After Hospital Care – Preparing your loved one’s discharge from hospital

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It’s great to find out that your loved one is ready to come home from hospital but, for many, care doesn’t end when they leave hospital. By being prepared and making the necessary arrangements, you can ensure your loved one’s care needs are being met from the minute they are discharged.

Continued care upon their arrival home may ease their transition, ensure that your loved one continues to recover with the care that they need.

When should your loved one be discharged?

Your loved one has the right to discharge themselves from hospital at any time but it should always still be done under the guidance of their medical team to make sure it is done at the right time.

If you’re unsure when your loved one should be discharged, see the NHS requirements detailed here.

Planning discharge

Planning for discharge should usually occur right away, as soon as you are admitted to hospital. This includes things like post-hospital care that may be provided by family, friends or a private care organisation like SuperCarers. You, your loved one and their care team should draw up a treatment plan as soon as possible. This should include plans for their discharge and ideally it should be completed within 24 hours of admission.

The NHS notes that if your loved one has limited capacity to make their own decisions that the Mental Health Act will apply. If this is the case, you and your loved one may consider enacting a power of attorney before they are admitted to hospital, to allow you to act on their behalf.

Who manages the hospital discharge?

Each hospital will have its own discharge policy and arrangements. You should be able to get a copy from the ward manager or the hospital’s Patient Advice and Liaison Service (PALS). Discharge is usually coordinated by a key worker, a healthcare professional, often a nurse, who is assigned to your loved one and will be their main contact and source of support during their stay in hospital.

Depending on their condition, your loved one may need ongoing care from different healthcare professionals and services. If this is the case, they may be assigned a reablement team which may include the following:

  • Liaison nurse
  • Nurse discharge coordinator
  • Assessment officer

Discharge plan

Your loved one’s key worker and other healthcare professionals looking after them will make their discharge plan. They will conduct a discharge assessment of your loved one’s situation and find out what support they need when they return home. If you are the caregiver, you may need to help with the assessment by answering some questions, providing insight into their needs.

Minimal and complex discharge

If the assessment determines your loved one as needing little or no care upon leaving hospital this is called a minimal discharge. If, however, the assessment determines that you need more specialised care after leaving the hospital, the discharge procedure is referred to as a complex discharge.

Discharge care plans

Complex discharge requires a care plan detailing your loved one’s health and social care needs. Your loved one will also receive a letter for their GP, detailing information about their treatment and future needs. The NHS have provided a list of what a care plans entail, including the following:

  • The treatment and support you’ll get when you’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 coordinating the care plan

Care plans can include various types of support depending on your loved one’s needs. These may include the following:

  • Intermediate care
  • Community care services, such as reablement services
  • NHS continuing healthcare
  • NHS funded nursing care
  • Care and support paid for privately
  • To read the complete guidance provided by the NHS, click here and here.

Carer’s involvement in discharge planning

If your loved one is in hospital awaiting discharge, you should never be put under pressure to take on a caring role or to accept more responsibilities than you already have. Having enough time to consider whether you feel able to accept further responsibility can be hugely valuable for you and your loved one, and you may request extra support whilst you make your decision. In situations like this, it may be advisable to find care through a service such as SuperCarers, while you make your decision.

If you decide to provide care for your loved one, you’re entitled to a free carer’s assessment from your local authority. This will determine what support you are entitled to, to ensure that you receive the help you deserve in your role as a carer.

What to expect on the day of discharge

The NHS advise that on the day of discharge, your loved one’s discharge coordinator should ensure the following:

  • You and your loved one have a copy of the care plan
  • Transport is arranged to get you home
  • Any carers will be available if needed
  • Your loved one’s GP is notified in writing
  • You have any medication or other supplies you’ll need
  • You’ve been trained how to use any equipment, aids or adaptations needed
  • Your loved one has appropriate clothes to wear
  • You loved one has their money and keys for their home

If your loved one is returning to care home, the care home should also be notified of the date and time of discharge, and they should also receive a copy of the care plan.

After discharge

Your loved one’s care should be monitored and reviewed routinely, following the advice in the care plan. The care plan will also tell you who to contact if you need extra support or face any problems with the care plan.

Referenced material

This article was written with reference to the following resources:

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When you loved one comes out of hospital or comes to the end of their six-week package of intermediate care, they may still need some extra help and support.

SuperCarers can match you with highly experienced and trained carers to provide personalised care to your loved one’s current abilities and symptoms based around practical, emotional, and physical support.


 

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