NHS continuing healthcare. This is care that’s provided free of charge to people who have very severe and complex healthcare needs. If it seems that the person you look after may be eligible, an assessment for NHS continuing healthcare must be carried out before any assessment for local authority community care services.
  • NHS funded nursing care. People who need care in a nursing home can get a payment from the NHS to help with the cost of this.
  • Intermediate care. This is short-term care that’s provided free of charge for people who no longer need to be in hospital but may need extra support to help them recover. It lasts for a maximum of six weeks and can be provided in someone’s home or in a residential setting.
  • Other NHS services, such as rehabilitation or palliative care
  • Equipment such as wheelchairs, specialist beds, or aids and adaptations for daily living.
  • Support from voluntary agencies. Some organisations such as Age UK and the Red Cross provide "home from hospital" services that can help with household tasks or shopping while someone is settling in back at home.
  • Care and support that’s paid for privately. This may be an option if the person you look after isn’t eligible for help from their local authority, or would rather pay for their own care. It could include care in the home from a personal assistant or paid carer, or residential care

Community care services

Someone may be in need of community care services if they:

  • need help with daily living tasks such as washing, dressing and preparing meals
  • have mobility problems 
  • need support to maintain links with friends and family, or access work or education

Community care services can be provided at home to help someone continue to live independently. Alternatively, if it’s no longer possible for someone to live at home safely, they may be able to move into more suitable accommodation, such as sheltered housing or residential care.

Community care services are provided by a person’s local authority. Before providing someone with services, the local authority will carry out a community care assessment to decide if they are eligible.

If it seems that the person you look after may need community care services when they leave hospital, the hospital must tell the local authority so that an assessment can be carried out. Once a decision is reached that the person you're looking after no longer requires hospital care, the hospital should inform social services. Social services then has three days in which to carry out a community care assessment for the person you're looking after. Any support that they’re assessed as needing must be put in place before they’re discharged.

Local authorities can charge for community care services. The level of any charges will depend on the finances of the person you care for. Find out more about local authority charges for care at home and charges for residential care.

Choice about community care services

If the person you look after has been assessed as being eligible for community care services, their local authority must provide services to meet these needs. If there is more than one option that meets the needs of the person you care for, the local authority can choose the cheapest.

There are measures in place to provide people with a choice about the services they get. Read the Choosing your own support page for more information. If the person you care for needs residential care, government guidance says that they should have a reasonable choice of care home. The residential care page has more information about choosing a care home.

If you don’t agree with what the local authority intends to provide, you could complain and argue that it doesn’t meet the assessed needs of the person you care for.

If someone has been assessed as needing residential care but wants to stay in their own home, hospital and social care staff should discuss whether there are other options that would allow them to be discharged safely. Again, you could challenge the decision and argue that residential care wouldn’t meet the needs of the person you look after. It’s not normally possible to force someone into a care home, but they won’t be able to stay in hospital indefinitely either. If someone persistently refuses the services they’re offered, their local authority may be able to argue that they have fulfilled their legal duty to provide services.

Your involvement as a carer

If the person you look after is being discharged from hospital, you should not be put under pressure to accept a caring role or take on more than you’re already doing. Instead, you should be given adequate time to consider whether or not this is what you want or are able to do. You should have a free choice about this. If necessary, you should ask for other arrangements to be made while you are reaching a decision. For example, the person you are looking after could be discharged from hospital into intermediate care for a few weeks.

If you decide that you are going to provide regular and substantial care for the person who is being discharged from 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. It may begin before the person you're looking after is discharged from hospital and continue once they are home.

When someone is discharged

On the day of discharge, the person co-ordinating the discharge should make sure that:

  • the person being discharged and their carer has a copy of the care plan
  • they have transport to get them home from hospital
  • their carer knows they’re being discharged, and will be available if needed
  • their GP is notified in writing about their discharge
  • they have any medication or other supplies that they’ll need
  • they have been trained how to use any equipment, aids or adaptations they’ll need
  • they have appropriate clothes to wear 
  • they have their house keys and money if needed

If the person you look after is being discharged to a care home, the care home should also be told the date and time of their discharge, and have a copy of their care plan.

After discharge

The care of the person you look after should be monitored and reviewed as set out in their care plan. The care plan should also include details of who to contact if things don’t work as planned.

If someone’s care plan includes community care services from their local authority, the local authority should check that their care package is working well within two weeks of their discharge from hospital. If they live alone, this should take place within the first few days of their discharge. Following this, their care plan should be reviewed at least annually.

Changing needs

You can contact the local authority at any time to ask for a reassessment if the needs of the person you look after have changed.

Complaints about hospital discharge

You might not be happy with the way someone’s discharge from hospital is being handled.

This could be because:

  • the hospital plans to discharge them before you think it’s safe to do so
  • there isn’t enough support in their care plan
  • you don’t think their discharge assessment and care planning was carried out correctly

If you have concerns about someone who is still in hospital, it’s best to raise them straight away so that they can be addressed as soon as possible. Speak to the person who is co-ordinating the discharge, or the consultant treating the person you care for.

You may find it helpful to get support from the hospital’s Patient Advice and Liaison Service (PALS) or your local Independent Health Complaints Advocacy service.

If you want to complain about how a hospital discharge was handled, you could start by speaking to the staff involved to see if the problem can be resolved informally.

You can also make a formal complaint through the NHS complaints process.

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Page last reviewed: 19/08/2013

Next review due: 19/08/2015

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